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Growing Support
4. Early years provision: nurseries and family centres
Daytime group care of young children is a long-standing form of service for families with young children. The goals and functions are diverse; some are offered on a universal basis and some are aimed solely or primarily at vulnerable families. Among the purposes are:
- providing good quality care for children while one or both parents do something else (often paid employment);
- offering play and social contacts for children;
- initiating children's education;
- helping children prepare for school;
- providing 'respite' for families under stress or with a disabled child; and
- monitoring children who have been abused.
Many establishments seek to meet several of these aims, while for others there is one primary purpose. At one time, distinctions were sharper than today. Day nurseries or crèches provided extensive hours of daytime substitute care; nursery schools and classes offered pre-school education (usually for children aged 3 or over); playgroups enabled children to play and mix together for short periods. Increasingly the trend has been towards more integrated services, which not only provide direct care of children, but also offer services to parents (normally mothers) including support groups, classes and various kinds of therapeutic help. This led to the development of multi-purpose family centres. In addition, nurseries have often taken on more family support functions too. Most have now been renamed as children's centres or family centres, though some are still in practice largely day care facilities. When examining research evidence it is not always clear precisely what kind of service is being referred to. Most early research was about nurseries and pre-school education; recent studies often focus on 'family centres', although these are not always family centres in the fullest sense. Outcome studies of playgroups are rare.
Nursery care
The development of early years services, such as day care facilities has not occurred without criticism. In particular some have viewed it as having a negative impact on child outcomes (Bowlby 1951, Belsky 1992), whilst others have argued that it perpetuates the unequal power divide between men and women in families, whilst not addressing the responsibilities of fathers (Cannan 1992, Kirk 1990). In this section we concentrate on the evidence about the impact of day care on young children. Nevertheless gender remains an important issue since not only do mothers usually provide more direct care than fathers, but they also tend to make alternative care arrangements, while very few nursery staff or childminders are men.
Much policy and research about the effects of early nursery care have been framed by attachment theory ( see section 2). Bowlby (1969) argued that infancy is a critical period when children are especially vulnerable to even short-term separation from an attachment figure. Therefore, according to Bowlby, children who were separated from their mothers in day care under the age of 3 were at serious risk of lasting psychological damage. Critics believe that his assertions about the effects of separation were fundamentally flawed. First, the negative effects, which he attributed to separation, were shown to be a result of a number of different factors that influenced the development and behaviour of children. In particular, children who showed linguistic and intellectual retardation were found to have a lack of stimulation in these areas, and children who exhibited conduct disorders and delinquent behaviour were thought to have experienced family discord (Rutter 1971; Holmes 1993). It was also found that separation from parents only had lasting negative effects when it was prolonged and there were additional adverse factors such as: absence of other people to whom the child is attached; a strange environment; the child is passed from one person to another; and no one person takes over the mothering role (Robertson and Robertson 1971).
Bowlby's early views both reflected and reinforced many public and political concerns about nursery care. Hence over the years, recurrent studies have tested the assumption that attending day care harms young children. On the whole the conclusions have been that children may experience initial distress, but this is short-lived. The greatest sensitivity to separation is experienced between about 6 and 18 months when young children have developed strong personal attachments to parents and others, but are not yet confident that absences can be temporary (Schaffer 1990). Systematic comparisons have repeatedly indicated that children in nursery care do just as well emotionally and socially as others (Rubenstein et al 1983; Scarr and Clarke-Stewart 1987). There are two provisos. It is necessary to compare comparable children, since many children attending day care come from disadvantaged backgrounds so tend to do less well than the average for that reason. Secondly, the nurseries must have adequate levels of staffing, resources and stimulation.
There is a wide body of evidence to suggest that children who enter day care develop normal attachments to both their mother and the day care staff, although some have argued that these attachments are likely to be insecure (Ainsworth et al 1978). Clarke-Stewart (1981) reviewed 28 studies that compared maternal attachment in children who attended day care with those who did not. Only one study found that children who attended day care were 'anxiously attached or ambivalent to their mothers' (Tizard 1986:12). Clarke-Stewart believed that this finding could have been attributed to the fact that children in day care were less dependent on their mothers, rather than having a disturbed relationship with them. In fact there is no evidence to suggest that disturbed behaviour or developmental delay occurs as a result of day care. There is evidence, however, to indicate that children attending day care, especially in the UK, do display behavioural problems. This is thought to be because the majority of places taken up in day care are by children from vulnerable families. In these cases it is thought that there are many positive aspects of day care that affect both child and parent (Holman 1988, Gibbons 1990, Clarke-Stewart 1992, Glass 1999). There is also evidence to suggest there is a correlation between quality of parenting and social support such as that provided as a result of day care or family centres (Culbertson and Schellenbach 1992, Kirk 1999).
Family centres
The introduction of family centres saw the recognition of a partnership philosophy between parents and child care services. Some were established to provide a preventative service for children at risk of abuse or of being taken into public care, while others offered a wider community service. Much of the research on family centres has documented their functions, principles and usage, but not examined their impact on children or families.
