Evidence Briefing - Early Years and Early Intervention

Descriptionevidence briefing - early years and early intervention
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Website Publication DateJune 02, 2008

EARLY YEARS FRAMEWORK - EVIDENCE BRIEFING


INTRODUCTION

1.1 This paper introduces the four thematic briefing papers provided for the Early Years Framework task groups. This introduction paper does not attempt to draw together the findings across the thematic papers rather it is intended to provide some considerations to bear in mind when interpreting the evidence.

1.2 The thematic papers draw together much of the seminal evidence and information in a way that should allow the task groups to progress their thinking on an evidential basis The papers have been produced on a thematic basis based upon the work of the task groups;

· Parenting

· Services

· Community

· Workforce

1.3 However, the integrated nature of much of the task groups' work and the related evidence means that each paper will contain some evidence applicable to all four task groups, therefore it will be important for members to look more broadly than their own theme. Where possible each paper also attempts to signpost areas of relevance in other papers.

1.4 The papers have been brought together by Scottish Government analysts and should provide a solid evidential foundation for the task groups but should be read within the following context.

Evidence Context

2.1 The papers are intended as a starting point for the work and discussion of the task groups. They have been produced in a compressed timescale and are unlikely to be fully comprehensive. The analysts have attempted to include the seminal papers on each subject and also to quality assure the evidence as it has been incorporated although this may not always have been possible within the time constraints.

Evidence Gaps

2.2 In writing the papers it became apparent that there are evidence gaps in a number of areas. In reading the papers it would be helpful to recognise that these gaps could appear for one of two reasons. Either, the gap exists in the paper because the time constraints meant that the evidence was overlooked or unable to be incorporated. Alternatively, the gap may exist because there genuinely may be an evidence gap on the subject. i.e. no research has been undertaken on the subject, and the authors have attempted to highlight where this is the case.

2.3 Where the gap exists due to time constraints, it may be possible that there is scope to explore the area further as the work of the groups progress.

Costs and Outcomes in Children's Social Services

2.4 In the many areas, there are often technical problems with measuring [costs and] outcomes and this can be reflected in the quality of research. Research published in 2007 [1] by the then Department for Education and Skills covers this issue specifically in relation to children's services and the following bullets attempt to capture the main findings:

· Attribution

Children, particularly younger children, are in receipt of so many different services simultaneously, formal and informal, that it is often impossible to attribute which services have contributed to the outcome.

· Counterfactual

For moral and ethical reasons that prevent the use of control groups and other comparison methods, it is often impossible to tell what would have happened in the absence of a service or intervention. i.e. the outcome may have been achieved in the absence of any intervention.

  • Personal Judgements

Outcomes for children's services tend to relate to subjective rather than objective measures that, by definition, are subject to personal judgements that may vary between professionals and also between professionals and service recipients.

  • Preventative Services

It is particularly difficult to establish outcomes derived from preventative services because it is impossible to establish something that didn't happen.

These issues are extremely complex to overcome but should be borne in mind.

Integration and Cost Effectiveness

2.5 It is quite common for the papers to cite evidence supporting the case for integrated services, particularly the paper on integrated services itself. However, the integrated services paper also highlights evidence that there is a lack of robust evidence demonstrating positive outcomes for children from integration.

2.6 A secondary consideration in this area is that evidence on the benefits of integration tends to focus on relatively small scale targeted interventions where integration may be more feasible. Integration can be costly to implement and is far from a panacea. Given the unproven links to outcomes and problems of attribution highlighted previously, integration can potentially lead to services that are not cost effective.

i.e. Even where an integrated service is delivering good outcomes, it is often extremely difficult to establish which components are working and which aren't. Where this situation exists it is impossible to identify, and therefore withdraw, failing or nonessential services so there is a tendency towards overprovision which is costly and inefficient.

2.7 It will also be worth acknowledging that there may be increasing marginal costs for integration such that large scale integration, such as that required for universal provision, actually ceases to be cost effective.

Transferability of Findings

2.8 Where possible, the papers reflect Scottish evidence but in many cases such evidence does not exist so the hierarchy becomes Scottish evidence, UK evidence and finally evidence from elsewhere. Regardless of source of the evidence, whether the findings are universally applicable remains something of a leap of faith. For example, it may be questionable whether robust findings from the US or Scandinavia are applicable in a Scottish setting. Equally, robust Scottish evidence may not be valid across geographic or socio-economic boundaries. i.e. findings from the central belt may not be appropriate in the islands and equally national evidence may not be suitable for minority groups.

Summary

3.1 This introduction is not intended to detract from the evidence contained within the four thematic papers that follow. There is a broad evidence base to support the development of the Early Years Framework and that should not be ignored. However, for varying reasons the evidence does not provide all the answers nor even touch upon all of the pertinent questions and task group members would be encouraged to bear some of these considerations in mind when deliberating over the evidence.

BUILDING PARENTING AND FAMILY CAPACITY

Introduction

This paper provides a review of the evidence base relating to parenting and family capacity covering the importance of parental behaviour on children's outcomes, both prior to birth and afterwards, risk factors for children and young people, effective parenting and effective interventions to support parental and family development. The paper has been divided into the three sections:

  • The Importance of Parenting
  • Identifying Children and Young People at Risk throughout the life-cycle
  • Effective Parenting Interventions amongst potential high risk groups.

Key Findings

  • Parenting has a critical impact on children's emotional, behavioural and educational development, and their health and wellbeing.
  • Warm, authoritative and responsive parenting has been found to be crucial for positive outcomes and in building resilience to adversity in children.
  • Parenting can be important in preventing negative outcomes for children in a range of areas including delinquency, crime and anti-social behaviour. However, predicting outcomes is very difficult as not all children exhibiting multiple risk factors go on to demonstrate negative behaviour.
  • There is no clear cut causal link between poverty and quality of parenting and effective parenting can counteract the adversities children face growing up in poverty.
  • High risk behaviour during pregnancy such as substance misuse, domestic abuse, smoking as well as diet and maternal nutrition impact on a child's subsequent health and development outcomes. There is also a strong link between antenatal anxiety and children's behavioural problems.
  • Breast feeding is known to confer multiple benefits to both mother and child but the UK (including Scotland) has one of the lowest rates of breastfeeding worldwide particularly among disadvantaged families.
  • Multi-faceted interventions appear to be most effective in supporting breastfeeding especially if they span the ante and postnatal period and draw on repeated contacts with professionals and or peer educators.
  • Effectively engaging parents is the first step in addressing problems yet parents most in need of family support services are often the least likely to access them.
  • A combination of both targeted and universal interventions/programmes, resulting in a continuum of support is likely to be most effective and cost effective in supporting parents.
  • Minimum levels of intervention and voluntary rather than compulsory approaches are generally favoured.
  • There are many parenting interventions/ programmes operating in different countries that have been found to be effective in improving outcomes for children later in life. These include intensive home visiting programmes, parent training/parenting skills programmes, cognitive/knowledge development programmes and programmes to tackle mental health amongst parents.
  • Care should be taken in assuming that these interventions will have the same outcomes in Scotland where a different set of social circumstances prevail.
  • The effects of programmes are not universal and the most disadvantaged families are least likely to benefit as they are least likely to become or remain engaged.

The Importance of Parenting

1.1 There is no doubt that childhood experiences lay the foundations for later life. Parenting has a critical impact on children's emotional, behavioural and educational development, and their health and wellbeing. Approaches to parenting can be key in ensuring positive outcomes for children as well as preventing a range of problems in young people [2]. Moreover, research has shown that open, flexible, interactive, communicative approaches to parenting will enable children to do well, regardless of mitigating circumstances such as poverty or deprivation.

1.2 A recent review of research evidence [3] demonstrates that the quality of parent-child relationships is significantly associated with:

  • Learning skills and educational achievement
  • Social competence and peer relationships
  • Children's views of themselves and sense of self-worth
  • Aggressive 'externalising' behaviour and delinquency
  • Depression, anxiety and other 'internalising' problems
  • High risk health behaviours (such as smoking, substance use, risky sexual behaviour, obesity)

Risk Factors and Resilience

1.3 Poor parental supervision, harsh and inconsistent discipline, parental conflicts and rejection, disrupted homes and parental separation and criminality in the family have been shown to be important predictors of behavioural and emotional problems including delinquency, offending, poor school attainment and relationships with peers [4]. Family structure seems less important than factors such as parenting style, family controls, relationships and activities. There is a strong association between delinquency and lower levels of parental supervision in managing day-to-day routines, friendships, use of money, bedtime, and behaviour [5].

1.4 Many studies have noted that problem behaviour often starts at an early age with a combination of temperamentally difficult toddlers and inexperienced or vulnerable parents, which can lead to a downward spiral toward early onset of problem behaviour where poor monitoring and discipline can inadvertently reinforce pre-school childhood difficulties [6].

1.5 Early criminal or anti social behaviour can be an indicator of more serious, violent and persistent offending later and this underlines the importance of parenting, family and school factors [7].

1.6 Three major risk factors associated with antisocial behaviour can become observable during primary school years including persistent physically aggressive behaviour, fighting and bullying [8], poor academic achievement and academic failure [9] and low commitment to school. Limitations in pro-social skills mean vulnerable children often do not mix well, are unpopular, withdrawn, isolated and rejected by other children. This, in turn, can result in their leaning towards the company of similarly isolated and potentially antisocial peers.

1.7 However, it is not possible to predict which vulnerable children will go on to demonstrate problems. Not all children and young people exposed to multiple risk factors become offenders. The majority of subjects demonstrating key risk factors do not go on to demonstrate aberrant characteristics.

Resilience/ Overcoming risk/ Protective Factors

1.8 Research has indicated that there are important factors in a child's life that can protect them against risk. Resilience has been defined in the literature as resulting from an individual constellation of characteristics and capabilities or personal processes that mitigate the impact of biological, psychological and social factors that threaten a child's health [10].

1.9 Rutter et al [11] identify eight "protective mechanisms" that promote favoured outcomes (for example, reducing the potential for risk factors to impact on a child, reducing negative chain reactions so that family strife does not lead to family breakdown, promoting self efficacy and self esteem etc). The most important influences in a child's life in developing resilience are concluded to be members of extended families, informal networks and positive peer association.

1.10 Warm, authoritative and responsive parenting has been found to be crucial in building resilience. Parents who develop open, participative communication, problem-centred coping and flexibility tend to manage stress well and help their families to do the same. Schools and community factors can also play a central role in promoting resilience. Additionally, differences in child temperament, among other things demonstrate that flexible, adaptable parenting is more likely to be effective than a "one size fits all" approach [12].

1.11 The research on risk factors therefore emphasises the need to balance knowledge about all the influences in a child's life and account for individual circumstances.

Child Poverty

1.12 One major issue impacting on quality of the childhood experience is that of child poverty. Child poverty has fallen markedly over the past decade, but 210,000 children in Scotland still live below the poverty threshold (21% of all children). Thirteen per cent of children in Scotland live in combined low income and material deprivation [13].

1.13 Lone parents are more likely to be unemployed or economically inactive than parents in general. In Scotland, 43.5% of lone parents are unemployed or economically inactive compared with 20.2% of parents in general [14].

1.14 Children who grow up in poor households are more likely to have low self-esteem, play truant, leave home earlier, leave school earlier and with fewer qualifications, and be economically inactive as adults [15]. Consequently, children born into poor families are more likely to be poor adults [16].

