|
Memorandum submitted by Professor Edward Melhuish Summary · Sure Start has been undergoing progressive change since its inception in 1999. To some extent evaluation results have influenced this process. · The early results indicated that lack of specification of how goals were to be achieved through service delivery led to great diversity in provision with some ineffective programmes. · Later developments have tightened up guidelines and the nature of service delivery considerably and . staff themselves have developed and become better trained and more proficient. However there is still scope for further development. · The contrast between the latest and earlier findings indicates that children and families are having increased exposure to Sure Start Children's Centres that have also become more effective, and that early interventions may improve the life chances of young children in deprived areas. · The latest evaluation results showed that families benefited from Sure Start. Parents in Sure Start areas relative to those in non-Sure Start areas reported using more services, with more engagement in developmentally facilitative parenting and children who are socially more competent. · In addition, contrary to the earlier (2005) results, all effects associated with Sure Start were beneficial, and these beneficial effects appeared to apply in all sub-populations and all Sure Start areas studied. · Hence the developments in Sure Start seem to have borne some fruit in that the latest impact results are encouraging, and indicate the beneficial effects of Sure Start are spreading. Nonetheless it is clear that further developments are desirable. In the meantime it will be some time before the longer term goals of the programme can be realised, and hence the final verdict on Sure Start awaits further evaluation. · There is evidence that better inter-agency working is associated with better outcomes for children. A major problem here is the lack of integration of health services with local authority services in some areas because health services are controlled by PCTs. There are indications that where health services are better integrated with Sure Start then outcomes are improved. However integration of health services with other early years services is variable around the country. · Development of Sure Start Children's Centres should give greater attention to the clarity of guidance based upon evidence of what works, and there needs to be a greater focus on enhancing children's language development. · The evidence presented here concerns Sure Start in disadvantaged communities. The move in Sure Start Children's Centres from disadvantaged areas to every community has occurred primarily in the last 3 years. The services provided in more advantaged areas will inevitably be substantially different because of funding differences, but the nature of these differences has not yet been documented. · It is likely that there will be substantial differences between local authorities in their interpretation of the legislation with regard to the provision of the newer Children's Centres. 1. While all countries in the
2. A decade ago the Cross-Departmental Review of Services for Young Children concluded that disadvantage among young children was increasing and when early intervention was undertaken it was more likely poor outcomes could be prevented.[1] The Review also noted that current services were uncoordinated and patchy and recommended there be a change in service design and delivery. It suggested that programmes should be jointly planned by all relevant bodies, and be area-based, with all children under four and their families in an area being clients. In July 1998, the then Chancellor of the Exchequer, Gordon Brown, introduced Sure Start aimed at providing quality services for children under four and their parents.[2] The original intent of the programme design was to focus on the 20% most deprived areas, which were home to around 51% of children in families with incomes 60% or less than the national median (official poverty line).[3]
3. In
4. Each Sure Start community had great autonomy. Community control was exercised through local partnerships, comprising everyone concerned with children, including health, social services, education, private and voluntary sectors, and parents. Funding flowed from central government directly to programmes, which were independent of local government, although local departments of education, social services etc. and health trusts would typically be part of the partnership. All programmes were expected to provide: (i) outreach and home visiting; (ii) support for families and parents; (iii) support for good quality play, learning and childcare experiences for children; (iv) primary and community health care and advice about child health and development and family health; and (v) support for people with special needs, including help getting access to specialised services, but without specific guidance as to how.[4] While evidence derived from early intervention programmes with clear unambiguous protocols for services were used to justify Sure Start, Sure Start programmes did not have a prescribed "protocol" and had freedom to improve and create services as they wished.[5] This was in contrast to examples of interventions with clear models of provision and demonstrable effectiveness used to justify Sure Start.[6-8]
5. The speed of funding was often overwhelming in a sector previously starved of support. Only 6% of the 1999 allocation was spent in that year. Despite this slow start, and without any information on the success of the initiative, the Treasury expanded Sure Start from 250 by 2002 to over 500 programmes by 2004, thereby more than doubling expenditure to almost £500 million by 2003-04.
6. The National Evaluation of Sure Start (NESS) was commissioned in 2001 and programme diversity posed challenges in that there were not several hundred programmes delivering one intervention, but several hundred unique interventions The evaluation used a variety of strategies to study the first 260 programmes that were rolled out, in particular studying children and families in 150 of these with great intensity. These included the gathering of area specific administrative data (e.g. census data, police records, social services,work and pension records, hospital episode statistics); developing systems that allowed the collation of information in non-standard geographic units (Sure Start areas); conducting surveys of Sure Start staff dealing with many aspects of the programmes; carrying out face-to-face and telephone interviews with programme managers, programme employees and parents about the operation of their local programme; and conducting a large-scale survey of child and family functioning in thousands of households in Sure Start areas, and in equivalent non-Sure Start areas. While over 40 reports and peer-reviewed publications have documented the different phases of the National Evaluation of Sure Start, this submission provides an overview of the evolution and impact of the Sure Start programme. Detailed reports are available at www.ness.bbk.ac.uk, with some findings summarised here.
