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Chapter 4 The Perceived Impact of Sure Start Scotland

'We know we are helping people but it's hard to show the evidence' (Sure Start Contact Officer)

Introduction

This chapter focuses on what the Sure Start Contact Officers said about the uptake and impact of Sure Start Scotland and provides qualitative evidence about such impact. Chapter 2 provided quantitative evidence on numbers of children supported and the range of services offered, while Chapter 3 identified the ways in which services have developed to meet the needs of vulnerable families. This chapter also considers what the Sure Start Contact Officers and key planners reported about the involvement of service users in the planning and delivery of services. Difficulties associated with measuring impact are also considered alongside issues related to monitoring and evaluation.

Uptake of services

All of the local authorities reported an increase generally in the uptake of Sure Start services since the end of 2001. In most local authorities the majority of projects are nearing capacity or are at capacity and some have waiting lists.

'The uptake of Sure Start Scotland services within (Local authority) has continued to be very positive. The projects have continued to report an ongoing increase in uptake, with figures stabilising and projects reaching their capacity. This includes the uptake of nursery or day care places for children under 3, the uptake of specialist support and group activities for parents'.

Some noted that it was hard to keep up with demand and that service development quite appropriately generates demand by identifying unmet need:

'If we take fostering as an example - if we have 20 fostering placements we will fill them, if we have 25 we will fill them. To a degree we draw the line according to the resources we have available. Now that Sure Start services are set up people see the value of them. Because the services exist, need that can be met by this type of service is identified, for example by health visitors, when they go to see a family. Setting up services encourages the identification of genuine need, which puts further pressure on resources'.

As in the 2001 mapping exercise, however, some Sure Start Contact Officers were keen to point out that quantitative measures of uptake do not do justice to the initiative nor to the impacts it may be making:

'We do not operate a "number of places" type of service, i.e. we do not offer solely a nursery type service, however there has been an increase in the number of families receiving a service over the years…. However, we have not adopted an attitude of "never mind the quality, feel the width", and gone for increasing our gross number of families serviced. We have tried to respond more flexibly to families in need, providing a higher level of service to the families in greatest need'.

'Uptake is a misleading term. Numbers are always low in rural areas'.

A few local authorities noted that they have ceased to advertise a particular service as further demand could not be met, and as will be discussed in Chapter 6, there were gaps in provision suggesting a level of unmet need.

Many Sure Start Contact Officers reported that it was difficult to reach the most vulnerable families and noted success in this area. Early intervention was considered very important and achieving this was one measure of the success of Sure Start Scotland. Encouraging vulnerable families to come forward was remarked upon as important when considering uptake:

'Parents feeling that it is not a sign of failure to require/seek advice, guidance and support with all aspects of parenting and stress management. Parents are being given a wide range of services to choose from'.

'We hope that making services easier to use will mean that those who were hardest to reach in the past will have more chance of benefiting from them'.

The impact of Sure Start Scotland

The Sure Start Contact Officer interviews and questionnaires provided the opportunity for the impact of Sure Start Scotland to be discussed. As noted by several respondents, measuring impact is difficult, for example:

'We need to be able to meaningfully assess outcome. We have a lot of services but need to look at them and determine which ones actually impact on the quality of people's lives'.

'Not all success can be measured'.

'We know we are helping people but it's hard to show the evidence'.

However, the data generated through the interviews and questionnaires were replete with evidence relating to perceived impact. At one level, this related to the delivery of services more generally, and how these meet the overall objectives of Sure Start Scotland discussed in Chapter 2. For example:

'We hope that making services easier to use will mean that those who were hardest to reach in the past will have more chance of benefiting from them'

'By developing parents' self-esteem and abilities to parent, services are supporting adults to be able to provide care and nurture for their children thus improving children's social and emotional development'.

'Services and projects which operate on a local basis have made an impact on the quality of life for the children and the parents'.

The interviews provided a strong sense that people know Sure Start works and that it makes an impact on parents' and children's lives. However, the evidence for such a conclusion is varied, ranging from anecdotal, the use of a range of feedback and more robust measures, including on-going evaluation and monitoring:

'We know it works from the discussions/feedback reviews, feedback from parents, other stakeholders and from staff's direct observation of, for example, children's capacity to interact better with their peers, the children's ability to play and explore their environment…'

However, as noted above, measuring success is difficult, not least because of the long term nature of some outcomes:

'We can establish changes in parent confidence and even parent-child interaction but can't yet say definitely changes in the life outcomes of the children. We have realms of feedback from parents saying the various services have made a difference'.