1.15 Although children are less likely to be in poverty if they live with a working adult (just 13 % of children in working households are in poverty), just over half of all children living in poverty live in working households [17]. Work can fail to lift families out of poverty if that work is low paid, part-time or temporary.

1.16 Children who experience poverty may lack many of the experiences and opportunities that others take for granted and can be exposed to severe hardship, deprivation and the negative effects of inequality and exclusion. Growing up in poverty can damage physical, cognitive, social and emotional development which are determinants of outcomes in adult life.

1.17 Experiencing poverty can impact on a child's educational opportunities. Poor children tend to have lower educational attainment and poorer health. These reduce productivity within the population which in turn reduces economic growth and limits the UK's ability to compete globally.

1.18 However, there is no clear cut causal link between poverty and quality of parenting. It is likely that different individuals respond in different ways to financial hardship. Factors such as family structure, neighbourhood and social support interact with parents' temperaments, beliefs and their own experiences of parenting [18].

1.19 There is evidence to indicate that good parenting can mitigate the disadvantages of growing up in a low income household or deprived neighbourhood [19]. Many parents living in poverty possess adequate parenting capacity and manage to deal effectively with adversity. The evidence that lifting families out of poverty improves outcomes for children is not particularly strong and the belief that tackling material deprivation through welfare to work, benefit increases or other programmes will inevitably lead to improved parenting is not well supported. Parents living in poverty should not therefore be treated as a distinct group simply because they are materially disadvantaged [20].

1.20 However, poverty can contribute to parental stress, depression and ability leading to disrupted parenting and it is this rather than poverty alone that may result in poorer long-term outcomes for children [21]. State support can therefore play a crucial role in helping families overcome these problems. The governments of the UK are committed to ending child poverty and have introduced many measures to tackle the problem.

Identifying Children and Young People at Risk Throughout the Life Cycle

Identifying risk before birth

2.1 Maternal and parental behaviour during pregnancy is known to impact on a child's outcomes. High risk behaviour such as substance misuse, domestic abuse, smoking as well as diet and maternal nutrition impact on a child's subsequent health and development outcomes. There is also a strong link between antenatal anxiety and maternal depression, and poor outcomes for children including development, parental bonding and behavioural problems [22].

2.1 The most promising services for pregnant women are therefore those offering high-quality social support alongside antenatal medical care.

2.3 Data from survey and other sources usefully demonstrates characteristics of the Scottish population and reveals some differences according to levels of deprivation and age.

Maternal health during pregnancy

2.4 Data from the Growing Up in Scotland (GUS) Survey shows that just over a third of mothers (37%) experienced pregnancy-related ill-health requiring medical attention or treatment - most commonly relating to raised blood pressure, bleeding or threatened miscarriage or persistent vomiting. While there were no significant variations in health problems on the basis of socio economic grouping, positive self-assessments of health during pregnancy were more likely among older, financially better off and better educated mothers. [23]

Nutrition during pregnancy

2.5 A rapid evidence review by NHS Health Scotland [24] indicates that the diets of pregnant women in the UK are inadequate. The review discusses the benefits of improving maternal nutrition for foetal development, avoidance of certain birth defects and the later heath of offspring. Providing advice and information alone is not enough to change dietary behaviour; the more intensive and direct the intervention the greater the chance of improving nutrition.

Smoking during pregnancy

2.6 Smoking tobacco during pregnancy is one of the most important risk factors to foetal growth and development [25]. There is also growing evidence of a link between maternal smoking during pregnancy and later behavioural problems. The number of mothers smoking remains substantial and is significantly associated with socio-economic disadvantage. GUS data reveals that around one in four mothers said that they smoked during their pregnancy and that mothers living in more deprived areas were more likely to have smoked during their pregnancy. Four in ten (42%) mothers living in the most deprived quintile reported smoking during pregnancy, compared with 9% in the least deprived quintile. Infants from the most deprived quintile are also more likely to be exposed to smoking in their homes [26].

2.7 Evidence shows that multi-faceted initiatives to promote smoking cessation are more effective than single services. Advice and support tailored for pregnant women is of limited impact and may not reach or be acceptable to those at highest risk [27].

Alcohol use during pregnancy

2.8 Alcohol consumption during pregnancy can also have a negative impact on foetal development. GUS data shows that around three-quarters of mothers did not drink alcohol at all during their pregnancy. Those that did largely said that they drank less often than once a month. Lone parents, younger mothers, and those living in deprived areas were less likely to have drunk alcohol while pregnant, than mothers in couple families, older mothers and those living in less deprived areas.

Drug use

2.9 GUS data shows that around one quarter of all parents (26%) said that they had ever taken illicit drugs, and about one in 20 (4.7%) said that they had used drugs in the previous 12 months. The vast majority of drug use was accounted for by cannabis use.

2.10 The evidence above emphases a particular need for interventions to improve nutrition and reduce smoking.

High risk groups

2.11 Sweep 1 of GUS asked a series of questions relating to pregnancy, child birth and the first few months which is useful in identifying high risk groups during the pre-natal period that may benefit from additional support. The evidence listed below indicate that high risk groups during the ante and neo-natal period are parents under the age of 20, lone parents and those in the lowest income quartile.

2.12 In terms of whether the pregnancy was planned, unplanned or not prevented, there were striking variations in the patterns of responses by age of mother, family type and by income.

2.13 Figure 1 below shows that pregnancy was more likely to be planned amongst older mothers. Mothers under 20 had the highest rates of unplanned pregnancy (61.8%).

Fig 1: Whether pregnancy was planned by age of mother at birth of cohort child

2.14 Figure 2 below shows that lone parents and parents in the lowest income quartile were less likely to have planned their pregnancy compared with parents in a relationship and in the highest income quartile. Thus, 22.5% of pregnancies amongst lone parents were planned compared with nearly 70% amongst those in a relationship. Conversely, 58.1% of pregnancies amongst lone parents were unplanned compared with 14.7% amongst couples. 78.5% of pregnancies amongst parents in the highest income quartile were planned compared with 33.5% in the lowest income quartile. Only 8% of pregnancies were unplanned amongst parents in the highest income quartile compared with 44.5% amongst parents in the lowest income quartile.

Fig 2: Whether pregnancy was planned by family type and household income quartile

2.15 Mothers whose pregnancy was not planned at all were much more likely than other mothers to say that they had been unhappy when they first found out about the prospect of having a baby - 9% felt very unhappy, 12% were fairly unhappy and a further 27% were neither happy or unhappy.

Engagement in antenatal classes and sources of advice

2.16 A key issue is the degree to which parents living in disadvantaged areas are able to access the support that is available and whether they feel it meets their needs. GUS data reveals that there is marked variation by socio-economic group and by maternal age at birth in attendance at antenatal classes. Around two-thirds of mothers aged under 20 did not attend any classes while three-quarters of those aged 30 to 39, by contrast, went to most or all.

2.17 The most common reason given by mothers for non-attendance was that they had attended for a previous pregnancy (48%) but mothers under the age of 20 (who were least likely to attend) were much more likely than other groups to say that they simply did not like classes/groups (28%) or that they did not know where there were any classes (14%).

2.18 Parents were asked about any other sources of help and advice they had drawn on during their pregnancy. Help was most often sought via personal contact, health professionals (GPs and health visitors) (90%) or from family and friends (69%). It should be noted that although educational/informational interventions can improve knowledge they are less likely to impact on behaviour or psychosocial well being [28].

Teenage pregnancy

2.19 The younger age of motherhood is associated with parental separation/divorce, exposure to violence, illicit drug use and low family income. [29] Teenage pregnancy is also associated with prenatal depression and anxiety. The early transition to motherhood also negatively impacts on adolescent relationships, antenatal health, educational attainment and later achievement resulting in benefit dependency and poverty [30].

2.20 Both teenage pregnancy and young motherhood are associated with socio-economic disadvantage. Women in socially deprived areas are less likely to use abortion than those in less deprived areas [31].

2.21 There is good evidence that school / community based sex education programme, education linked to contraceptive services, youth development programmes and family outreach programmes can be effective in averting pregnancy amongst teenagers. Educational support and improved job prospects and condom use campaigns are also effective [32].

Interventions during Pregnancy

2.22 One example of a successful intervention targeting low young, low income women during pregnancy is the Nurse Family Partnership (conducted and evaluated in the United States). This is a home visiting programme during pregnancy and in the period following birth (up to two years). Evidence from randomised control trials show a major impact on life outcomes for socioeconomically deprived mothers and their children eg lowered likelihood of children receiving health care for injuries during first two years of life, lower likelihood of severe behavioural problems at the age six follow up, amongst mothers there were fewer arrests and convictions, less time on welfare, fewer incidents of child abuse and neglect. [33]

Identifying Risk in the Neo-Natal phase

Breastfeeding, and information and support about breastfeeding

2.23 There is a large body of evidence to show that breast feeding confers multiple benefits to both mother and child and is an important factor in tackling health inequalities. However, the UK has one of the lowest rates of breastfeeding worldwide particularly among disadvantaged families. In Scotland mothers in deprived areas are less likely to breast feed, as are younger mothers. The target of 50% of mothers breastfeeding at 6-8 weeks (in place since 1994) has still not been reached. Consequently, there has been a renewed emphasis to promote breast feeding and in Scotland legislation has been passed to make it an offence to public breast feeding a right.

2.24 Older mothers, those in higher income households and with higher levels of educational qualifications are more likely to have intended to breastfeed or to have done so at all and to have still been breastfeeding at six months. Around 40% of mothers aged under 20 planned to breastfeed, compared to 71% of mothers aged 30 to 39. In areas of highest deprivation around 40% of children were breastfed, compared to 77% of children in the least deprived areas [34].

2.25 Of mothers who breastfeed, younger mothers, lone parents, mothers with lower educational qualifications and mothers living in the most deprived areas breastfeed for a shorter period of time. Less than 10% of mothers under the age of 20 who breastfeed do so beyond 6 months, compared to 40% of mothers aged 40 or older.

2.26 Evidence [35] also indicates that mothers who receive advice before birth and who attend antenatal classes are more likely to breastfeed and this finding is backed up by recent data from the GUS 2007 survey: 67% of women who received advice before the birth breastfed compared with 41% of mothers who did not receive any advice. These findings therefore support an information based approaches to promote breastfeeding.

2.27 Many reviews of initiatives to support breastfeeding exist and a useful summary is provided in Angela Hallam's paper [36]. Hallam concludes that multi-faceted interventions appear to be most effective in supporting breastfeeding especially if they span the ante and postnatal period and draw on repeated contacts with professionals and or peer educators. Other useful activities include educational and support programmes routinely delivered by health practitioners and peer supporters, changes to policy and practice to support and promote breastfeeding, clinical care to support mother-baby contact, peer or volunteer support for mothers in early postnatal period, support targeted at women on low incomes, one to one needs based education throughout the first year and local media programmes to target teenagers to improve attitudes to breastfeeding.

Effective parenting interventions amongst potential high risk groups

Engagement

3.1 Engagement and inclusion are particularly important for preventative services to be effective. However, parents most in need of family support services are often the least likely to access them. For example younger mothers and lone parents are less likely to attend parent support groups than older mothers and mothers from couple families [37].

