Sure start (case study) - Assignment Example

?Sure Start Intervention in the UK: A Case Analysis Introduction Sure Start was an anti-poverty programme established under Gordon Brown’s administration and financially supported by the New Labour Government Treasury Department. It was introduced in 1998 as a 10-year plan, intended for families with children aged four years and below living in the poorest, most underprivileged communities (Clarke, 2006). But Sure Start did not emerge from nowhere. Its development is part of a succession of policy reforms in children’s services; and its principles were influenced by a series of international empirical findings about the success of early interventions in enhancing educational achievements, security, and health of underprivileged children. This case study therefore tries to answer these three questions: (1) what motivated the development of Sure Start, in terms of theory and practice; (2) how were the evaluation challenges addressed; and, (3) was it able to achieve its stated objectives? Overview of Sure Start The design and progress of Sure Start was rooted in the belief that the earliest years of childhood were the most important in the emotional, social, and physical growth of children. There had been increasing findings and growing recognition during the 1990s of the interplay between the forces resulting in social exclusion, like poor health, increased unemployment rates, and low educational levels (Weinberger, Pickstone, & Peter, 2005). The former Chief Medical Officer Donald Acheson revealed that health inequalities are deeply entrenched in the British society. The fundamental causes of such health inequalities were believed to begin in the early years of childhood and to continue later in life and across generations (Anning & Edwards, 2006). However, at the same time, the prevailing assumption of health services intended for children aged four years and below was that they were displaced, inept and erratic, especially in communities of numerous disadvantages where children are particularly exposed to environmental forces (Anning & Edwards, 2006). Sure Start was designed to be a coordinated solution to such inequalities in health; it was created as a community-based intervention that could sever the connections between social exclusion and poor health. It was expected that an array of early interventions could result in progress in the cognitive and emotional growth of children, boost parents’ self-reliance and independence, and reduce the prevalence of accidents and poor health in children (Little, 2012). Consequently, such gains would result in higher educational achievement and attainment of occupational skills for parents and children. Finally, over time, these social gains would affect the Treasury by means of higher employment rates and lower costs of social exclusion and poor health, particularly teenage pregnancy, mental disorder, substance abuse, and chronic disability (Hoghughi & Long, 2004). It is vital to mention that there was to be no national standards for local programmes; every local Sure Start intervention would be community-based and founded on certain major principles. Such principles state that interventions would be intended for both children and parents, that services and interventions must be provided in a way to prevent stigmatisation, labelling, and singling out of ‘problem families’ (Hoghughi & Long, 2004, p. 335) and that Sure Start interventions would be comprehensive, focused on consolidating and adding value to current services in social care, health, and education. Even though there was no standards for Sure Start programmes, every Sure Start Local Programme was obliged to provide basic services and create local objectives that were based on national objectives as well as local conditions and requirements (Cowley, 2007). The basic provisions for family and child health services comprised smoking cessation support, diagnosis of mothers vulnerable to postnatal depression, prevention of accidents and ill health in children aged five years and below, support for and information on breastfeeding, and provision of prenatal assistance and counsel for parents (Clarke, 2006). In most instances definite, irrefutable findings about the long-term outcome of Sure Start programmes to bridge health gaps will wait for longer-term and more inclusive research. The local interventions demonstrate how Sure Start Local Programmes have approached Sure Start health goals. A positive feature of Sure Start has been the encouragement it gave to healthcare providers to reflect on new and creative means of consolidating services (Cowley, 2007). The Pampering Group is a perfect model of an intervention that blazes a trail by consolidating new and expectant parents in a casual environment that was intended to generate social and health advantages (Avis, Leighton, & Schneider, 2007, p. 29). It also reveals an issue that persists in numerous Sure Start programmes—an effort to provide services and counsel in a casual, informal way that depends on making a programme appealing to the individuals or populations who are the targeted recipients. The Theoretical and Practical Motivation of Sure Start There was growing concern worldwide for the snowballing consequences of social exclusion for children’s life chances and directions. Seminal findings preceding Sure Start were circulated by the Luxembourg Income Study (Anning & Ball, 2008, p. 10). In 1998, the Labour government ordered a succession