Some respondents provided some basis for their overall perception that Sure Start is making an impact, as in the example above where a combination of feedback from staff and parents and direct observations provide evidence of improvement in children's social development.

This next example demonstrates how success can be measured, and draws on one of the illustrative case examples provided by the Sure Start Contact Officers:

A single parent with 2 children was referred to (the service) by the local health visitor due to concern about the younger child's behaviour. The mother was anxious that her child not be labelled as 'difficult'. On the initial visit the child appeared to be controlling the interaction with his mother. The mother was reluctant to mix socially outwith the home due to the child's unpredictable behaviour and frequent temper tantrums. Over a 6-month period the parent and child engaged in play sessions and the interaction improved, culminating in the mother successfully hosting a birthday party for her son. In the longer term, the child has now successfully entered primary school and both mother and father (separated) have agreed boundary issues for their child's behaviour. The intervention showed a 50% reduction in the child's behavioural problems (as measured by the Behaviour Checklist) and a reduction in the mother's anxiety (as measured by the HAD scale); the family were successfully discharged from care.

Others provided less precise reasons but nonetheless were convinced of the positive impact of Sure Start, for example through identifying better transition to nursery:

'There is reason to believe that the transition from home to nursery is more manageable with nursery staff being faced with fewer unknowns when welcoming 3 year olds into nursery. There is also reason to believe that planning for transition allows parents to be more content with arrangements made around their children'.

Or, as in the following example, how a particular service can impact on confidence and self-esteem:

'Some of the parents that were involved initially in the drop-in service are now committee members, or some of the local parents have gone on to do (a child care qualification), so it's creating employment over and above self-esteem and confidence. So we have strong indications that it is having that kind of impact. The impact on children can be more closely monitored as we've got fully qualified and experienced staff providing those services to children. The children, through child development, are being monitored as well. That's had an obvious and very visual impact on children being able to interact with their peer group and be in their local community…and they probably wouldn't have access to those kinds without the service provision so I think the impact, although I'm saying it's difficult to measure confidence and self-esteem, I think you can safely say that for some people their confidence and self-esteem has been built up'.

Positive impact of Sure Start Scotland services on children/families

There were a large number of positive impacts of Sure Start services on children and their families reported by the Sure Start Contact Officers during the interviews. However, these should be understood as subjective assessments although based on experience often at service delivery level. As noted by some of the respondents, objective measures and assessment of longer term impact are not often collected, although qualitative evidence through case examples and case studies and smaller service level evaluations are available. The reported impacts mentioned in the interviews can be summarised within the following areas:

Reported positive impacts on children

• Improved health
• Improved oral health
• Healthy eating/improved diet
• Improved social and emotional well-being of children
• Children safe and well cared for
• Improved capacity to learn and develop socially/improved child development
• Early literacy of children
• Improved resilience

Positive impacts on parents

• Improved self-confidence for parents
• Improved self-esteem
• Gain more skills and knowledge
• Improved parenting skills/better understanding of child's development

Positive impacts on both parents and children

• Relieving stress on families
• More social contact/families less isolated
• Education for children and parents
• Allows parents to work
• Child and adult literacy improved
• Improving parent-child bonding/interaction
• Overall well-being of families improved

Other positive impacts

• Raising awareness of health
• Able to identify children with additional support needs and help them
• Prompt assessment of need/risk
• Support and help for specific groups: breastfeeding, young parents, post-natal depression
• Prevent need for child protection due to support from services
• Home to nursery transition more manageable and improved
• Improved transition from nursery to school
• Increased access to local provision, services easier to access
• Early intervention

In order to provide illustrations of how families have been helped by Sure Start Scotland, each Sure Start Contact Officer was asked to provide an anonymous case example, usually in the questionnaire but occasionally during the telephone interview. Almost all were able to do so. The selection provided below demonstrates the range of ways in which families are supported, from short term to longer term interventions. In order to further protect confidentiality, the local authorities are not named and other identifying features have been removed or slightly altered.

The first example shows the success of a short term intervention:

This is an example of a simple but effective piece of work. A mother with two boys (5, 2) self-referred. There were no problems with the eldest but the youngest had behavioural difficulties. Mother was unsupported due to partner working away; there is not a family network to help out. In this family there are no problems with poverty, very bright and able parent, just huge problems with this second child. The worker spent a morning in the park with the mother and the child. Mother thought there was something wrong with the child and was very relieved when the worker gave reassurance. Having that discussion with the mother, and giving advice about making boundaries etc, the worker then returned a month later and things were a lot better partly because the mother had been reassured. That was the limit of the piece of work. That could have escalated into something quite difficult by the time the child reached P1, so that was a very successful simple piece of work.