3.2 Younger mothers and parents in lower income households are more wary of professional support or intervention than older mothers and those in couple families and less likely to voluntarily seek help and advice. Yet respondents in the former groups are also more likely to suggest that professionals do not offer enough parenting advice and support suggesting a degree of misunderstanding around the implications of that support. Lone parents and young mothers are less likely to have used other formal sources of advice such as books or telephone lines, and likely instead to seek advice from informal sources, particularly their own parents [38].

3.3 A further problem is that of lack of awareness of available services and interventions. Awareness of programmes such as Sure Start and Parentline is low amongst all parents regardless of their socio-economic level.

3.4 Evidence suggests that engagement can be improved by:

  • Accessible venues and times for service delivery
  • Trusting relationships between staff and users
  • A 'visible mix' of staff by age, gender and ethnicity
  • Involving parents in decision making
  • Overcoming prejudices concerning disabled parents, parents with learning difficulties and parents with poor mental health [39].

Early intervention

3.5 One of the main recommendations of the Kilbrandon Report (1964) [40] (which formed the basis of the Children's Hearing System) was of the value of early intervention to prevent the development of future problems. A growing body of evidence over the years supports this further, demonstrating both the effectiveness and cost-effectiveness of early intervention. [41] In particular, interventions delivered before the child reaches the age of 8 are most likely to reduce the likelihood of problematic behaviours continuing [42] and can produce measurable benefits in attainment at primary school stage, in behaviour by about 12 and in criminality and health (eg lower first pregnancy, lower drug use). [43]

3.6 This finding is supported by more recent studies such as the Seattle Social Development Project which has shown that intervening earlier in a child's life is a more effective and cost-effective approach than intervening at a later stage.

3.7 However it is important to note that while earlier intervention is effective, the effects should also be sustained over time through age-appropriate support. While early intervention does help to significantly reduce risk, it is not an "inoculation" against the development of later problems.

Targeted versus universal provision

3.8 Some research findings strongly advocate the targeting of resources towards socially disadvantaged, high risk children via high intensity interventions in which the majority of resources is concentrated on a small population. Targeted programmes have had documented success at the higher end of the risk spectrum. Such programmes are positively evaluated on the whole and there is some evidence to suggest that they are more effective and cost effective (see below).

3.9 Other literature however argues against focussed targeting and suggests that wider "public health" interventions are more cost effective in reducing problems [44]. Universal interventions are argued to be more successful in tackling common parental needs at the lower end of the risk spectrum [45].

Cost Effectiveness

3.10 In terms of the cost effectiveness of each approach, evidence is mixed. While early intervention as a general policy does not always represent good value for money, the evidence on investment in early years consistently shows a positive return on investment in the long term. Early intervention does not generally yield short-term cost benefits but accrues over the individual's life course [46]. Returns on investment are shown to be sharply declining as time goes on with rate of return in those under three years markedly higher than for primary school spending which in turn is higher than secondary schooling and later training.

3.11 Regarding work with families, the evidence base is much stronger for specialist programmes (usually targeted work with vulnerable families) rather than on universal family support services which promote general wellbeing - although the evaluated services appear to be both relatively low cost and very well-received [47].

3.12 In Scotland resources tend to be targeted on the basis of demonstrated need/risk rather than prevention [48].

3.13 A final consideration in relation to cost effectiveness is that the costs and benefits of early interventions fall to different agencies - for example some of the costs may fall to local authorities and health boards, while some of the benefits may accrue to police and the prison service.

Continuum of Support

3.14 It would appear therefore that a continuum of support from universal provision through to specialist targeted provision most effectively meets the needs of children and families at different ages and stages across the life course. A variety of different services and interventions are required to address the often very different needs of families and the multiple risk factors that impact on children's outcomes. [49]

3.15 The importance of 'pick up' mechanisms through health visiting practice, pre-school provision and at entry to primary school are indicated. These provide structural opportunities for preventive work or early years intervention to address disadvantage and difficulty without stigmatising children, and before antisocial behaviour consolidates through peer association and low school attainment at adolescence.

3.16 There are however ethical issues associated with targeting interventions. For example, The Kilbrandon Report drew attention to the importance of avoiding stigmatising children, young people and their families and stated that the minimum level of intervention should be used.

Compulsory intervention: Parenting Orders

3.17 This raises the issue of using compulsory measures to control parenting behaviour and identifies the tension between care and control, and the amount of interference that the state should have on private, family matters. The existing body of research literature on the use of compulsory measures is currently small but the evidence that is available shows that the highest drop out rates are amongst involuntary or court-ordered clients. [50] Clients are much less likely to become engaged in interventions if they perceive that the power of the social worker is being used over them or against them. [51]

3.18 The issue is of concern in the context of the recently introduced Parenting Orders in Scotland within the Antisocial Behaviour (Scotland) Act 2004. These were introduced to provide compulsory mechanisms as a means for local authorities to require parents by law to accept support. An order would be appropriate where parents are not prepared to take steps to address serious concerns about their child's welfare or behaviour and where voluntary help and support offered to them has not been taken up. Parenting orders are intended for the small minority of parents who are found to be unwilling to accept help and where a clear need for support has been identified.

3.19 Parenting Orders legislation has so far attracted criticism. Some see it as heavy handed and unjust, failing to address the issues facing families and parents, indicative of a preference for intervention at odds with Kibrandon's recommendations and of 'punitive intolerance' to under-privileged parents [52].

3.20 Responses to a consultation on guidance on parenting orders in Scotland indicated that there was general agreement across Scotland on the importance of parenting but less universal agreement about the need to introduce Compulsory Parenting Orders. To date no local authorities have applied for a Parenting Order in Scotland and therefore it has not been possible to assess the impact of the legislation.

Effective interventions

Summary of Meta-analyses

3.21 Farrington and Welsh (1999) conducted a meta analysis of 24 published evaluations of parenting programmes (which satisfied their criterion of methodological quality) covering a range of interventions (home visiting, day care, pre-school, school, clinic, community and a multi-systemic therapy context. They found that most interventions were effective in reducing childhood anti-social behaviour and later delinquency. Programmes that included parental education were particularly effective. However, some programmes were not effective due to lack of parental participation, poor attendance and lack of commitment by young people. Thus effectiveness can be compromised by family risk factors. [53]

3.22 A more recent meta analysis by Farrington and Welsh (2003) focussing on family centred programmes found that the most effective practice was evident in programmes that incorporated cognitive-behavioural approaches, particularly those that promoted the development of positive, pro-social adult role models whilst enhancing parental engagement. [54]

3.23 The National Institute for Clinical Excellence [55] makes a number of recommendations for the effective delivery of parental interventions. Group based parent training programmes are recommended in the management of children with conduct disorders except where there are difficulties engaging parents /families whose complex needs are better managed individually. All programmes should be structured, be informed by principles of social learning theory, include relationship enhancing strategies, enable parents to identifying their own objectives, use trained and skilled facilitators and involve role play and homework.

3.24 Maintaining programme integrity and employing appropriate methods are important to effective outcomes; this element is the most likely one to be 'watered down' as programmes are rolled-out. Behavioural and skills based methods have proven to be the most effective in making improvements, in particular home visitation, day-care/preschool for under five's, general parent training, school based parent training, home/community programmes for older children and parents, structured family work and multi-systemic family work for adolescents. [56] Evidence on the issues of the duration, intensity and sequencing of programmes of intervention remains limited.

Effective interventions from birth up to 2 years

3.25 Evidence on interventions for parents of under-3s is limited as these have not been evaluated to the same extent as other interventions [57].

3.26 Intensive home visiting programmes delivered through nurses, health visitors or trained volunteer "community mothers" are notable examples for this age group. These include interventions such as the "Perry Preschool Programme" [58], "Starting Well", "the Child Development Programme", "Community Mothers Programme" and "Home Start". (For more information see services paper). Evidence shows that these programmes have long term benefits for children and families, including significant reductions in criminal behaviour in later life [59]. There is also evidence to support psychosocial interventions working with whole family units, and for baby massage to promote interaction with and stimulation for the child.

3.27 A national audit of parent antenatal and postnatal education provision in Scotlandwas conducted in 2005 which included a survey of parents to obtain their views as service users. [60] The major findings of the audit were that:

  • A range of parenting educational initiatives is available in Scotland delivered by a range of professional groups and volunteers. The central belt may be better served than rural and remote areas.
  • Services target parents facing a range of health and lifestyle challenges and most providers believe they reach some of their target group
  • Users are often involved in service planning
  • Participation was affected by accessibility issues such as childcare, transportation.

Effective interventions for children aged 2-8

Parent education and skills programmes

3.28 There are a considerable number of interventions seeking to prevent or treat problem behaviours in 2-8 year olds. These largely focus on promoting better parenting skills in high risk families. Some of these parenting programmes have sought to extend their effectiveness by extending into reinforcement programmes with children and teachers.

3.29 Notable parent training interventions include: the "Incredible Years" programme [61], "The Positive Parenting Programme" (or "Triple P") [62], "Mellow Parenting", "Parenting Wisely [63] and Parent Management Training [64]. The first three operate in the UK.

3.30 The Incredible Years programme, designed by Carolyn Webster Stratton, a Canadian educational psychologist, is aimed at parents of children aged 1-10 with early indications or at high risk of conduct disorder. It addresses child behaviour and the parent-child relationship. Delivery is via group work, including discussion and role play bolstered by home based activities and support for parents. [65] Incredible Years has been reported to enhance parenting skills and parenting self confidence along with a range of other positive effects. Parenting Wisely (a US programme) also delivers parent and child training in key communication and management skills but through a self delivered CD ROM series.

3.31 The Triple P Programme is a family intervention programme originally developed in Australia in the 1970s based on five core principles:

  • Ensuring a safe and engaging environment for children
  • Creative a positive learning environment for children
  • Using assertive discipline
  • Having realistic expectations, assumptions and beliefs about the causes of children's behaviour
  • The importance of parental self care

3.32 Triple P has been reported to improve a range of behaviours and relationship problems for up to two years after intervention and to be effective in a range of settings and with several different family types.

3.33 Mellow Parenting aims to support families who have relationship problems with their infants and young children.

3.34 Two other programmes running in the UK are the Veritas/ Family Caring Trust programme and the NCH Programme but there is little review data available.

3.35 Another example is the Seattle Social Development Project involving training to improve the social competence and thinking skills of elementary school pupils, combined with a parenting skills programme and training in proactive classroom management for teachers. There are also cognitively based approaches to training parents, mostly coming from the US and programmes that aim to extend parents' knowledge about child care, development and health.

3.36 Robust evaluations have demonstrated the effectiveness of some of these parenting programmes for both parents and children. However, it is difficult to extract clear messages from such a diffuse subject area. It should be noted moreover, that many of these evaluations are based on programmes running in other countries outside Scotland and the UK (eg the USA or Australia) and it cannot be assumed that what works in one country will necessary be successful in another where different social circumstances prevail.

3.37 "Sure start" and "Communities that Care" are two UK programmes targeted at high risk groups. These are discussed in greater detail in the Services Paper.

Interventions addressing parents' emotional and mental health

3.38 There is a clear body of evidence demonstrating that parents with poor mental or emotional health often cope less well with the demands of parenting and that this can have measurable adverse effects on children's wellbeing (health, educational and behavioural). Reviews find that a diverse array of parenting programmes addressing emotional and mental health are successful [66].