7. Setting-up Sure Start: In looking at the initial implementation of Sure Start programmes it became apparent that for a variety of reasons; including, lack of availability of suitable staff, the need to train new staff, the time taken for planning permission for new buildings, the time taken for the construction or conversion of buildings; setting up programmes took a lot of time. It was typically not until three years after the initial approval of a Sure Start programme that it became close to fully functional. This meant that the first 60 programmes approved in 1999 did not become fully functional until 2002. This has considerable consequences for how the evidence on Sure Start is interpreted.
8. Community-Level Change: A defining feature of the Sure Start initiative was that it was area-based, founded on the premise that communities, not just children and/or families, should be the target of intervention. Ultimately, the view was that children and families could be affected by the programme both directly, via services encountered, and indirectly, via community changes that derived from the programme (e.g., reductions in crime, feelings of cohesion, changed 'local norms' about parenting). Reflecting this focus on community change, the evaluation documented the status of Sure Start communities over time (2001 to 2005). Some improvements were detected, but could not be causally linked to Sure Start.[9, 10] Overall, Sure Start areas became home to more young children while the proportion in households dependent on benefits decreased markedly. For instance, the proportion of children under 4 in 'workless' households in Sure Start areas dipped below 40%, having started at 45% in 2000/01. Some aspects of crime and disorder also improved, notably burglary, school exclusions and unauthorised school absences. Moreover, children from 11 upwards demonstrated improved academic achievement. While infant health (e.g. birth weight) did not improve, reductions in emergency hospitalisations of children (0 to 3) for severe injury and for lower respiratory infection suggested improved health care. Also the percentage of children identified with special educational needs or eligible for disability benefits increased over 2000-2005, suggesting improved health screening.
9. Early Findings on Children/Families (up to 2005): A study of children and families in Sure Start and non-Sure Start (Sure Start-to-be) areas provided mixed news.[11, 12] Although there were some overall effects for Sure Start on family and child outcomes, some results varied by subgroup. Specifically, three-year-olds of non-teen mothers (86% of sample) in communities receiving Sure Start exhibited positive effects associated with Sure Start programmes in terms of fewer behaviour problems and greater social competence as compared with those in comparison communities, and evidence indicated that these effects for children were mediated by Sure Start effects of less negative parenting for non-teens. Whereas adverse effects emerged for children of teen mothers (14% of sample) in Sure Start areas in terms of lower verbal ability and social competence and more behaviour problems at age 3. Also children from workless households (40% of sample) and from lone-parent families (33% of sample) in Sure Start areas scored lower on verbal ability than equivalent children in comparison communities.
10. Consideration of these findings along
with other
11. Variability in programme effectiveness: The National Evaluation of Sure Start examined why some programmes might be more effective than others. Detailed information collected over several years on 150 programmes was systematically rated. Programmes could be differentiated on many dimensions including the range and balance of services, providing quality training for staff, exercising effective leadership and management and having effective strategies for identifying families in the community, to name just several of 18 distinct dimensions. Not only did programmes rated high on one dimension tend to score high on others, but better implemented programmes appeared to yield greater benefits.[13, 14] While the evidence was not overwhelming, it was consistent with theory about which programmes should prove most effective and provided guidance as to what works for Sure Start Programmes. Also some evidence indicated that health-led programmes had some advantages, possibly reflecting their better access to birth records and health visitors providing a ready-made home-visiting service generally accepted by disadvantaged families.
12. Changes to Sure Start: As the early National Evaluation of Sure Start findings indicated that programmes were not having the impact intended, and evidence from another project, the Effective Provision of Pre-school Education (EPPE) project,[15, 16] showed that integrated Children's Centres were particularly beneficial to children's development, the government decided to transform Sure Start programmes into Children's Centres. This was announced in 2005 alongside a transfer of the new Sure Start Children's Centres to Local Authority control. Hence from 2006 Sure Start programmes became Children's Centres with a more clearly specified set of services and guidelines, and were controlled by Local Authorities rather than being managed by central government. These changes meant that from April, 2006, local authorities became the accountable bodiesfor the whole Sure Start Children's Centre programme, and health agencies were legally obliged to cooperate in the provision of services within Children's Centres. The spend on Children's Centres and the associated programmes was £1.3 billion in 2005-06. For 2006-07 £1.7 billion was provided to local authorities for Children's Centres. For 2007-08, £1.8 billion was set aside.