The second example, from the same respondent, is of a more long term piece of work and demonstrates not just how the mother and child were helped but that there were wider spin offs in terms of the playgroup and therefore the support it might provide other children in the future:

In this second example, a 3 year old (only child) had just started playgroup and had been excluded within 2 weeks. The mother was desperate and didn't know what to do with this child. A worker became involved and talked about techniques (how to manage the child) with the mother and then with the playgroup. The worker became the vehicle because it had completely broken down between the mother, the other parents and the playgroup. This assisted the child to come back into the playgroup with everybody using the same behaviour management techniques. It was also clear there were very likely other issues around. The mother agreed to referral so there could be a joint assessment with health. That was a successful piece of work because that child has now got an early assessment not just in terms of his school needs but his family have got help about how to manage him at home, and there's a very positive link now between the playgroup and the parents. Also the playgroup feels more confident about managing such children in the future so they've learned that you don't just exclude, you try different sorts of techniques, and also there are people that you can talk to…so the playgroup have come on. Lots and lots of positives in that.

The third example is of a complex case and shows how the extended family are also brought into the integrated package of care:

This case is of a drug user aged 17 years with a young baby. The grandmother helps support her but finds it very difficult to cope. The centre provides a place for the baby and works with the mum and grandmother and the addiction services. Social work and health have a very high input to this family but the centre brings all these services together to save duplicating the records and discussions. Family support workers provide appropriate discussions and training to help this family meet the needs of the baby and the mum is going into rehab for two weeks. The grandmother will then have time to attend stress management classes in the centre and meet other adults in similar situations who attend a support group. Before this input, this baby was about to be taken into care and now there is hope that things will turn out all right for their future as a family unit.

The fourth example shows how identifying need early can lead to appropriate support prior to attendance at primary school:

A primary school discovered one of its pupils had a young sibling at home who was not attending any nursery provision. A referral was made to the Homelink Worker who contacted the family and arranged a home visit. Both transport and isolation were problems so the Homelink Worker helped arrange assistance with transport and also contacted Home Start. The child now attends nursery on a regular basis, a volunteer from Home Start visits weekly and the family has been able to access other community activities e.g. a playgroup. This is a very typical example of support.

CASE STUDY: Service Users' Views

In order to obtain a richer picture of the felt impact of Sure Start Scotland, a small sample of service providers were interviewed over the telephone as part of the Case Study component of this mapping exercise. These examples show the range of services used and how they helped the family.

The service providers participating in the study were asked if they would recruit a few parents who had used a Sure Start service into the study to provide some information on parents' views. Information sheets and consent forms were sent to the service provider for distribution. The parent was then able to return the consent form directly to the CRFR team in the supplied stamped addressed envelope. Seven replies were received. Short telephone interviews were conducted with four mothers (two could not be contacted on the number provided and one subsequently did not wish to be interviewed) and verbatim notes taken. The interview covered basic demographic information; a discussion of the service or services used for their young child; what they thought of the service; whether they had suggestions for changes or improvements and whether there were additional services or supports that they would like to be able to use.

All service users were very positive about their involvement in Sure Start Services. Different services had been accessed: Sure Start groups, family centre, parent and toddlers, childminder and young mothers' group. One mother with a child with special needs describes the Sure Start group she attended as 'fantastic' and the leader as a 'ray of light'. This mother said that it took her a few months before she felt able to access services and this and other groups were suggested to her by the local community nurses. This was one of a few services she used, such that her child was involved in both mainstream and special provision. When describing benefits to her child, she said that she could see impact on speech, ability to learn from other children and also growing independence. From her own perspective, the Sure Start group and classes at the family centre (supported by crèche facilities) give her confidence; she made friends and found others with similar problems. She felt the impact extended to the whole family. When asked about improvements, this mother felt that more could be done to pass on information. She also felt other services in the area (not Sure Start) needed to be more responsive to children with special needs.