3.39 In general, Hallam's (2008) conclusions, based on her comprehensive review of parenting and educational support programmes, is that they can improve emotional and behavioural development in children. However, effects are not universal and the most disadvantaged families are least likely to benefit as they are least likely to become or remain engaged. Hallam also concludes that parenting skills programmes are strongly associated with good outcomes for both parents and children.

CREATING COMMUNITIES THAT PROVIDE A SUPPORTIVE ENVIRONMENT FOR CHILDREN AND FAMILIES

Introduction

1.1 This paper highlights the key evidence with regard to the role of communities in providing supportive environments for children and families. It looks at the different experiences across communities: between deprived areas and the rest of Scotland and rural and urban areas. It considers measures that would improve the physical and social environment for young children focusing on services, schools and play spaces as well as the role of informal support between parents. Examples of previous approaches taken are discussed.

Key Findings

  • Experiences and outcomes differ across communities in Scotland: between deprived areas and the rest of Scotland and between urban and rural areas.
  • Improvements in facilities and activities for children are seen as important by approximately one-fifth of parents.
  • Education is particularly connected with place and communities with schools more than most other public services embedded within neighbourhoods.
  • Play is recognised as an important part of a child's development. The evidence suggests that outdoor play is declining amongst young children.

The importance of communities

2.1 Creating communities that provide a supportive environment for children and families is an important component of any early years approach. Local circumstances have been shown to exert a strong influence on outcomes such as educational attainment and participation [67]. Children's lives need to be understood in their neighbourhood as well as family context as social policies can be targeted at areas as well as at individuals.

Deprived areas and the rest of Scotland

3.1 There are differences in the experiences of those living in the most deprived and the rest of Scotland. For example:

  • The 15% most deprived data zones in Scottish Index of Multiple Deprivation (SIMD) 2006 contain 36% of Scotland's income deprived population and 33% of Scotland's employment deprived working age population.
  • 77% of school leavers from the 10% most deprived areas entered a positive destination (further or higher education, employment, training or voluntary work) in 2006/07 compared with just over 93 per cent of those from the 10% least deprived areas [68].
  • People living in the 15% most deprived areas were just as likely as those living in the rest of Scotland to say that they particularly liked the social aspects of their neighbourhoods [69].
  • People living in deprived areas are more likely to encounter common occurrences of anti-social behaviour such as noisy neighbours (17 per cent in the 15% most deprived and six per cent in the rest of Scotland), vandalism (42 per cent in the 15% most deprived and 14 per cent in the rest of Scotland), rubbish (49 per cent in the 15% most deprived and 25 per cent in the rest of Scotland), groups of people taking drugs (45 per cent in the 15% most deprived and 18 per cent in the rest of Scotland) or groups of young people hanging around (52 per cent in the 15% most deprived and 31 per cent in the rest of Scotland) [70].
  • Since 1999, the percentage of respondents rating their neighbourhood as a fairly or very poor place to live has decreased, and this decrease has been relatively larger in the 15% most deprived areas [71].
  • Life expectancy is 70 years in the 10% most deprived areas of Scotland compared to 81 years in the 10% least deprived areas [72].
  • Whilst people living in the 15% most deprived areas are nearly twice as likely to be income poor as people living in the rest of Scotland, 77% of income poor people do not live in the most deprived areas [73].

Urban and rural areas

4.1 There is little difference between urban and rural areas in the prevalence of poverty although there may be some differences in how people in rural areas experience poverty as some goods are more expensive in rural areas and some services are less convenient to access [74].

4.2 Access to services is an issue of particular relevance to rural communities. Of the 1,203 data zones in rural areas over 60% are in the 15% most access deprived areas compared with only 4% of data zones in urban areas [75].

4.3 Mothers in remote small towns are less likely than other mothers to attend antenatal classes. When asked about reasons for non-attendance access problems - including a lack of knowledge/awareness of classes, no classes available or travel problems - stood out as particular problems for mothers in rural areas. 32 % of mothers in remote and accessible rural areas (combined) mentioned at least one of these reasons, compared with just 18% in large urban areas [76].

How people view their neighbourhood?

5.1 Findings from the 2006 Scottish Social Attitudes Survey found that most people feel they have a reasonable degree of social support and 'connectedness' within their own communities [77]. However, a 2003 Home Office Citizenship Survey found that 30% of children interviewed aged 8 to 10 years did not feel safe walking around or playing in their street or block [78].

5.2 Research based on a survey on 2000 parents in England found that how much parents earn has a dramatic effect on how they view their neighbourhood and whether they believe they are able to do the best for their families. Only 35 per cent of those on the lowest incomes feel confident that their neighbourhood can provide the best opportunities for their family, compared to 73 per cent of the richest [79].

Deprived areas and the rest of Scotland

6.1 Figure 1 shows that a higher percentage of people in the 15% most deprived areas rate their neighbourhood as a fairly/very poor place to live compared with the rest of Scotland.

Figure 1: Perception of neighbourhood as a fairly/very poor place to live, 2000-2006, by deprivation

Source: Scottish Government, Scottish Household Survey

6.2 However, people living in the 15% most deprived areas were just as likely to say that they particularly liked the social aspects of their neighbourhoods as those living in the rest of Scotland. Particular social aspects that were chosen were good neighbours (35 per cent in the 15% most deprived areas, 32 per cent in the rest of Scotland), friendly people (28 per cent in the 15% most deprived areas, 30 per cent in the rest of Scotland) and community spirit/good sense of community (six per cent in both the 15% most deprived areas and the rest of Scotland).

6.3 Of the specific aspects that people liked about their neighbourhoods, those in the 15% most deprived areas were more likely to say that they liked the good public transport (20 per cent, compared with 15 per cent in the rest of Scotland). They were less likely to say, however, that they liked the area for being safe/having low crime (eight per cent in the 15% most deprived, 17 per cent in the rest of Scotland), being quiet and peaceful (36 per cent in the 15% most deprived, 61 per cent in the rest of Scotland) or for being nicely landscaped/having open spaces (nine per cent in the 15% most deprived areas, 20 per cent in the rest of Scotland) [80].

6.4 As illustrated in figures 2 and 3 with the exception of whether people find their area quiet and peaceful the most deprived areas are similar to the rest of Scotland in terms of what residents like about them. There are, however, stark differences in terms of what they dislike, with much greater dissatisfaction with quality of life issues such as vandalism; the lack of things for young people to do and places for children to play (Scottish Household Survey, 2006).

Figure 2: Aspects of neighbourhood particularly liked, 2005-06, by deprivation

Source: Scottish Government, Scottish Household Survey

Figure 3: Aspects of neighbourhood particularly disliked, 2005-06, by deprivation

Source: Scottish Government, Scottish Household Survey

Urban and rural areas

7.1 There are also differences in the perception of a neighbourhood as a fairly/very poor place to live between urban and rural areas with a higher percentage of people in urban areas rating their area according to this classification.

Figure 4: Perception of neighbourhood as a fairly/very poor place to live, 2000-2006, by urban/rural

Source: Scottish Government, Scottish Household Survey

7.2 Differences exist across areas in what people like/dislike about their area with households in urban areas more likely to like 'good local shops' and less likely to like 'community spirit' than those living in rural areas (refer to figures 5 and 6).

Figure 5: Aspects of neighbourhood particularly liked, 2005-06, by urban/rural

Source: Scottish Government, Scottish Household Survey

Figure 6: Aspects of neighbourhood particularly liked, 2005-06, by urban/rural

Source: Scottish Government, Scottish Household Survey

Measures that would improve the physical and social environment for young children

Services

8.1 There is a widespread belief that public services delivered in more deprived areas are of a lower quality than average. This may compound the problems faced by low-income or excluded groups living in these areas. The evidence base in this area is weak. Hastings and Bailey (2002) examined levels of satisfaction with public services in different types of neighbourhood in Scotland, and explored the factors (at individual, household and locational levels) which determine differences between these areas. They found a relationship between neighbourhood deprivation levels and dissatisfaction for some important services such as parks/open spaces, schools and GP services [81].

8.2 Duffy (2000) explored attitudes to public services in deprived areas using data from a large national survey, the People's Panel. His analysis found very high levels of use of some social welfare services by residents in deprived areas, for example, GPs and hospitals [82].

8.3 Evidence from the Scottish Household Survey shows that least deprived areas are more likely to use sports centres and swimming pools than the most deprived areas.

8.4 Overall, the poorest neighbourhoods use public sports and swimming facilities at just under half the rate found in the least deprived areas, or about two-thirds of the average rate [83].

Facilities in need of improvement

9.1 The Growing up in Scotland Survey provides us with evidence on the facilities which parents with young children in Scotland would most like to see improved. Facilities for young children were seen as being most in need of improvement by one-fifth of respondents (21%), particularly those who had no such facilities in the area already: 40% of parents who said there was no playground or park in their area indicated that facilities for young children would be their first choice for improvement compared with 15% of parents who said there was a park and they used it often [84].

9.2 Parents also viewed the need for more organised activities for children and young people as a priority (23 per cent overall) [85].

9.3 Families in rural areas have been shown to have different needs from those in more urban areas. For instance a quarter of parents who live in the countryside say that better public transport is the one thing that would improve their neighbourhood the most for families, and a further 17 per cent chose reducing traffic as their number one priority. In urban areas parents are much less concerned about traffic and more worried about reducing crime and anti-social behaviour (50 per cent in the inner cities) [86].Bus services have been found to be much more important and a much greater priority for improvement in deprived areas compared to other areas [87].

9.4 Good quality affordable housing was the second most mentioned service or issue in need of improvement (12%) by those participating in the Growing up in Scotland Survey. Successive Scottish House Condition Surveys show that the number of homes suffering from condensation or dampness has fallen, but 73% of local authority housing, 64% of housing association housing and 70% of private sector housing falls short of the new Scottish Housing Quality Standard, and 41% of houses have some urgent disrepair [88].

Schools

10.1 Education is particularly connected with place and communities with schools more than most other public services embedded within neighbourhoods [89]. Figure 7 shows that in general a slightly higher proportion of people in deprived areas are dissatisfied with their child's schooling, although as the graph below shows this difference is very small.

Figure 7: Percentage very or fairly dissatisfied with child's schooling, 2000-2006, by deprivation

Source: Scottish Government, Scottish Household Survey

10.2 Numerous qualitative studies on education and other subjects reveal some of the adverse affects of living in a poor neighbourhood for young people's educational experiences, including:

  • Low aspirations due to labour market conditions
  • Effect of neighbourhood stigma on self esteem
  • Parental isolation and low social capital influencing factors such as childcare, and school choices
  • Limited educational resources such as libraries, safe play area and supervised youth activities [90].

Lupton (2006) argues that the available evidence suggests that neighbourhood has some effect, in that it is probably worse for a persons education to live in a poor neighbourhood than a rich one. Schools in disadvantaged areas tend to score less well than those in more affluent areas. Differences between schools are said to account for somewhere between eight and 15 percent of attainment differences with individual, home and background factors accounting for the rest (referenced in Lupton, 2006). On this basis Lupton concludes that better schools in poor neighbourhoods might not compensate for wider inequalities, but it would make a contribution to closing the social class gap in educational outcomes.