of inter-departmental conferences which produced insights for anti-poverty programmes, like Sure Start. However, the extent of child poverty in the UK did not decrease and social inequalities are increasing. Between twenty-two and forty-eight months, the health and achievements of children with similar physical and cognitive developmental level, but from different social classes, start to move away from each other (Anning & Ball, 2008, p. 10). By six years of age, the differential patterns are fixed towards later life. Sure Start was an innovative, revolutionary, and bold effort to remove the most at-risk young children in the UK from the vicious forces of poor ambitions, inadequate work-related prospects, ill health, and poor education (Eisenstadt, 2011). Based on findings that experiences during early childhood affect future life opportunities, like employment and educational opportunities, for poor, underprivileged children, the Government established Sure Start in 1998. Its objective was to enrich the security, wellbeing, and health of children prior to and after birth, to support their growth by the time they go to school and to support parents’ work-related prospects and parenting (Avis et al., 2007). More than 500 Sure Start Local Programmes were launched in disadvantaged neighbourhoods all over England, giving services adapted to the particular needs and circumstances of the local community. As a component of the Every Child Matters Green Paper, which was developed to consolidate services to support vulnerable children, the Government declared in 2003 plans to establish a Sure Start Children’s Centre in the most disadvantaged areas in England (Lloyd & Harrington, 2012, p. 96). Sure Start was envisioned as a way to encourage children’s education, growth, and development. Motivated by the Comprehensive Spending Review of 2000, funding was given to 524 programmes in England’s most deprived neighbourhoods with a population of roughly 400,000 children aged four years and below (Avis et al., 2007, p. 9). A new programme for children was established in 2004, with an innovative idea for Children’s Centres, successfully leading to a large-scale reform in the features of the Sure Start intervention. Sure Start was launched with clear goals: “to achieve better outcomes for children, parents and communities by: increasing the availability of childcare for all children; supporting parents as parents and in their aspirations towards employment” (Moyse, 2009, p. 7). The major Sure Start objectives of enhancing emotional, education, and health development are obviously interrelated, because a child with health or emotional needs may be incapable of making the most of educational prospects, and emotional and physical growth are core features of young children’s education. Similar to numerous early years’ interventions, Sure Start placed emphasis on the general needs of children (Moyse, 2009). Yet, not like any earlier programmes, Sure Start interventions focused on a number of basic principles. The supporting theoretical perspective was the ecological model of child development by Bronfenbrenner (1979). He discusses the value of “the recognition that environmental events and conditions outside any immediate setting containing the person can have a profound influence on behaviour and development within that setting” (Anning & Ball, 2008, p. 11). He focuses on the dynamic role individuals fulfil in moulding their environment. He argues that “the interaction between a person and an environment is viewed as two-dimensional, that is characterised by reciprocity” (Anning & Ball, 2008, p. 11). Sure Start adopted this comprehensive model to improving young children’s life chances, enclosed in families, consequently enclosed in entire communities as its foundation (Simon & Ward, 2010). Sure Start was an inclusive community-based programme directed towards the most disadvantaged neighbourhoods with the goal of removing entire communities from poverty. Sure Start Local Programmes (SSLPs) were mandated to provide yearly evaluation statements for the national coordinating centre. This obligation to report regularly had a tendency to divert the attention of programme managers from the wider effect of their SSLPs and to influence the products of local assessments. As interventions further expanded and more features were subsumed into the evaluation interest, the reports became a routine, providing insufficient time for the integration of outcomes (Clarke, 2006). The National Evaluation of Sure Start (NESS) demonstrated the SSLP inclusive model of intervention (Eisenstadt, 2011). Addressing the Evaluation Challenges The system of evaluation was essentially complicated. The stated requirements for the evaluation agencies demanded systems that could determine whether Sure Start is successful; the costs; in what conditions is it successful; which components are the most effective; and why and how it is successful. In order to address such questions, the evaluation report enumerated a sequence of additional questions that have to be answered (Eisenstadt, 2011, pp. 119-20): (1) how effective is Sure Start in mitigating social exclusion among young children, their families, and the communities wherein they belong to; (2) how effective is Sure Start in enhancing the cognitive, physical, emotional, and social development of young children; (3) how effective is Sure Start in addressing child poverty, and is it successful in ending the intergenerational pattern of poverty; (4) how