Originally set up by voluntary agencies the legislation acknowledges them as providers of family support services, and they have therefore become part of a comprehensive range of formal provision that can be provided by local authorities. According to the Guidance to the Children Act (1989) they are 'Centres where family members may attend for occupational, social, cultural or recreational activities and for advice guidance or counselling'. De'Ath (1985) stated that services may include day care for young children, play groups, family therapy, health education and so on. In addition she also pointed out their diverse nature, but as indicated by Walker (1991) they tend to share three characteristics in common: a focus on the whole family unit; location in neighbourhoods displaying a high incidence of disadvantage; and a task of preventing family breakdown. However, according to Holman (1988) there are three individual models.
- client model - offering specialist services to social work clients in difficulties;
- neighbourhood model - providing support for a wider set of families in the locality; and
- community development model (very much in the minority) - used by anyone in the locality but with the aim of empowering local people to develop and run their own services.
The Children Act classification is slightly different and suggests three different types: therapeutic, community and self-help. The model along which the centre is organised does not strictly determine what type of families attend as there is overlap depending on the area and other resources available. Evidence does suggest that those attending the client- focused model tend to be families referred by social work, and according to Cannan (1992) these centres provide somewhere 'to contain, monitor and treat what appears to be increasing numbers of dangerous families'. Kirk (1995) in her study of one local authority's provision in a disadvantaged area of Scotland found a similar scenario of a variation in the needs of clients between centre types. Those using the client-focused model tended to be from the lowest income group with high levels of stress and ill health and the least sources of informal support. The neighbourhood centres catered for a more mixed group, but still catered for a number of very vulnerable families.
Evidence about types of family centre, access and stigma
Most commentators favour a proactive non-stigmatising, universal family support service, which they claim is more effective than a reactive, targeted, referral based professional service with a narrow child protection focus (Bachelor et al 1998: 206). However it would appear from the findings of a national survey (Warren 1990) that child protection was a predominant function in at least 70 per cent of family centres rather than a generic family support, or child-focused education or welfare. This can be seen as a form of targeting the most vulnerable families, but proponents of universal services argue that these not only overcome stigma (which may deter usage) but also transcend the child care debates on the provision of universal versus selective services, and primary preventative services versus reactive secondary and tertiary provision. However there remains a challenge in ensuring that those who are most vulnerable are engaged with such services without being stigmatised as a result of the referral process (Smith 1996).
Gibbons et al (1990) carried out a study in two local authority areas, which examined the use of neighbourhood family centres. They found that these centres were successful in attracting disadvantaged families as there was little stigma attached. Benefits from attending the centres included increased social networks and decreased social isolation. This study also reported differences in satisfaction between referred users and 'drop-in' users. The latter were more satisfied and also had more choice. Hence it could be that opportunities for participation and for the service to be responsive to people's expressed needs are important elements for a successful service.
Even though this model of family centre may be attractive to families who are disadvantaged but are concerned about being labelled and/or stigmatised, the problem still remains that other users may dislike being associated with those who are most vulnerable and disadvantaged. A study by Stones (1989) of a neighbourhood centre that catered for a mix of needs found that when the media made stigmatising references about the centre, the drop-in users blamed those with more severe problems.
A more recent study by Bachelor et al (1998) addressed these issues by carrying out an evaluation of an existing family centre to inform the development of a needs led policy. The study was undertaken using an integrated method case study, which used quantitative methods to measure the relationship between need and service provision and a qualitative approach for the collection and analysis of data from interviews, observations and documents. The study found many users disliked attending centres that were based on a referral system. Users regarded such a 'client-focused' centre as a 'dumping ground'. Based on the data from the needs assessment and the more qualitative data, the research team proposed 'an integrated cluster model, which aims to bridge the gap between existing intensive therapeutic provision provided by social services and user organised drop-in support' (Bachelor et al 1998:205).
Thus the evidence is not conclusive about which model(s) are preferable, but does indicate that open-access, non-stigmatising services are most likely to engage those disadvantaged families that need help and support but are not viewed as child protection cases. Bachelor et al (1998) suggest the necessity for 'multi-faceted needs assessment strategies' as a means of providing the most appropriate model of family centre provision. Smith (1993) concluded from a study of Children's Society Family Centres that project type was not the most important issue when examining effectiveness. He suggested that 'worker style, a mix of activities, an adult education approach and the provision of scarce resources and services in neighbourhoods lacking facilities are probably more important than project type'. McGuire and Richman (1986) indicated that a social mix amongst those attending such facilities is valuable as this will help to reduce any stigmatising effect.