10.3 A number of studies have sought to identify factors that might help schools in disadvantages areas to be more successful [91]:

  • A shared belief in the potential for growth and development in all pupils and staff
  • A distributed leadership approach
  • Investment in staff development
  • Emphasis on high quality personal relationships
  • A commitment to interconnections between home, school and community
  • Strategies to foster social and emotional development as a precursor to learning

10.4 The evidence thus shows that schools do matter, and that equalising the quality of schooling across neighbourhoods is an important factor in reducing the gap in educational outcomes.

The importance of outdoor play

11.1 The importance of play in children's development is well understood by child development theorists, early years practitioners and those offering play provision for older children. The research evidence emphasises the importance of outdoor play and the impact that it has on the well-being of children [92]:

  • Education benefits of outdoor play: Research has shown that play benefits children's learning [93][94][95]
  • Health benefits of outdoor play: The rise in obesity could be linked to a decrease in outdoor physical activity. Evidence from children shows that they do not play outside as often as they would like [96]. In a recent survey of children's natural play, evidence is cited to support the contribution of play to children's physical and mental health and well-being [97].
  • Economic aspects of play: Children living in more deprived areas often have more limited access to outdoor spaces [98]. Out -of-school care services, including after school clubs, kids clubs, play centres and play schemes have significant economic benefits through enabling parents to take up training opportunities [99].

11.2 The Scottish Health Survey 2003 reported that 74% of boys and 63% of girls aged 2-15 years achieved the minimum recommended level of activity. Activity levels decline with age amongst girls (but not boys) after the age 8-10 years.

11.3 A study of children's outdoor play in 1973 found that 75% of children observed played near to their homes, mainly on roads and pavements (Department of the Environment, 1973). Data collected for the National Travel Survey 2005 (Department for Transport, 2006) suggests that only 15% of children aged 5 to 15 years played outside on the street [100].

11.4 Poorer families are less likely to have access to a pleasant well-maintained green space, to feel safe in their neighbourhood at night or even have confidence that neighbours would help them out in a crisis [101]. There is a big gap in equality of access to high quality natural environment between children from rural backgrounds and children from urban backgrounds. Children from more affluent backgrounds in rural areas generally had good access to outdoor space. This contrasts with the experience of children from deprived backgrounds in urban areas [102].

11.5 Children's opportunities to play outside safely and freely are increasingly restricted because of adults' fears for children's safety. The two main concerns stopping children from playing out are traffic and harm by strangers. Valentine (2004) argues that parental fear surrounding strangers and public spaces means that parents impose limitations on their children's independent mobility in order to protect them [103].

11.6 The evidence also shows that children themselves are increasingly fearful about playing outside (refer to Lacey, 2007). A study which consulted with children aged between 5 and16 years from inner city, edge of town council estates, and rural villages, asking them about the time they spent in public spaces found that safety was an important dimension to young people's use of public spaces. The young people in this study perceived traffic as the greatest danger, far outweighing fears of bullies and gangs, strangers and fear of gangs (Matthews and Limb, 2000). A further study by Transport 2000 involving consultation with 150 children and found that children had a fear of traffic [104]. More than 25% of all child pedestrian injuries take place in the 10% of most deprived wards in the UK (Social Exclusion Unit, 2003).

11.7 The association between socio-economic status and child mortality due to road-related accidents has been well established, and a relationship between social deprivation and non-fatal road injuries has also been identified. A combination of factors appears to put children from deprived backgrounds at greater risk, including [105]:

· neighbourhood characteristics: urban deprived areas tend to have higher volumes of traffic than more affluent areas, increasing exposure to risk

· housing design: living in a home with insufficient space to play, or in housing that opens directly onto the street also increases the risk of child pedestrian accidents

· family circumstances: poorer children are more likely to walk to school and less likely to be accompanied on the journey, or supervised crossing roads, than children from more affluent backgrounds

· individual behavioural and emotional factors children with hyperactivity appear to be at increased risk of accidents involving moving vehicles

11.8 Play Scotland commissioned a questionnaire to gather baseline information on play in a local authority context. Play is perceived to be a priority in 68% of local authorities. Whilst 68% of local authorities have a physical activity strategy for children only 22% have a play policy.. Three-fifths of local authorities provided opportunities for career development for playwork staff. Only 25% of LA's offered children free access to leisure centres.

Figure 8: Percentage of childcare centres with an outdoor play area, January 2007, by deprivation thirds

Source: Pre-school and Childcare Statistics 2007

11.9 Among primary schools 45% have no sports pitches, compared to only 4% of secondary schools. Among secondary schools 92% have at least one on-site sports pitch compared with 52% of primary schools [106].

11.10 New play projects have been shown to make a significant difference to New Deal for Communities areas including promoting social interaction and promoting a sense of community in deprived neighbourhoods [107].

What works to improve the safety of young children?

12.1 A number of measures have been identified which improve the safety of young children [108]:

· Area-wide engineering schemes and traffic calming measures are effective, relatively low cost and, while focusing on the most vulnerable groups, are effective for people of all ages and circumstances

· Such schemes also have the (often unmeasured) potential to increase cycling and walking at the neighbourhood level, together with the potential for children to play outdoors, with benefits for both health and environment

· There is evidence that improvements to playground design can reduce the frequency and severity of injuries

· Educational programmes alone appear to have little effect, irrespective of the form they take (including skills training, mass media exposure and targeted education courses) or the focus (such as road safety or parental awareness of the risks from drowning in the home)

· Interventions incorporating legislation, education, safety equipment and environmental modification are the most likely to yield positive results

12.2 An education programme that does appear to have had a positive impact is the 'Kerbcraft' child pedestrian training programme in Scotland [109]. This was designed to enhance pedestrian skills in 5-7 year old children over a period of 12-18 months. It focused on the following skills (1) recognising safe versus dangerous crossing places (2) crossing safely at parked cars and (3) crossing safely near junctions. Strong statistical evidence was found for the positive impact of training in Kerbcraft skills. In addition the evaluation found that 43% of head teachers surveyed considered that the Kerbcraft programme had actively improved the relationship between parents and schools.

Examples of previous approaches - physical environment and neighbourhood

Active Schools

13.1 Active Schools is a term given to schools in Scotland that provide their pupils with sufficient opportunities to get active. A critical component of the Active Schools is the development and support of a network of professionals to organise and coordinate activity. The Year Two evaluation of the delivery and management of Active Schools indicates that provision has settled into a more established phase with evidence of increased opportunities and improved provision. However, there are concerns about accessing more 'difficult to reach' groups and at this point in the evaluation the level of increase in the absolute number of children participating is unclear [110]. The impact on primary school pupils was found to be greater than the impact on secondary school pupils with the proportion of primary school pupils achieving the recommended daily activity level of 60 minutes rose dramatically.

13.2 The year two evaluation identified six key themes of particular importance:

  • Partnership working and the embeddedness of Active Schools
  • Limited availability of co-ordinator time
  • Funding, resourcing and sustainability
  • Recruitment of volunteers
  • Importance of establishing community links
  • Use of monitoring data for management purposes

Better Play Programme

14.1 The Better Play Programme was a four year £10.8 million grant programme funding children's play services across England [111]. It objectives were:

  • To produce opportunities for children to play safely within their neighbourhoods
  • To offer opportunities for community members to take part in providing good play opportunities for children
  • To enhance the health and safety of children in disadvantaged neighbourhoods
  • To address the play needs of particularly disadvantaged groups within neighbourhoods.

14.2 An evaluation of the programme found that all six projects provided children with opportunities to play safely in their neighbourhoods. This was through the presence of skilled staff, the provision of safe environments and the trusting relationships between children, families and workers. External partnerships and work with families enhanced the range of play opportunities. It was found that these projects provided children with a real alternative to playing on the streets and increased children's opportunities to a range of new play opportunities.

Home Zones

15.1 Having originated in the Netherlands home zones gained prominence in the UK in the 1990s. A home zone is a group of residential streets designed so that the street space is available for social uses such as children's play, while car access is also allowed. Street design and traffic calming measures in residential areas mean that people take priority over traffic. In residential areas street space is shared between pedestrians, cyclists and motorists. An evaluation of Home Zones in Scotland [112] found that their principal benefits were in relation to community involvement with comparatively minor changes in vehicle speeds or volumes. It found that the potential benefits of children's involvement in Home Zone design and the creation of safer places for outdoor play can be an important factor in identifying potential locations for Home Zones and informing the process by which projects are designed and implemented.

15.2 In England all 7 evaluations by Transport Research Laboratory of Home Zones show consistent support from adult and child residents for the measures introduced in their streets [113]. Residents tended to welcome the changes and to feel the schemes had made their streets more attractive and safer. All 7 evaluations also found that traffic speeds and volumes had gone down after implementing the schemes. Five of the seven evaluations suggest a positive impact on play opportunities for children and young people.

Neighbourhood Toolkit

16.1 To respond to the decreasing opportunities for play Joseph Rowntree Foundation and the Housing Corporation, carried out a three-year action research project to develop and pilot, in a small number of areas, a practical and comprehensive set of resources for improving public neighbourhood play spaces and services for children and young people [114]. The Neighbourhood Play Toolkit was conceived to develop and pilot a practical, comprehensive set of resources for improving public neighbourhood play spaces and services for children and young people. Five local community groups took part in developing and piloting the resources, which sought to bring together 'play development' and 'community development'. An evaluation of this project found that it became a tool for building social capital and for enriching the lives of all those who took part and were impacted on by the project and its outcomes. Participation in this project was found to bring real and positive changes to the neighbourhoods.

Measures to encourage more mutual support between parents and others

Involvement in local groups and organisations

17.1 The Growing up in Scotland Survey provides evidence on the involvement in local groups for children or parents:

  • Half of parents in the birth cohort (50%) and just a quarter in the child quarter (26%) attended a parent and toddler or parent and child group in the past year.
  • Around 42% of all parents in the birth cohort and 51% of those in the child cohort did not report attendance at a parent and child group at either sweep. Mothers from couple families and older mothers were more likely than lone mothers and younger mothers to say they had attended a group in the past year. Parents in remote areas were significantly more likely than those in accessible areas to have attended parent and child groups in the previous year.
  • Younger mothers and lone parents were more likely than older mothers and those in couple families to mention feeling shy or awkward about attending a group.
  • The lower involvement in such groups evident amongst lone parents, those with poorer educational attainment and in less affluent households fits well with the analysis of social network and informal support data. This analysis suggests that many parents in these groups have more limited and weaker social networks and further, draw more heavily than other parents on support directly from family and friends rather than that received via other mothers in unfamiliar settings such as parent and toddler groups
  • Evidence of greater formal community involvement among those with higher levels of education and in more affluent households

Informal support

18.1 Informal networks are also crucial to parents. Analysis on the use of informal support by families with young children in the Growing up in Scotland Survey found that [115]:

  • Generally all parents have access to and make considerable use of informal support.
  • The child's grandparents were a key source of informal support. Almost all families (around 95%) in both cohorts were receiving some type of help or support from the child's grandparents.
  • Study of the composition of social networks identified some small but important distinctions in the types of informal support that different parents accessed. Younger mothers, those who were unemployed and those on lower incomes, were shown to draw on a more limited support network, relying much more on their own parents for support than did older mothers and those with higher incomes.
  • In contrast, for those mothers in more economically advantageous situations, having a child seems to extend their social and support network so that their resources, whilst including both kin and friends, move beyond 'known' individuals to also include 'other parents' such as those they may encounter at mother and child groups.
  • The examination of attitudes towards seeking help and/or advice indicated that mothers with no qualifications and those from low-income households were more likely to agree that seeking help from professionals would result in interference than mothers with qualifications and those from higher income households.