effective is Sure Start in consolidating current services to boost outcomes and coordination and how did it affect children and families; and (5) how effective is Sure Start in adding value to current services by reforming them? Looking at these very important questions, it becomes clear that the evaluation is too complex and challenging, and that Sure Start was designed to meet diverse, multifaceted challenges and needs. It is not surprising that all ministers engaged in the programme were certain it would eradicate all social problems for the present and future generations. In order to address these issues the NESS research policy integrated five major factors (Eisenstadt, 2011, p. 120): (1) encouragement and assistance for local evaluations— delivery of technical assistance for programmes to carry out their own assessments; (2) cost-effectiveness—do the outcomes validate the costs or expenses, could similar results have been attained in a more cost-effective manner; (3) local community context evaluation—the demographical features of Sure Start communities, education, health, crime, employment, and poverty records; (4) impact evaluation—the impact of Sure Start on communities, families, and children; and (5) assessment of the implementation of SSLPs—major features of programme theory, practice, and strategy, as well as calculations of the costs of provided services. The evaluation system guaranteed interconnectedness between the elements so that, for example, the cost-effectiveness component would draw information from the implementation component and the local context evaluation component would guide the impact component. The local context evaluation was especially vital to determine if the Sure Start communities were considerably more disadvantaged than the other parts of England and, in fact, if communities transformed as an impact of Sure Start (Stuttaford & Coe, 2007). Moreover, it would be helpful to compare various types of communities and the ethnic composition of Sure Start zones. Such aspects would offer relevant contextual information for the impact analysis and for the implementation analysis. The impact analysis was the most difficult and complex in structure. As implementation study was mostly explanatory, the impact analysis should be quantitative, involving a certain level of comparison between children residing in Sure Start communities and those who are outside Sure Start provisions (Stuttaford & Coe, 2007; Weinberger et al., 2005). Due to the focus on local authority of Sure Start interventions, it seemed understandable to oblige programmes to make their own evaluations. Thus, all programmes were permitted to allot a portion of their financial resources to their own evaluation. The NESS group gave technical support for local evaluations, but SSLPs were to decide where the evaluation resources would go (Cowley, 2007). Programme managers experienced difficulties meeting the targets of delivery and they seldom had knowledge or experience in directing evaluation. Thus, the local evaluations were different in terms of quality and were seldom substantial. They were usually quite inadequate or too narrow in scope to offer useful information for service improvement (Belsky, Melhuish, & Barnes, 2007). Generally, they were less useful in clarifying the major issues that evaluation has to address. Was Sure Start Able to Achieve its Objectives? In a nutshell, Sure Start aspires to attain healthier, improved outcomes for children, families and communities through (Waterston, Helms, & Platt, 2005, p. 339): Increasing the availability of childcare for all children; Improving health, education and emotional development for young children; Supporting parents in their role and in developing their employment aspirations These objectives will be attained through (Waterston et al., 2005, p. 339): Helping services to develop in disadvantaged areas, while providing financial help to enable parents to afford quality childcare; Rolling out the principles that drive the Sure Start approach to all services for children and parents The NESS became the biggest organised procedure and impact study of a multifaceted programme embarked on the UK thus far. Outcomes were to be evaluated against established objectives in the cognitive, emotional, and social development of children, their wellbeing and health and the performance and functioning of their families and communities. Local programme assessments were also carried out together with national evaluations (Allen & Black, 2006). However, the evaluation produced a wide range of promising and, occasionally, questionable reports on partnership between communities, families, and professionals. An instrument was developed to determine to what level the programmes had been carried out based on original goals. Programme areas evaluated were multi-agency collaboration, partnership performance, and the development of an environment that empowered and motivated personnel and service users (Lloyd & Harrington, 2012). As reported by Stuttaford and Coe (2007), programmes that followed rigidly the original implementation rules and were better implemented were discovered to have a higher favourable impact on the families and children. It was discovered that health-agency-led Sure Start Local Programmes were related to better outcomes for the wellbeing and health of children and families. This discovery was substantiated in the cost-effectiveness study. Such reports on the usefulness of health organisations