Another mother who used a Sure Start group for her daughter from aged 10 months to 3-4 years, said that she heard about the group from her health visitor and that is sounded fun, that the timing was good (morning) and it was nearby. Although the group includes children up to age 5, most stop going once they start nursery. She liked the structure of the group as the children know exactly what they are going to do and when, in a routine moving from one activity to another. In terms of the impact on her daughter she said 'she can get messy without being shouted at', but also that she learns to share and begins to help with the younger ones. For herself she said that she benefits from talking to other mothers (very few fathers go) and that although it can be a bit daunting at first, it is 'fantastic'. She said you can ask advice and 'you don't have to clean up!' She also praised the group leader and that she would miss the group once her daughter stops going. When asked about improvements she felt the area could do more for older children.

The story of the third respondent in this case study shows how Sure Start can support a parent to develop and move into work. This mother used a Sure Start parent and toddler group with her young daughter. Since she was new to the area she didn't know anybody. A neighbour told her about the group - there is good word of mouth in the area and also a newsletter detailing services. She and her daughter loved it, and she continued to use the group in the morning (once a week) even when her daughter started nursery. She talked about how the service grew and that Sure Start and community education worked together to provide locally based courses and crèches. This respondent has gone on to part-time work as a result and has also been involved in service development. As with the other respondents, this mother describes the impact on the child as supporting social development, helping the transition to nursery and encouraging children to play together. When asked about possible improvements, she said that the physical state of the premises needed to be upgraded.

The fourth respondent provided information on services used by her teenage daughter who has a young child. Sure Start provided support to this family by funding a child minder; this enabled the young mother to continue her education and the respondent to continue to work - 'a godsend' was how the respondent described it. A Sure Start group for young mums provided support and confidence around the birth and breastfeeding and enabled the young mother to meet others. The family found out about the service through a leaflet at a local hospital. The respondent was 'full of praise' for the help. Her only concern was over continuity of provision once her daughter left school and went to college.

All the service users in this small case study were full of praise for the Sure Start services they had accessed. It is clear that the provision impacted positively on themselves and their young child, and also the whole family. From the perspective of these respondents, the Sure Start objectives were being met. There were small areas of improvement mentioned: ensuring people know about the service and an improvement to premises and continuity.

Negative impacts of Sure Start Scotland services on children and families

In addition to asking about positive impacts, the questionnaire also asked about any negative effects of Sure Start Scotland on children and families. The vast majority of Sure Start Contact Officers reported that there were no negative effects; indeed, as Chapter 6 outlines, the response to Sure Start was overwhelmingly positive. However, a few issues were mentioned in this context:

• A concern that demand for services outweighs supply
• Support may not continue across the transition to primary school
• Expectations may be raised that cannot be delivered in terms of support beyond age 3-5
• A limited amount of anecdotal concerns about continued dependence on support services within a few families remaining with services for a number of years
• A concern that services are well-coordinated to ensure that support does not become intrusive
• Issues of prioritising families with highest need with lower-need families not necessarily having their needs met, thus limiting scope for preventative work

Stigmatisation is thought to be avoided through mainstream and universal services:

'Research on Sure Start in England suggests that some families in England feel stigmatised and reluctant to become involved. The approach taken in this Local authority to add onto mainstream services appears to have avoided this pitfall'.

Involvement of service users in the planning and delivery of services

The interviews with the key planners, the Sure Start Contact Officer questionnaire and interview, all asked questions about the involvement of services users, particularly parents, in the planning and delivery of services. For almost all local authorities, parents had involvement in these processes, although the nature of such involvement varied as did the degree to which this was formalised and embedded into planning structures.

The planner questionnaire asked how the Local authority consults with and involves service users in the planning and delivery of services; whether the consultations were planned (ad hoc or coordinated) and how frequently and at what stages consultation happened. It then went on to ask whether planners thought this pattern of consultation would change and develop over the next three years. The Sure Start Contact Officers also expressed their views about the planning and service delivery process. All local authorities made some response to these issues; however, answers should be seen as indicative rather than comprehensive. The detail of response varied considerably across respondents, some supplying one or two examples whereas others spoke of up to ten examples of involving service users in planning in some way.

The majority of local authorities indicated that the most important and frequent type of involvement and gathering service user views came direct from frontline services and from consultations:

'Service users contribute to the planning process and the "shape" of services by the feedback obtained in individual reviews of the integrated package of care, by feedback and suggestions when the groups are evaluated and by comments made by parents at the time of the 4/6 month follow-up that occurs following closure of the case'.