Differences in accessing and using support

19.1 The Growing up in Scotland study reveals some interesting differences in access and use of support amongst parents in more affluent and less affluent circumstances. For example, antenatal classes are potentially a key source of support for parents. There is evidence of a difference in attendance by socio-economic group and by maternal age at birth [116]. 91% of mothers from highest income households had attended at least some classes compared to less than half of mothers from low income households. This is further discussed in the paper on 'building parenting and family capacity'.

Support from employers: 'family-friendly policies'

20.1 Parents also need to be supported in a work context. Growing up in Scotland [117] provides evidence on the extent to which parents are supported by their employers in helping to maintain a work-life balance:

  • Among those respondents who were employed, 4 out of 5 in both cohorts reported that their employer offered at least one family friendly working arrangement, mainly flexible working and time off when a child is sick.
  • Around 6 out of 10 respondents in both cohorts could take advantage of these policies at their workplace.
  • In general, all forms of family-friendly policy were more widely available to respondents in professional or managerial occupations than to those in other occupational classifications. However, the differences were particularly stark amongst the less common policies. For example, whilst 30% of respondents in managerial or professional occupations could receive childcare vouchers via their employer, only 6% of those in semi-routine or routine occupations could do the sam e.
  • In both cohorts, 80% of respondents who had at least one family-friendly policy available to use were using it and many were using several.
  • Flexible working was the arrangement most likely to be used by respondents; in each cohort, 96% of those whose employer offered flexible working were using it. Home-working was also popular and was used by around 70% of parents in both cohorts for whom it was available.
  • Use of childcare vouchers was less common, used only by a third of parents in both cohorts for whom they were available (36% in birth cohort, 33% in child cohort).
  • Despite the difference in availability of family-friendly policies by occupational classification there was less difference in the extent to which different respondents used the policies which were available to them. In the child cohort for example, 80% of parents in managerial or professional occupations whose employer offered family-friendly policies were using at least one arrangement compared with 73% of parents in semi-routine or routine occupations.

Models for delivering more integrated services

21.1 As discussed above neighbourhood factors make a difference to educational opportunities and to children's outcomes. Therefore equalising neighbourhood conditions through neighbourhood renewal and regeneration strategies could be expected to have a positive impact on outcomes. Over time a large number of renewal strategies have been implemented at a area and neighbourhood level. These include Social Inclusion Partnerships; Community Planning Partnerships and the New Deal for Communities. One of these the New Deal for Communities is discussed in more detail below. Models for delivering integrated services such as Sure Start and Working for Families are discussed further in the paper on integrated services.

New Deal for Communities

22.1 The New Deal for Communities programme was launched in 1998. The aim of the programme was to narrow the gap between 39 deprived localities and the rest of the UK. The 39 NDC Partnerships each face unique combinations and types of disadvantage, but all tackle problems across 6 themes: poor job prospects, high crime, educational underachievement, poor health, poor quality housing and physical environment. Between 1999/2000 and 2005/06 £1.54 billion (2005/06 prices) has been spent by the 39 partnerships (DCLG, 2008).

22.2 An evaluation by the Department of Communities and Local Government in 2007 found clear evidence that considerable improvements occurred in NDC areas between 2001/02 and 2006. Of the 63 indicators, 59 moved in a positive direction. However, in general positive change is more obvious in relation to place, rather than people based outcomes. This may be due to the fact that people leave the areas as their personal circumstances improve (DCLG, 2007).

22.3 NDC areas have made encouraging improvements on 'place-based' outcomes, such as satisfaction with the area, crime and fear of crime, but more slowly on 'people-based' outcomes, such as worklessness, education and health. The evidence also demonstrates that interventions focussed on tackling one aspect of an areas problems reap benefits across a range of others: as the housing and physical environment in an area improves, crime rates reduce; as the worklessness rate of an area decreases, health outcomes improve: a clear argument for a holistic approach to regeneration. The report emphasises that the NDC partnerships are a recognised and valuable source of experience in community-led renewal and the programme provides good learning for others responsible for implementing neighbourhood regeneration [118] (DCLG, 2008).

DELIVERING INTEGRATED SERVICES THAT MEET THE HOLISTIC NEEDS OF CHILDREN AND FAMILIES

Introduction

1.1 This chapter provides a review of the evidence base relating to integrated services that meet the holistic needs of children and families. It covers range of services including: parenting, homeless/housing; alcohol and substance misuse; home visiting; childcare and pre-school; transitions and also examines sustaining the impact of interventions beyond the early years and models for delivering integrated services.

1.2 The chapter has been divided into seven sections:

  • The importance of integrated services that meet the holistic needs of children and families (Section 3).
  • The effectiveness of adult support services for vulnerable groups that impact upon children (Section 4)
  • Childcare and pre-school (Section 5)
  • Transitions to pre-school and primary school (Section 6)
  • Sustaining interventions beyond the early years (Section 7)
  • Models for delivering integrated services (Section 8)
  • Strategic planning by local authorities (Section 9)

Key findings

2.1 Where there is a child protection issue, services are better joined up - it is echoed in various parts of the literature that procedures and protocols related to child protection issues are better developed than other formal approaches to family interventions and that support was poorly co-ordinated unless there was an inter-agency child protection plan in place.

2.2 Keyworker approaches providing one link point of contact for families seem to be particularly successful in engaging vulnerable parents. In some cases (for example the Community Mothers Programme), the use of peer community volunteers (others from a similar background who have been specially trained to provide support) has been very successful.

2.3 To date [119] there is a lack of hard evidence demonstrating positive outcomes for children from integrated services, although there is subjective evidence on the impact on process and outcomes for professionals (improved communication, better understanding of other professions, reduction in duplication of work, improved job satisfaction and increased feelings of support and so on.

The importance of integrated services that meet the holistic needs of children and families

3.1 It is now generally accepted that integrated services and joined up working between professional groups is a good thing. The impetus and recommendations for integrated working have in part arisen from high profile child protection cases such as Victoria Climbie and Caleb Ness. In these cases a lack of joined up working and shared information were identified as key factors in contributing to the tragic outcomes of the children involved.

3.2 What do we know, however, about the merits of integrated services and joined up working? There is wealth of anecdotal evidence from the perspective of professionals and families on the positive impacts of integrated services as well as some of the difficulties with, and barriers to, implementing integrated services. There seems, however, to be a lack of hard evidence demonstrating positive outcomes for children from integrated services (Brown [120], unpublished) as the majority of research to date has focused on process rather than outcomes. On the plus side, integrated working can: provide professionals with a better understanding of other professional groups; reduce duplication of effort; improve communication (Daniel, Vincent & Ogilivie-Whyte, 2007) [121], increase feelings of support and improve job satisfaction (Rushmer & Pallis, 2002 [122]; Anderson-Butcher & Ashton, 2004 [123]; van Eyk & Baum [124], 2002). Specific research studies looking at the impact of multi-agency working and the use of keyworkers to join up services have all reported positive outcomes based on the perception of professionals (Liabo et al, 2001; Borrill et al, 2002) but these have not been measured objectively. The rest of this chapter will work from the basis that integrated services are a good thing, however, this is with the caveat that we do not yet have objective outcome evidence on this (Brown, unpublished).

The effectiveness of adult support services for vulnerable groups that impact upon children

Scottish review of health and social work services

4.1 There was a Scottish review in 2000-2001 of local authority social work and health services to support vulnerable families [125] with children aged 0-3 years. Key findings from this were that:

· A wide range of services was offering support to families, but support was poorly co-ordinated unless there was an inter-agency child protection plan or supervision plan in place. Children with physical or learning disabilities or sensory impairments were particularly poorly managed. The impact of the disability on the family as a whole was not taken into account in planning, and carers' needs were not consistently assessed.

· Midwives were reported to not have a clear sense of their responsibilities to vulnerable families, or perceived themselves as offering the same service to all new parents, regardless of risk factors.

· Negative perceptions of field social workers hindered families from seeking early help from social work services, but families with experience of support were more objective and realistic - may be an important finding in how to work with families requiring social work input.

· Parents valued health professionals who took time to discuss problems and were honest about the help they could offer - health visitors were particularly appreciated for the practical support and advice they provided.

· Parents were very positive about the support they received from family centres, particularly valuing respite, emotional support and advice and social support from peers but wished to have better information on a range of topics, specific provision for fathers, and additional support at evenings and weekends.

Parenting services

4.2 There was a mapping of parenting services (MacQueen et al, 2008) in 2007 (27 of the 32 local authorities responded). Information was gathered on 381 services across Scotland that provided some form of parenting service or support. Key findings include:

· Two-thirds of services provided intensive support (a high ratio of staff to clients), 47% offered crisis support and 42% group work. Services were commonly delivered by addressing parenting skills/training (68%), or offering support/advice with regard to parenting issues (68%), were the most common ways that services were delivered, followed by home visits (58%) and peer support (45%). Individual work was offered by 35% of services, while preventative work was offered by 30% of services.

· Homeless families (4%) and travellers (1%) were the least well served.

· A little over one-third of services (36%) offered a 'universal' service to all. The most common service providers were social work services (35%), voluntary organisations (30%) and education (29%).

· Actual availability of services varied widely between each LA and CHP area.

· Funding and resources were commonly cited as a particular problem with service provision. Services that were very structured were reported as being generally only available for those families where the level of need and/or risk was high.

· The main gap in services was reported to be early intervention provision or preventative work to be carried out. Procedures and protocols related to child protection issues are better developed than other formal approaches to family interventions identified in the interviews. Although multi-agency work was reported as common in many areas, inter-agency communication regarding individual cases was often reported as being patchy at times.

· Parenting issues/difficulties are most difficult to identify in relation to children in the 3 to 5 years age group unless they are serious or very visible. There are no formal health checks under Hall 4 when a child is aged 3-5 years so this is only picked up if a child attends pre-school. If they do not it may remain unnoticed until primary school. Potential parenting difficulties can be highlighted as early as pre-birth.

· The importance of early intervention was emphasised, although lack of resources and demands on time were often mentioned as barriers to providing this.

Homeless/housing services

4.3 This includes services such as the 'Dundee Families Project' as well as 'life skills training' provided within homelessness services.

4.4 Many people who are/are at risk of homelessness do not have the skills to manage a tenancy or the self-confidence and interpersonal skills needed for dealing with agencies and forming relationships. Young people, care leavers, ex-offenders, ex-service personnel, people with low educational achievement and literacy problems are all particularly vulnerable. A research project by Scottish Homes aimed to identify the range of life skills training provision available in Scotland, to examine evidence on the role of life skills training in resettlement and tenancy sustainment. Key findings include:

· Life skills training provision: research in 2001 on range of Scottish provision available found there was limited knowledge on needs of particular groups: families, people from black and minority ethnic groups and women.

· Were wide variations in the length of time that Life skills training was provided to clients within homelessness provision. There is little evidence of the effectiveness of life skills training as part of the resettlement and tenancy sustainment process as none of projects had evaluations.