and personnel in child and family outcomes were shown in the further stress on health that was to define later Children’s Centre interventions (Hill et al., 2013). Since 2004 this raised the Sure Start idea into a higher stage. Other aspects of the Sure Start intervention discovered to be successful, like the empowerment of service users via the community-development model, did support the findings of previous investigations of early years’ centres (Little, 2012). From the point of view of parent partnership, it was discovered that minority ethnic groups and Blacks in Sure Start communities could have been more successfully served, especially because they are more prone to be impacted by poverty than the other groups (Anning & Ball, 2008). This topic had been emphasised before, while a review of literature on successful means of involving black and minority ethnic (BME) parents in interventions highlighted the significance of respecting diversity across and within ethnic groups in tailoring programmes for local needs (Belsky et al., 2007). Uncertainties were also raised whether or not such integrated service approach permitted professional social workers to work appropriately with the most disadvantaged families. With regard to policy, since the Sure Start intervention was carried out without drawing on concurrent advances in early years practice and policy it received severe criticisms. Penn (2007) claimed that Sure Start strengthened the gap between social-welfare-based and universal early years model. One of the leading professionals in the UK on early intervention and prevention examined whether the structure of Sure Start was appropriate for dealing with child poverty and could be significantly evaluated in the least (as cited in Hill et al., 2013, p. 113). 3,500 Sure Start Children’s Centres had been launched by 2010, supervised by voluntary sector partnerships, health departments, and local authority Children’s Services (Hill et al., 2013, p. 113). One main distinction between SSLPs and Sure Start Children’s Centres is their focus on major services, instead of reacting adaptably to locally stated demands, as the Sure Start programme aimed to accomplish (Eisenstadt, 2011). Even though the community development model has been withdrawn, the Sure Start focus on family and child health services has been reinforced. From 2008 onwards every Children’s Centre offers the ‘Healthy Child Programme’ provided by multi-agency units, as one of the components of a campaign to address major public-health issues like adult smoking and childhood obesity (Hill et al., 2013, p. 113). The main programme of the centres also involves parenting assistance and counsel like employment support. Unfortunately, this new early years centre approach only partly incorporates health, education, and care aspects. A proposed evaluation of Sure Start Children’s Centres is in progress; threats to their effectiveness are discovered in several studies. They function on a much lower budget, in comparison to the first Sure Start intervention’s subsidy. Continuous financial difficulties ensued (Eisenstadt, 2011). The Childcare Providers Survey in 2008 showed that 58% of childcare and early education in Children’s Centres was offered by local officials themselves, reversing the terms of the 2006 Childcare Act (Hill et al., 2013, pp. 113-4). The 2009 Ofsted paper on Sure Start Children’s Centres reveals that partnership or collaboration across day care and other services was unsuccessful in most of the centres studied. Even though the Ofsted research revealed encouraging short-term effects on children and families, more comprehensive investigations of longer-term effects on children and families are thus far insufficient (Hill et al., 2013, p. 114). Studies are particularly few on the work of Children Centres with families where protecting and nurturing children is a problem. It is somewhat premature to evaluate the longer-term impact of Children Centres on the security, wellbeing, and health of children, families, and communities (Clarke, 2006). Lowering the prevalence of childhood accidents has been a long-term objective of some government programmes. This objective was especially important to SSLPs because it was believed that there is a connection between social exclusion and the risks of a childhood accident. As a result numerous SSLPs vigorously focused on child injury prevention initiatives by means of providing education, guidance, and home safety devices (Lloyd & Harrington, 2012). Nevertheless, it remains uncertain whether the use of home safety devices can be effective in decreasing home accidents. Besides permitting healthcare providers to innovate, Sure Start programmes also gave a chance to early years and health personnel to acknowledge and understand the importance of expert interventions for certain families. Cooperation with mental health delivery and speech and language services within SSLPs, as well as the availability of training, has resulted in an ‘added value’ as an outcome of the greater expertise and assurance that personnel have achieved in resolving such matters as maternal mental health disorders or language deficiencies (Belsky et al., 2007). The assessment of Potter and Hodgson of a staff training programme intended to enhance the quality of language learning and instruction in preschool environments revealed that preschool health providers were more informed of techniques and chances to improve the communication setting (Avis et al., 2007, p. 