13. Latest Findings on Children & Families (2008): In the longitudinal investigation of thousands of children and families comparisons were made of children and families in Sure Start areas with those in similar non-Sure Start areas revealed beneficial effects for children and families living in Sure Start areas. [17, 18] At three years of age, children in Sure Start areas showed better social development, exhibiting more positive social behaviour and greater independence/self-regulation than their counterparts in non-Sure Start areas. This result appeared to be partially a consequence of parents in Sure Start areas manifesting less negative parenting, as well as providing a better home learning environment. Also families in Sure Start areas reported using more child and family-related services than families in non-Sure Start areas. There were two additional findings (i) that children in Sure Start areas received more recommended immunisations and (ii) had less accidental injuries than those in other areas. However these latter two findings could have been an artefact of the two-year difference in when data were gathered on the two groups, as these two outcomes tended to improve over time nationally.
14. Conclusions: Latest findings differ markedly from earlier findings. In the early stages there was some evidence that the most disadvantaged 3-year-old children and their families (i.e., teen parents, lone parents, workless households) were sometimes doing less well in Sure Start areas, while somewhat less disadvantaged children and families benefited (i.e., non-teen parents, dual parent families, working households). However with changes to the Sure Start programme, the latest evidence indicates benefits for all sections of the population served. This indicates that Sure Start Children's Centres have learnt from earlier findings and are now making sure that they serve all their populations, particularly the most disadvantaged, even though they are often the hardest to reach. Various explanations can be offered for the differences between the 2005 and 2008 findings. It seems likely that the contrasting results accurately reflect the contrasting experiences of children and families in Sure Start areas in the two phases. Whereas the 3-year-olds in the first phase were exposed to 'immature' programmes-and probably not for their entire lives (because programmes took 3 years to become fully operational)-the 3-year-olds and their families in the second phase were exposed to better developed programmes throughout the entire lives of the children. Also programmes had the opportunity to learn from the earlier phase of the evaluation, especially with respect to greater effort to reach the most vulnerable households. Thus differences in the amount of exposure to programmes and the quality of Sure Start programmes may well account for both the initial adverse effects for the most disadvantaged children and families and the subsequent beneficial effects for almost all children and families living in Sure Start areas.
15. Sure Start has been evolving and ongoing research has partly influenced this process. Later developments have clarified guidelines and service delivery considerably. It is plausible that the improved results in the evaluation of Sure Start reflect actual changes in the impact of Sure Start programmes resulting from the increasing quality of services, greater attention to the hard to reach, the move to children's centres, as well as the greater exposure to the programme of children and families in the latest phase of the impact evaluation. The results are modest but sufficiently large to be of policy significance and suggest that the value of Sure Start programmes is improving. The identification of the factors associated with more effective programmes has informed recent improvements in Sure Start Children's Centres and may be part of the reason for the improved outcomes for children and families now found for Sure Start. The evaluation results indicate a need for greater clarity of guidance to Children's Centre based upon the evidence of what works, and that there should be increased focus on enhancing children's language development. October 2009 References 1 HM Treasury. Modern Public Services for 2 HM Treasury. Comprehensive Spending Review: Cross Departmental Review of Provision
for Young Children. 3 Melhuish E, Hall D. The policy background
to Sure Start. In: Belsky J, Barnes J, Melhuish E, eds. The National Evaluation of Sure Start: Does Area-based early
intervention work? 4 Sure Start Unit. Sure Start: Guide
for trailblazer programmes. 5 Glass N. Sure Start: the development of
an early intervention programme for young children in the 7 Reynolds AJ, 8
Schweinhart LJ, Barnes H, Weikhart,
D. Significant benefits: the High/Scope
Perry Pre-School Study through age 27. 9 Barnes
J. How Sure Start Local Programmes areas changed. In: Belsky J, Barnes J,
Melhuish E, eds. The National Evaluation
of Sure Start: Does Area-based Early Intervention Work? 10 Barnes
J, Cheng H, Howden B et al,. Changes in
the characteristics of SSLP areas between 2000/01 and 2004/05. 11 www.ness.bbk.ac.uk/impact/documents/1183.pdf (last accessed 21 Jul 2009) 12 Belsky J, Melhuish E, Barnes J, et al. Effects of Sure Start Local Programmes on children and families: Early findings from a quasi-experimental, cross-sectional study. BMJ 2006;332:1476-8, doi:10.1136/bmj.38853.451748.2F (published 16 June 2006) 13 www.ness.bbk.ac.uk/impact/documents/1184.pdf (last accessed 21 Jul 2009) 14 Melhuish E, Belsky J, Anning A, et al. Variation in Community Intervention Programmes and Consequences for Children and Families: The Example of Sure Start Local Programmes. J Child Psychol Psychiatry 2007;48:543-51. 15 Sylva K, Melhuish E, Sammons P, et al. 16 Melhuish EC, Sylva K, Sammons P, et al. Preschool influences on mathematics achievement. Science 2008;32:1161-2. 17 www.surestart.gov.uk/_doc/P0002519.pdf (last accessed 21 Jul 2009) 18 Melhuish E, Belsky J,
|