4.5 The Dundee Families Project, run by National Children's Homes (NCH) Action for Children Scotland, provides services for families who are/are at risk of becoming homeless due to anti-social behaviour. A range of services are offered including: individual and couple counselling, family support and group work. The three main service types are:

· Outreach: a preventive service offered to families in their existing homes

· Dispersed tenancies

· Core: accommodation offered to the most needy families in a residential block for up to four families

4.6 Key evidence relating to the Dundee Families Project is that:

· It has worked with 126 families in 4 years (1996-2000), about half of all referrals to the project. Information on closed cases showed that the majority of families made good progress, particularly regarding housing issues; however, many still had serious childcare problems.

· Positive impacts have been identified included: changes in their housing situation, facilities for children, positive changes in family relationships and behaviour (both children and adults).

· Evidence suggests that the project generates cost savings, through stabilising families' housing situation, avoiding costs associated with eviction, homelessness administration and rehousing and, in some cases, preventing the need for children to be placed in foster or residential care

· Crucial ingredients of the service were: good management, stable staff, shared ownership by other agencies, a repertoire of challenging methods and a holistic approach.

Misuse of alcohol and other drugs service

4.7 Over the past few years, there has been growing concern about the potential impact of adult substance and alcohol misuse upon children. Alcohol consumption has been increasing (particularly among women and young people generally) and the misuse of a number of other psycho active drugs (such as cannabis, heroin, cocaine, benzodiazepines, amphetamines and solvents) has become much more widespread (NHS Scotland, 2007).

4.8 Hidden Harm [126] (2003), estimates that there are up to 60,000 children under 16 years old in Scotland who have a parent with a drug problem (approximately 5% of the total population in this age group). Further estimates indicate that 10,000-20,000 children live with a drug-using parent, while the number of babies born to drug-misusing mothers rose to nearly 18 per 1,000 in 2000 (It's Everyone's Job to Make Sure I'm Alright, 2002). 'Hidden Harm' also reports that, on average, 25% of children on child protection registers were there because of parental alcohol or drug use.

4.9 A scoping review in 2006 [127] commissioned by the Scottish Executive aimed to collate knowledge and evidence on effective practice to address the issue of parental substance misuse. Key findings include:

· A range of services for children and families is developing, but there is a need for a continued expansion of such responses, and for their rigorous evaluation.

· Studies which were able to demonstrate their effectiveness at improving children's risk and protective factors and behaviours were not able to clarify which resilience factors determine positive outcomes.

· Research on this to date has failed to focus on children's views.

· There is a need to view parental substance misuse as part of a far wider, multi-dimensional picture.

4.10 Please see the briefing paper on 'Parenting and family capacity' for a fuller coverage on pregnancy interventions for vulnerable families.

Home visiting programmes

Starting Well

4.11 This initiative began as a national health demonstration project in Glasgow, focusing on intensive home-visiting support and the provision of a strengthened network of community-based services in two deprived communities. It was implemented through health visitor-led skill mix teams. There is no indication of how or if the work of Starting Well was integrated with Sure Start. After the initial phase, the service moved to a targeted approach for those most likely to gain from the interventions. It has now devolved across Glasgow.

4.12 Key findings include:

· Phase 1: of the service has been evaluated, but findings are difficult to interpret mainly due to the fact that the initiative was implemented differently in the two intervention sites, and the approach was diluted to some extent.

· The intensive visiting programme encouraged mothers to trust services.

· Better quality information on needs and life circumstances helped in putting together individualised care packages.

· Variations in process and outcomes depended on the receptivity of mothers to the service, and health visitor caseload pressures.

· Phase 2 (2005-06): moved from a universal service to a targeted approach. Multi-agency teams across Glasgow providing short-term, intensive support for highly vulnerable children were created.

· Phase 2 was evaluated and the report was due to be made public in January 2008 but has not yet been published.

Parents and Children Together (PACT)

4.13 This was an approach developed under Starting Well in Glasgow for vulnerable families where seven teams were formed including colleagues from Health and Social Work Services They were located either within community premises or within local authority buildings.

· Key interventions within PACT include: individual work with parents and children to increase self-esteem, reduce isolation, promote play and development; parenting work (individually and/or in groups); practical support (such as money advice, advocacy, accessing relevant services and supports) and group work (such as women specific and men specific groups focusing on building confidence, social skills etc.)

· PACT has not been evaluated although a case study has been produced to draw out general lessons in managing change and providing a resource for managers involved in planning and implementing complex change.

Child Development Programme (CDP) and the Community Mothers Programme (CMP)

4.14 The CDP programme operates throughout the UK and internationally. It offers monthly visits to parents by specially trained health visitors, starting antenatally and continuing for the first year of the child's life. The programme focuses on health, language, cognition, socialisation, nutrition and early education. It aims to develop the potential of the parents, rather than making them dependent on the health visitor. The CMP programme evolved from CDP and uses volunteer 'community mothers,' who receive training to support recipients of the programme.

4.15 Key findings on the two programmes include:

· An evaluation of the CDP in the UK indicated that empowering parents to take control of the health and development of their children and fostering their parenting skills are fundamental for the success of the programme

· A longitudinal study of the effectiveness of the First Parent Visitor Programme (a variant of the CDP) in the UK was unable to demonstrate an overall advantage over conventional health visiting

· An evaluation of the Comprehensive Child Development Programme in the US found that children's health, ability to concentrate and social behaviour were better, compared with those who received conventional postnatal care, and that they were more likely to have story books at home.

· An evaluation of the CMP in the Irish Republic found that visits from community mothers had beneficial effects on parenting skills and maternal self-esteem, which were sustained over time. The effects also carried through to subsequent children born to mothers, who were more likely to have received immunisation and to have been breastfed.

· In general, it is not clear from the evidence whether outcomes were better or worse for particular groups of families within the communities participating in evaluations of the CDP or CMP and, therefore, it is hard to tell whether the initiatives are effective for the most disadvantaged families.

· The CMP is not a costly or intensive intervention and offers benefits to the community volunteers and, potentially, to the wider community as well as to the mothers visited.

Home-Start

4.16 This is a UK-based volunteer home visiting programme which offers support, friendship and practical help to young families under stress, in their own homes. All volunteers must have experience of being a parent.

4.17 Key findings on Home-Start include:

· There is little information about the effectiveness of the intervention in Scotland - an evaluation of the 18 schemes operating in 1998 appears to have relied on survey information and self-reported health improvements

· The volunteers who delivered the scheme were valued as friends who offered practical support

· An evaluation of the costs and outcomes of Home-Start support in Northern Ireland and the south of England found that mothers valued the service, exhibited fewer depressive symptoms at follow-up and were experiencing less parenting stress. However, much of the change appeared to be due to the passage of time and greater experience of parenthood. At follow-up, there were no significant differences in formal service costs between the study and comparison groups, although the receipt of Home-Start services pushed costs for the study group higher than costs for the comparison group.

· The researchers who carried out the costs and outcomes study suggested that the benefits of a community-based initiative, which does not aim to provide a structured, intensive programme, might only be apparent after a number of years.

Childcare and pre-school

Childcare statistics

5.1 Key childcare statistics from 'Growing Up in Scotland' include that:

  • A little over two-thirds of parents in the birth cohort (68%), and virtually all parents in the child cohort (99%) were using some form of childcare (Anderson & Bradshaw, 2007) [128].
  • Higher income groups are more likely to use childcare than lower income groups (84% of the highest income quartile used childcare, compared to 57% of those in the lowest income quartile) (Anderson & Bradshaw, 2007).
  • There was a shift to greater use of formal care between sweeps ( from 40% at sweep 1 to 53% in sweep 2 for the birth cohort) (Anderson & Bradshaw, 2007)..
  • The average amount of childcare was 22-26 hours per week (birth and child cohorts respectively) (Anderson & Bradshaw, 2007).

Findings on childcare

Working for families fund (WFF)

5.2 This fund was established to invest in new initiatives to improve the employability of disadvantaged parents who have difficulties in participating in the labour market, specifically in employment, education or training. The main support provided by WFF is based around 'Key Workers,' 1 who support clients who wish to move into work, education or training through: 1) helping them to improve their employability; and 2) addressing the childcare and other practical barriers that stand in their way. A key element of WFF support is helping clients to identify and access the childcare they need at each stage. Often this takes the form of information and advice, linking them to an existing childcare place, but it may also involve financial assistance ( e.g. paying one-off, 'upfront' nursery registration fees, or paying for childcare while a parent attends education or training, or paying for childcare for a short time until tax credits come through).

5.3 When registering, clients were asked the top three goals they would like to achieve by participating in WFF, 44% responded that they wanted to access childcare more easily.

5.4 Key findings from an evaluation of WFF include:

  • Clients engaging with WFF suffered multiple barriers to entering or remaining in employment, education or training. These extended far beyond childcare issues, indicating that a flexible and holistic approach, as developed by WFF, was required in order to meet their varied needs [129].
  • The major barriers identified by clients were: 80% indicating caring responsibilities (with 68% citing childcare responsibilities, 57% the cost of childcare and 40% its availability).
  • Childcare issues were perceived as less of an issue for over 57% of clients (six months after initial registration).

Fragmentation

5.5 Studies on parents needs in terms of access to and demand for childcare [130] (PADCS) (Hay, 2007) and the 'Growing up in Scotland' (GUS) study (Anderson & Bradshaw, 2007) both provide data on parents use of childcare and their views on costs.

5.6 Key findings relating to the fragmentation (that is when more than one provider is used) of childcare):

  • Many families used complex patterns of childcare, which is particularly common among working parents. Few parents in the study had what might be considered 'simple' models of childcare involving one care provider such as a nursery or childminder (Hay, 2007).

· Complex arrangements can work fine when all is well but are particularly vulnerable when one aspect breaks down (e.g. due to child or carer illness). This is due to the fact that many parents do not have backup arrangements available, particularly when they do not have extended family living locally. This is especially true for families living in rural areas, where there are limited childcare options (Hay, 2007).

· Parents often have extremely complex childcare arrangements to provide what they see as ideal for the child, for example, they do not wish to disrupt an existing arrangement even when their circumstances have altered and it is no longer convenient (Hay, 2007).

  • 60% of parents in the child cohort were using two or more childcare providers compared to 35% of babies' families. One fifth used three or more providers (Anderson & Bradshaw, 2007).
  • 85% of parents said they had found it very or fairly easy to make the necessary childcare arrangements, with only one in ten reporting it to be difficult or very difficult (Anderson & Bradshaw, 2007).
  • Parents appeared more content with their childcare than a year ago, with only 9% in the child cohort saying they would change their main childcare provider at sweep 2, compared with 18% saying so at sweep 1 (Anderson & Bradshaw, 2007).

Cost/funding issues

5.7 The Scottish Household Survey 2005-2006 provides a picture of parents' views on childcare, some of which relate to cost.

Chart 1: Satisfaction with childcare

Percentage tending to agree or strongly agreeing with statements about childcare, by deprivation, 2005-06

Source: Scottish Government, Scottish Household Survey, 2005-06

5.8 Approximately 35% of the 15% of the most deprived parents report finding it hard to pay for the childcare that they use. This falls to approximately 22% when all parents in Scotland are considered.