Studies of the impact of family centres
In terms of providing effective services to vulnerable families, there have been a number of studies that have reported improvements in the lives of parents - (predominantly mothers) and their children (Tibbenham 1986, Cigno 1988, Kendrick 1987, Gibbons et al 1990, Smith 1993). However, as indicated by Kendrick, these studies have methodological limitations, as none used experimental designs and no longitudinal investigations were undertaken. The study carried out by Tibbenham was based on staff assessments of 38 families referred to a local authority client-focused centre. Over half of these families were on the child protection register. It was reported that 47 per cent of families 'kept their commitment to attend'. An examination of 14 families in more detail found that mothers had increased their social networks, were more able to manage their children and had more self-confidence. However, as Tibbenham himself suggests, the long-term effect is unclear, since mothers attended as 'a prerequisite to keep their children' and he questioned how long these gains would last if they stopped attending.
Another British study used the views of staff and users to assess the effectiveness of three different models of family centres (Smith 1996). Again, the findings from this study must be viewed with caution, as the study did not use any sort of experimental design. Participants' views are pertinent, but without external assessments or comparison groups it is hard to be sure that gains can be attributed to the family centres. Mothers using the service in Smith's study reported an increase in the size of their social networks and gains in self-confidence. The most important outcome they identified for themselves was their increased knowledge of children's development and behaviour that helped them to cope with their child. Equally important, they believed their children benefited from learning to mix with others and having the opportunity to play in a safe environment with a wider variety of toys. Overall, parents and staff felt that the greatest impact had been on children rather than adults, apart from single parents who reported that the centres gave them 'time off', which they felt was highly beneficial. There were some differences in the perceived impacts in the different types of project. For example in the client-focused centres mothers gained in their understanding of child behaviour, whereas in the neighbourhood centres users identified the impact in terms of the effect on their self-confidence, learning new skills and feeling less isolated.
It is difficult and perhaps unwise to be prescriptive about the most effective type of family centre, as there is still relatively little reliable evidence to do this. However, evidence from a range of sources about various types of provision indicate that improvements in children's learning and development tend to be greater when their parents (mothers) are also involved (Kirk 1995). Goldshmied and Jackson (1993) provide descriptions of approaches that can be used with children under 3 years. Having reviewed relevant research, Yoshikawa (1994:44) indicates that in order for early years provision to be effective it should focus on both parents and child, last at least two years, have a strong educational emphasis in day care, and offer informational, health and emotional support to parents, as well as vocational and educational counselling where necessary.
Early educational interventions
Nursery schools and classes are largely restricted to children aged 3 or over, but now most group facilities for younger children also have educational components. Intensive structured programmes such as High/Scope and Head Start have been developed in North America and are now widely used in Britain. It is not always clear from research the extent to which under-3s were involved or whether the provision assessed was 'routine' or intensive.
In general pre-school educational experiences have been found to provide positive outcomes for children in terms of both cognitive and social development. The gains tend to be greatest for vulnerable families, especially when the parents participate, though the benefits can readily fade unless there is sustained follow up (Rutter 1971; Bronfenbrenner 1979). Most evidence has come from the US, but a study in an inner-city area of Dublin by Kellaghan and Greaney (1993) reported positive educational outcomes compared with a control group. Young people who attended a pre-school programme were followed up at 16 years of age and were found to have stayed on longer at school and attained more qualifications than the control group who had not attended pre-school groups. The ages when the children attended is not recorded.
The High/Scope programmes in the US have undergone rigorous experimental outcome research in the form of RCTs. These have demonstrated positive learning outcomes (Macdonald and Roberts 1995). Among the ingredients are a structured and active learning curriculum, specially trained staff and parent participation. The studies that have been undertaken indicate a number of positive outcomes for those attending the programmes (Schweinhart and Weikart 1993, cited in McDonald and Roberts 1995). A longitudinal follow-up indicated lasting differences between attenders and non-attenders across a surprising range. Graduates of the programme were followed up at age 27 years and it was found that, compared with non-attenders, they had significantly:
- higher average monthly earnings;
- a larger percentage of home ownership and second car ownership;
- a higher level of schooling completed;
- a lower percentage receiving social services at some time in the past 10 years; and
- fewer arrests for crimes of drug-taking or dealing.
It has been suggested that for children younger than 1 year the outcomes are less clear cut, although even then the trend reflects the outcomes found in older children. It has also been shown that as well as developing long-lasting academic, social and cognitive gains, the programme results in cost-effective outcomes (Sylva 1994). Similar programmes in the UK have helped improve children's self esteem, attitudes to learning and task orientation (Smith 1999).
Also in the US, the Head Start programme was developed as an early education intervention aimed at breaking the cycle of poverty. Again this programme has been rigorously evaluated using experimental methods (Macdonald and Roberts 1998). The early studies showed that the IQs of children attending improved, but the gains disappeared after entry into school. However by applying more sophisticated outcome measures it was reported that benefits in cognitive ability, self esteem, scholastic achievement, motivation and social behaviour were achieved as a result of attending the programme (McKey et al 1985). Head Start schemes particularly benefited children from the most disadvantaged families (Lee et al 1988).
It is evident that programmes such as High/Scope and Head Start provide good social and academic outcomes for children from disadvantaged families, but as indicated by Macdonald and Roberts (1995) the positive effect of such interventions on the 'here and now' quality of life for children in vulnerable families should not be forgotten.
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