Such feedback is gathered by practitioners, continuous user feedback augmented by group discussion and informal chat, feedback sheets, service entry and exit questionnaires and other questionnaires. A few local authorities had initiated consultation with more vocal young children. One respondent commented that strong user feedback came through the process of self referral/selection for a project. Another noted that users commented on an individual project plan. In another a user pressure group had been formed at a local centre. Many Sure Start Contact Officers reported the routine ways in which service users are consulted and involved in services, through feedback through the practitioner, as the following example suggests in answer to a question on the extent to which service users are involved in the planning process:

'This would vary between projects. Community based projects in particular are very skilled in user involvement. More specialist services would develop services in response to user feedback'.

In some cases the Sure Start Contact Officer him or herself was directly involved in obtaining feedback on services and feeding this in, as the following example illustrates:

'I think on a very local basis we get people, when they've received a service, to have some sort of feedback at the end and that is fed back and collated. I also attend lots of user groups and I'm very open to people - the one thing I do like is people being very creative and thinking through and everything, but I'm very keen to just ask people and I enjoy the process of actually talking with people 'well if we did it like this/that' and that sort of dialogue…and we have changed things very positively with the involvement of users'.

Others talked of some of the difficulties in involving vulnerable parents:

'I think where there are very vulnerable service users, it's quite difficult to get them involved in the delivery of that service but what we try and do is consult with them and check out what is appropriate'.

A few respondents expressed doubts as to the efficacy of having users involved in planning groups, feeling that their experience indicated users were only able to represent themselves rather than the wider group and that therefore it was more important to get feedback from users at the local service level rather than the planning level. Three local authorities spoke of disseminating planning information and user views via the Web, a Sure Start Bulletin or a newsletter.

The majority of local authorities said that parents are actively involved in service delivery through community-based groups, parents groups, parent and toddler groups, helping in crèches and nurseries, helping deliver parenting programmes, parent workshops, parent support groups and other groups. Parents are involved as volunteers in many services; they may also bring about new service developments.

Although local authorities were involving service users in a range of ways in the planning and delivery of services, many also noted that this was an area for improvement:

'So a lot of parent involvement, but I don't ever feel complacent about that'.

'I think we do consult and there's going to be an ongoing piece of work with …University. I don't know if we ever do it enough. But it's also doing it in a way that's not patronising'.

'We use questionnaires, group meetings, review panels, informal discussions, research to inform our planning process'.

Several local authorities said they were always reviewing their methods of consultation and a few said they needed to be more strategic and systematic in what they did. Developments in infrastructure would help for example, guidance from the Integrated Early Years Strategy, employing someone in a research role and guidance on how to consult young children. A few said that they would welcome the development of a national network to share good practice. The example below shows the range of consultation methods being used within Stirling:

We use a large range of methods for consulting with parents - parent groups, parent forums, groups of parents coming together and contributing to dialogue about a service, parents built into planning process. With children - we have done innovative work on how to gather views of young children, age groups 3 and 4 year olds focused on for consultation. For example, have one to one or group discussion, what they like, what they don't like in nursery and use this to build a picture to influence practice. The need for more outdoor play was identified by children in one consultation so now this is a cross service strategy and has been implemented; there is outdoor play each day with appropriate clothing. With very young children the workers observe what children seem to be enjoying.

Local authorities plan to start or continue developments under existing or forthcoming formal arrangements: Children's Services planning; Regeneration agreements; Education Service improvement plan; greater use of the Childcare Information Service; following the Child Protection Inspection; under consultation jointly with health, under Hall 4. Users were reported as being involved in formal planning structures and consultation events for: Community Planning; citizen's panel; Children's Service Planning; theme groups; Childcare Partnerships; Best Value and Service Review; inspections (integrated, HMI/Care Commission, child protection); specialist officers - Children's Participation officer and Children's Rights Officer.

There were queries about feeding back joint consultations, on how consistent the Care Commission is and how to bring the new Birth-3 initiative alongside Sure Start. One local authority mentioned the possibility of developing eGovernment resources. There was mention of the difficulties of conflict resolution in difficult local communities, how consultation is made difficult by rural geography and how it was important that people were not over consulted.

Evaluation and monitoring

Some respondents spoke of more formal evaluation of projects using: interviews with parents; focus groups through services; ongoing evaluation at the project level and regular monitoring at local community level. A few spoke of conducting ad-hoc evaluations as required or in advance of a new service development. The majority of local authorities described various aspects of formal consultations they were carrying out: telephone interviews; questionnaires; focus groups and meetings; local forums; using external consultants. A number of issues were raised by respondents about monitoring and evaluation, with some in the process of developing specific frameworks or commissioning external evaluations. Many pointed out that local projects often evaluated their own work, but that there was a need for monitoring and evaluation to be further developed:

'There is no overall evaluation of the complete range of projects. A couple of projects have been funded to undertake independent evaluations'.