57). The outcomes of an integration of Sure Start local evaluations of speech and language programmes made public by NESS substantiate the significance of personnel achieving proficiency in matters surrounding communication and developing the skill to improve communication and interaction settings (Belsky et al., 2007). On the other hand, maternal mental health issues and postnatal depression continue to be very challenging for they are not sufficiently understood. It is difficult to determine the reasons for the continuous existence of adverse attitudes to individuals with mental health disorders because the prevalence of mental health disorders is quite high (Simon & Ward, 2010). But majority of health experts have difficulties talking about mental health problems, particularly within the perspective of parenthood. According to Anning and Ball (2008), the effect of parenthood on maternal mental wellbeing is just starting to be acknowledged as an area of concern. Hall and Finnigan identify a Sure Start programme to offer training and counsel in maternal mental wellbeing to local family health agencies (Avis et al., 2007, p. 18). Their study demonstrates the problem in attempting to evaluate a programme that tries to deal with the stigma related to having a mental health disorder, and the poor confidence that numerous healthcare providers encounter when having to deal with mothers’ mental health issues. Avis and colleagues (2007) argued that the basic services for children’s centres have to involve smoking cessation services, speech and language assistance, appreciation and care for mothers experiencing depression, nutrition and security, hygiene, education about breastfeeding, and prenatal assistance and counsel. Conclusions Early years experts in the UK have generally supported a universal and inclusive early years intervention which would be defined by genuine partnership between professionals and families and where in a larger number of social welfare services would be completely consolidated. However, in spite of important advances in policy concerning centralised early years services, the early year service structure has not been really recreated. Early years policy in the UK, as demonstrated by the Sure Start programme, still prefers early-years-service structure characterised by inclusivity. This concept implies that several services are inclusive, whilst extra resources are directed towards children and families believed as most disadvantaged. This is largely done through a divided structure of provision, like in the case of Children’s Centres. There are several lessons to be gained from this case study. Childcare and early education included in the first types of centralised consolidated early years services for poor children, but its capability is threatened in its latest manifestation. It appears quite ironic that quality delivery in this area is still unattained, in spite of numerous findings about its encouraging effects on the life chances, health, and security of poor children. References Allen, M. & Black, M. (2006) “Dual Level Evaluation and Complex Community Initiatives: The Local Evaluation of Sure Start,” Evaluation, 12(2), 237-249. Anning, A. & Ball, M. (2008) Improving Services for Young Children: From Sure Start to Children’s Centres. London: SAGE. Anning, A. & Edwards, A. (2006) Promoting Children’s Learning from Birth to Five. New York: McGraw-Hill International. Avis, M., Leighton, P., & Schneider, J. (2007) Supporting Children and Families: Lessons from Sure Start for Evidence-Based Practice in Health, Social Care and Education. UK: Jessica Kingsley Publishers. Belsky, J., Melhuish, E., & Barnes, J. (2007) The National Evaluation of Sure Start: Does Area-based Early Intervention Work? UK: The Policy Press. Bronfenbrenner, U. (1979) The Ecology of Human Development: Experiments by Nature and Design. Cambridge, MA: Harvard University Press. Clarke, K. (2006) “Childhood, parenting and early intervention: A critical examination of the Sure Start national programme,” Critical Social Policy, 26(4), 699-721. Cowley, S. (2007) Community Public Health in Policy and Practice: A Sourcebook. UK: Elsevier Health Sciences. Eisenstadt, N. (2011) Providing a Sure Start: How Government Discovered Early Childhood. UK: The Policy Press. Hill, M. et al. (2013) Children’s Services: Working Together. London: Routledge. Hoghughi, M. & Long, N. (2004) Handbook of Parenting: Theory and Research for Practice. Thousand Oaks, CA: SAGE. Little, M. (2012) “In the Shadows: Children’s Social Policy during the Blair Years,” Adoption & Fostering, 36(1), 52-59. Lloyd, N. & Harrington, L. (2012) “The challenges to effective outcome evaluation of a national, multi-agency initiative: The experience of Sure Start,” Evaluation, 18(1), 93-109. Moyse, K. (2009) Promoting Health in Children and Young People: The Role of the Nurse. UK: John Wiley & Sons. Simon, C. & Ward, S. (2010) Does Every Child Matter? Understanding New Labour’s Social Reforms. London: Routledge. Stuttaford, M. & Coe, C. (2007) “The ‘Learning’ Component of Participatory Learning and Action in Health Research: Reflections from a Local Sure Start Evaluation,” Qualitative Health Research, 17(10), 1351-1360. Waterston, T., Helms, P., & Platt, M. (2005) Pediatrics: A Core Text on Child Health. UK: Radcliffe Publishing. Weinberger, J., Pickstone, C., & Peter, H. (2005) Learning from Sure Start: Working with Young Children and their Families. New York: McGraw-Hill International. Read More