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Listen
Growing Support
1. Introduction
The literature review
The Scottish Executive commissioned the writers to carry out a literature review of evidence concerning the effectiveness of interventions aimed at assisting vulnerable families with children aged under 3 years.
Funding was provided for work over two months. Given the time-scale, the review was necessarily partial in its coverage of topics and in its capacity to read and summarise the literature on any one topic. An initial structure was developed which covered holistic theoretical approaches; centre-based, professional and community initiatives; child protection and alternative family care. Consultation with the funders refined priorities. Thus, it was agreed not to give attention to childminders, day carers or playgroups, but to include material on 'routine' or 'mainstream' work by health visitors and social workers.
The context
For a long time the first few years of life have been seen as vital, both for the development and life-chances of the individuals concerned and for society's interest in optimising the positive contributions made by the next generation and minimising the problems and demands. Promoting parental skills and providing support at this stage of a child's life are of cardinal importance if children are to attain positive developmental outcomes in later years (Dunst et al 1988, Cochran et al 1990, Holden 1997). In recent years it has become apparent that the 'family' is not always the centre of nurturing and in some situations may have a more negative than positive affect, as when children are persistently abused or neglected.
The recurrent concerns with prevention and early intervention have become prominent again in the last few years across a range of areas (e.g. education, health, crime, poverty, and child protection). This has been a prominent element in government's plans to reduce social exclusion or increase social inclusion. Services may assist children directly through improving their learning, health or social development, for example. Children can also benefit indirectly if their parents' economic situation, employment opportunities or caring capacities are enhanced.
The current focus on the early years incorporates long-term issues related to child poverty, managing the work-care tensions in early parenthood and health and educational inequalities. It also reflects demographic, social and economic changes that have affected parenting processes for many, e.g. higher and more diverse expectations of parents, commercial pressures, reduced access to kin supports (Henderson 1999). On top of these, persisting structural and gender inequalities in society are making parenthood more difficult for disadvantaged groups (Middleton et al 1994). It has been suggested that in some cases ethnic minority families and those where the family is headed by a lone mother are more vulnerable to poverty and stress (Williams 1989, Glendinning and Millar 1992). Parents, especially mothers, who experience disability, marital breakdown or domestic abuse generally have to contend with low incomes, which in many households is less than half the average income (DoH 2000). According to Steinhauer (1996) poverty serves as a source of stress in its own right, but it also erodes parents' limited psychosocial resources and magnifies interpersonal and psychological problems. In addition to the effect poverty has on children it is also clear that other deprivations tend to coexist with poverty, which together undermine competency and resilience in parenting (Steinhauer 1995; Byrne et al 1996). Other factors such as poor health; substandard housing; alienation from the mainstream of society; and individual depression have also been identified as consequences of poverty, which also predispose families to vulnerability (DoH 1995).
Partly as a result of the demands of the job market many families are also living away from their original communities and have little support from extended family members and friends. In addition the change in community structures has also meant that some communities are less cohesive than they once were. Although in some areas assistance by neighbours remains strong or has developed new forms of support, in others where once neighbours could rely on each other, they now hardly know each other (Hill 1987; Allan 1991). This has put increased pressure on the nuclear family and has deprived families of help and companionship from a wider source. According to Belsky (1984) these systems of support are one of the factors that can buffer the parent-child relation from stress. Others have also identified support from friends and family as an alternative to secondary and tertiary services within the community and as a means of coping more effectively (Belsky and Vondra 1989, Werner 1990, Monat and Lazarus 1991, DoH 2000). Holman (1988) advocates the development of non-coercive community-based support as an effective means for helping disadvantaged families to carry out their caring responsibilities.
Changes in other areas of social policy such as health and community care legislation have meant that parents with mental health problems for example, are likely to spend more time at home in acute stages of their illness, resulting in added stress for them and their children.
Current legislation and policies
A number of recent legislative measures and policy initiatives are relevant (Kirk and Hill, 2000). The UN Convention on the Rights of the Child has emphasised the universal entitlements of children to provision and protection, while recent British legislation has endorsed the view that parental rights towards children derive from a set of specific responsibilities for their long-term welfare and education. Among other things, the Children (Scotland) Act 1995 prescribed that each local authority has a duty to provide wider services for children of any age who are 'in need' and their families (S. 22(1)). Children in need are those whose health or development would be adversely affected without the provision of services, and children who are themselves disabled or who are 'adversely' affected by disability of a family member (S. 93(4)(a)). More specifically, local authorities have a duty to provide day care for 'children in need' who are under 5 (S. 27(1)). Authorities have a power to provide day care for young children not 'in need' (S. 27(1)).
In the last few years, the government in Scotland has developed a general Childcare Strategy, rooted in the principles of the UN Convention. The SureStart programme funds initiatives which are particularly targeted at very young children. This programme is explicitly based on evidence about the potential positive impact of early intervention programmes on young children living with vulnerable families. The review by Glass (1999:262) indicated that these might achieve:
- gains in emotional and cognitive development for the child, and improved parent-child relationships;
- improvements in health-related indicators;
- improvements in educational process and outcomes;
- increased economic self-sufficiency, initially for the parent; and later for the child; and
- reductions in criminality and teenage pregnancy.
Guidance issued in 1998 encourages inter-departmental co-operation in early years provision, while in July 2000 funding was announced to develop the training of child care workers. Nursery education places have been expanded. At the same time as aiming to improve services for all children and their parents, projects have been promoted which focus on particularly vulnerable groups or areas (e.g. Starting Well in Glasgow). These initiatives build on a range of existing provision, provided by a number of professions and types of organisation. Statutory services include health and various local authority departments (e.g. education, social work, housing, and recreation). Many kinds of service are provided by voluntary organisations, large and small; local, regional and national.
Coverage and format of the report
Given the time-limited nature and specific focus of the review, it has not been possible to examine fully the possible meanings of 'vulnerable', although certain indicators were mentioned briefly above. In any case, relevant publications adopt different approaches to this, depending on their professional or theoretical orientation and the time of writing. Loosely, vulnerability has been interpreted to correspond with the legal definition of children in need, i.e. the child's health or development is currently impaired or is likely to be so, as a result of economic, social or psychological problems affecting the family or owing to disability.
Given the huge number of studies relevant to this subject, we have often not been able to scrutinise original research reports and had to rely on overviews. Both specific studies and overviews, like early years provision itself, do not always confine themselves to vulnerable children so it has been relevant to report wider conclusions about the impact of services, highlighting where we can, findings particularly relevant to the most vulnerable. Similarly, services and research often cover a wider age span and do not identify under-3s as a particular group. Therefore we report results on all pre-school children where these include or have implications for children under 3.
The report begins with a brief summary of key approaches to early years services and a consideration of what counts as 'effectiveness' and evidence for it. The main body of the report considers particular types of service in turn, recognising that these often overlap.
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