'We are reviewing monitoring and evaluation to build it in from the start'.

'We would welcome dialogue about evaluation'.

A variety of procedures for monitoring and evaluation are in use in local authorities and some were developing more robust approaches:

'We've got a reasonably robust monitoring and evaluating framework for projects funded who are in the voluntary sector, and there's a person in post who deals with that but the issue is around where the funds have gone elsewhere, i.e. to education or anywhere within the Local authority. So Sure Start itself as a whole has not been monitored, just bits of it through the monitoring and evaluation frameworks for the voluntary sector, and that's reasonably robust and has been strengthened over the last few years' .

The following are examples of procedures and approaches that were mentioned during the interviews or in questionnaire responses:

Frameworks/evaluation tools

• LEAP 'Learning Evaluation Planning' framework or other frameworks
• Monitoring through Council's 'Following the Public Pound' processes and contract compliance monitoring
• Self-evaluation tool, 'Child at the Centre'
• Commissioning of a Best Value review
• Reporting framework for community nurseries
• Single Case Evaluation

Visits/Inspections

• External organisational review
• Care Commission/ HMIE inspections
• Review days

• Visits to services

Production of reports

• Annual reports produced by teams
• Services produce reports detailing work and evaluation, presented at Childcare Partnership or other strategic meetings
• Annual Standards and Quality Report produced
• Children's Services Plan

Other

• Standard weekly evaluation process/forms and at end of service for service users
• Service level agreements
• Twice yearly reviews of service
• Annual monitoring and review of external services
• Local forum input into the development of children's services
• Internal evaluation carried out through Sure Start steering group or by other groups, such as Sure Start type teams

• A working group to pull together the different methods of monitoring and evaluation in services and develop a more standardised approach

• Managers/providers identify needs of the community and engage with it

Some local authorities have commissioned evaluations of services to be carried out or have carried out their own evaluations of service, including for example:

• Fife: East Fife Women's Aid Children and Young People's Service Evaluation
• Shetland: 'Fife and Mossbank Family Centre' Health Impact Assessment and research on the 'Bruce Family Centre' parent and staff views
• Highland: Evaluation of NCH Sure Start projects in Lochaber, Alness and Merkinch and Family First Evaluation
• Dundee City: Celebrating Sure Start in Dundee. An evaluation of all Sure Start services in the Local authority
• West Lothian: Family Support Worker Evaluation
• Aberdeen City: Travellers' Project Evaluation
• Glasgow: currently auditing Family Learning Centres (using Changing Children's Services Fund)
• Edinburgh: has developed a new framework for monitoring and evaluation

Summary and Conclusion

Local authorities, through the key planner and/or Sure Start Contact Officer, reported an overall increase in the reach of Sure Start Scotland, in terms of vulnerable and hard to reach families but also an overall increase in numbers of families supported. In addition to positive reports about uptake of a greater diversity of services, respondents also suggested a range of impacts on families. Some local authorities have been involved in formal evaluations of at least some of their Sure Start services, and most conduct some kind of monitoring as part of their service development. However, there is no overarching framework for monitoring and evaluation and no consistent approach to measuring success. Nonetheless, reported impacts, often derived from service providers' observations and user views (through questionnaires, discussions and involvement in service delivery) suggest improvements in the quality of life of parents and their very young children. Examples of cases provided by Sure Start Contact Officers, and a small number of interviews conducted with parents as part of this mapping exercise, illustrate the range of ways in which Sure Start services are perceived to impact on families. Improvements in parenting, in children's behaviour, in parents' self confidence and increased access to services all suggest that Sure Start Scotland is reaching vulnerable families and is felt to make a difference there. In summary:

• Local authorities report increased uptake of services and increased reach towards the most vulnerable.
• Local authorities have a range of ways of consulting parents and involving them in the planning and delivery of services, although there is diversity across Scotland.
• Many local authorities would like further guidance on issues relating to monitoring and evaluation, although some were developing frameworks themselves and also commissioning specific evaluations.
• Many local authorities would like to improve on their consultation methods.
• Evidence for the impact of Sure Start Scotland relates to case examples, where perceived and felt impact suggest improvements in parental self confidence and child behaviour alongside access to services.

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