5.9 Other studies, such as PADCS and GUS also offer relevant findings relating to parents views on childcare costs:

· The cost of childcare (whether actual or perceived) seems to be of particular relevance to lone parents, lower income working parents and those with higher than average numbers of children (Hay, 2007).

· Some parents have actually looked into different childcare options and have decided that it is unaffordable based on the costs and their income. Others have not actually investigated the costs of different childcare options but have assumed that their income would not be sufficient to cover childcare (Hay, 2007).

· Although it is more commonly a problem for lower income households, most parents felt that the cost of formal childcare is too high (Hay, 2007).

· Childcare benefits are more important for those who are not working; 34% of this group believe that the benefits they receive are vital and that they would not be able to access childcare without them, compared to 15% of those in full-time employment and 21% of those in part-time employment (Hay, 2007).

  • Around half of those using childcare do not pay anything for it, compared to around one in four paying less that £40 every week and around one in ten paying more than £76 a week. Those not paying anything mainly include parents using informal childcare, primarily relatives and friends. childcare benefits are more important for single parent families. Over one-third of lone parents responding to the survey claim that the benefits they receive are vital and that they would not be able to access childcare without them, compared to only 15% of two-parent families. Cost is also an important factor for parents when choosing a childcare provider, especially for low income households and those with more than two children. Only 7% of all respondents who do not use their ideal arrangements said it is because they cannot afford it (Hay, 2007).
  • Of those respondents who were paying for childcare in the birth cohort, the average weekly cost of childcare for the cohort child was £67 per week (Anderson & Bradshaw, 2007).
  • One quarter of parents in this group said that they found it difficult or very difficult to pay for the all the childcare used, with 31% finding it neither easy of difficult and 43% saying they found it easy or very easy to pay their childcare costs (Anderson & Bradshaw, 2007).

Pre-school

The Effective Provision of Pre-School Education (EPPE) project

5.10 This is the first major European longitudinal study of a national sample of young children's development between the ages of 3 and 7 years (beginning in 1997). A wide range of information has been collected on 3,000 children. The study also looks at background characteristics relating to parents, home environment, and pre-school settings children attended. Settings were drawn from a range of providers and all settings were in England. A sample of 'home' children (who had no or minimal pre-school experience) were recruited to the study at entry to school for comparison with the pre-school group.

The Early Years Transition and Special Educational Needs (EYTSEN)

5.11 As part of the wider study, the EPPE team conducted an investigation into children who might be 'at risk' of special educational needs (SEN). The EYTSEN project was a sub-study within EPPE. Focusing on children from ages 3-6 years, the study used a range of information to identify children 'at risk' of developing SEN.

5.12 Key findings from these studies include:

· Duration of attendance at pre-school is important - an earlier start (under age 3) is linked to better intellectual development.

· The number of months a child attended pre-school continued to have an effect on their progress throughout Key Stage 1 (primary 1-2, age 5-7).

· High quality pre-school provision, combined with longer duration, had the strongest effect on child development.

· Whether a child attends pre-school full-time or part-time is not important.

· High quality pre-schooling is related to improved intellectual and social/behavioural development for children.

· Settings where staff have higher qualifications have higher quality scores and children make more progress.

· Disadvantaged children benefit significantly from good quality pre-school experiences, especially where they mix with children from different social backgrounds.

· Integrated centres (combining education and care) and nursery classes are more effective than other types of provision in promoting positive child outcomes

· The quality of the home learning environment is more important for intellectual and social development than parental occupation, education and income.

· Those children who had no pre-school experience were more likely to be 'at risk' of Special Educational Needs, even taking into account this group's higher level of multiple disadvantage.

· The form of pre-school provision may be important. Children 'at risk' of poor cognitive development benefited from integrated centres and nursery schools; children 'at risk' in terms of poor social behaviour benefited from both of these and playgroups as well.

Other studies on pre-school education (USA)

5.13 Key findings are:

· Some recent studies in the USA reinforce the findings of EPPE suggest pre-school centred based provision (e.g. family centres and nurseries) are strongly associated with improved cognitive functioning and educational achievement (maths and reading) at a later age for disadvantaged children, particularly for those beginning at age 2 to 3 years.

· In contrast, however, entering childcare early seems to hold negative socio-developmental outcomes "increasing behavioural problems" for these same children. (Loeb et al 2005:80). However these findings are from the USA and may not reflect outcomes in Scotland.

The High/Scope Perry Pre-school Study

5.14 The study, which began in 1962, examined the lives of 123 African Americans from low-income families and at high risk of failing in school with the aim of finding out if pre-school education could make a long-term difference to children's wellbeing. At ages 3 and 4 years, children were randomly divided into a programme group (58 children) and a non-programme group (65 children) who received no pre-school provision. The curriculum for the programme group included five key groups of experience (creative representation; language and literacy; initiative and social relations; movement and music; logical reasoning). Children followed the programme for two years and received intensive input from highly trained workers. An evaluation of the project has monitored their achievement, motivation and social behaviour from the ages of three to 41 years, with very little attrition of the study sample.

5.15 Key findings from the evaluation of this study include:

· The programme was successful (in the short and long-term). Success is likely to be due to the broad coverage of the curriculum.

· High/Scope Perry is cost-effective: the major cost is the initial investment, while the major benefits are reduced costs of education, increased earnings, and decreased costs of welfare assistance and crime.

· Other American studies (such as the Early Training Project, the Carolina Abcderian Project and the Milwaukee Project) which have received rigorous evaluation have found positive effects on school and college attainment. Although there were variations in the implementation of key aspects of the interventions, over time participants' motivation and social skills reduced the impact on criminal justice services and improved health and job market performance [131].

· Evaluation of the Seattle Social Development Project, which combined training to improve children's social competence and thinking skills with a parenting programme and classroom management programme for teachers (with promising long-term outcomes) highlighted the finding that a 'late intervention' programme did not produce the significant long-term effects achieved by the full intervention.

· It is not clear whether outcomes for the most disadvantaged children matched those with fewer risk factors.

· Since all the evidence comes from the US, it is not known whether these programmes would be transferable to the Scottish context.

· Systematic review of day care for disadvantaged pre-school children: reported positive effects on mothers' education, employment and interaction with children. For children: there was an increase in their IQ and positive impacts on behavioural development and school achievement. Long-term follow up demonstrated increased employment, lower teenage pregnancy rates, higher socio-economic status and decreased criminal behaviour.

· Systematic review of day care: most of the trials combined day care with some element of parent training or education (mostly targeted at mothers) and did not separate out the possible effects of these two interventions.

Transitions

Transition to pre-school

6.1 Growing Up in Scotland offers some findings on parents' views of their child's transition to pre-school:

· Almost universal (94%) uptake of free pre-school places

· Six in ten parents had sought advice or support before enrolling their child in pre-school (a third from pre-school staff and a third from friends).

· Evidence suggests that there do not seem to be problems with children making the transition to pre-school. Only a minority of parents (8%) felt they or their child had needed support adjusting to pre-school and most felt they had received it.

· The vast majority of children said positive things about pre-school and looking forward to attending.

· Some families were concerned about child readiness for pre-school - these were: whether their child would find being apart from them difficult (31%) and whether the child would be reluctant to go (34%). This concern was more common in parents of boys, those who had only used informal childcare and those who were not working. (Anderson & Bradshaw, 2007).

Nurture groups

6.2 A nurture group is a small supportive class of up to 12 children usually in a mainstream Primary School, which provides a secure, environment where the different developmental needs of each pupil are catered for. They focus on emotional and social development as well as academic progress.

6.3 A pilot and full evaluation was carried out on the Glasgow local authority school nurture groups.

· Pilot: nurture group children improved significantly compared to matched peers in three key areas: behaviour; their social and emotional wellbeing and academic attainment (particularly in basic literacy skills).

· Full evaluation: (16 nurture groups matched to 16 control groups, 179 children assessed) also sought views from parents.

· Parents identified a variety of improvements in children's skills relating to: improved emotional intelligence (empathy, being a good loser, controlling temper); sharing; social interaction (friendly to other children) and communication skills (verbal descriptions; listening skills, turn taking) and so on.

· Results from pupils were not given in the summary report.

6.4 Cooper & Whitebread (2007) [132] carried out a longitudinal study on the progress of 546 school pupils in 23 schools across England with an average age of 6½ years who were in nurture groups. They tracked the children over a period of two years and compared findings on children in nurture groups with other children in the same schools who displayed similar social, emotional and behavioural difficulties (SEBD) but were not in nurture groups.

6.5 Key findings include that:

· There were greater improvements in social, emotional and behavioural functioning for the children in nurture groups than it was for the children in the same schools who were not attending nurture groups (nurture groups: 88% had borderline/abnormal scores [133] in term 1 falling to 67% in term 4 compared to 84% falling to 74% in term 4 for non-nurture group children). Similarly 'normal' scores increased more for children in nurture groups (12% in term 1 rising to 33% in term 4) compared to non-nurture group children in the same schools (16% rising to 26%). This was marginally but not statistically significant Cooper & Whitebread, 2007).

· Schools with nurture groups appear to work more effectively with pupils who have SEBD even if they do not attend a nurture group compared to schools that do not have a nurture group on site Cooper & Whitebread, 2007).

· Having an effective nurture group in the school also impacts upon those children with SEBD who are not actually attending it and contribute to the development of a 'nurturing school' Lucas, 1999 [134]; Doyle, 2003 [135]).'Mainstream' staff develop more 'nurturing' approaches to pupils on the basis of their interactions with nurture group staff Cooper & Whitebread, 2007.

6.6 Research on the link between mental health and behaviour in schools was commissioned by the Scottish Executive Pupil Support and Inclusion Division (Shucksmith et al, 2005 [136]). This did not directly examine nurture groups but deals with some of the same approaches. Views of parents, children and schools on successful approaches to meeting the needs of children who displayed behaviour with a mental health/wellbeing root were reported on. Six different case study approaches/interventions to supporting children, with these types of behaviours, were examined [137]:

6.7 Results include that:

· Some of the best examples of work in the case studies offered integrated service packages, however these tended to operate to professional-led agendas rather than being community responsive.

· The use of workers (employed outside the traditional professional roles e.g. pupil and parent support workers or family learning co-ordinators) seems to be one of the more successful ventures in being able to provide very disempowered parents with more legitimate voices and routes of access into the school system. This resonates with the 'keyworker' approach that was found to be particularly successful in engaging vulnerable parents in WFF.

6.8 Similarly, other research from the USA (King et al (2002)) argues that the 'quiet room', which offers a nurturing space away from the classroom to children who have social, emotional and behavioural problems has been positive and that the project has potential for extension.

Sustaining the impact of interventions beyond the early years

Evaluations of High/Scope Perry Pre-school Project

7.1 There is evidence from Highscope/Perry and EPPE that the effects of early years interventions endure well beyond the early years into adulthood and even middle age, in the case of Highscope/Perry and into early primary school in the case of EPPE.

7.2 In the case of High/Scope positive results were not immediate. For ten years, virtually no differences were found between those who had received the High/Scope intervention and those who had not (and instead received direct instruction [138]) in terms of intellectual and academic performance. Once the differences began to emerge, they showed a stark contrast.

7.3 Key findings from Schweinhart and Weikert (1997) [139] included that:

  • Differences in 'community behaviour' began to emerge and the direct instruction group reported committing 2½ times as many acts of misconduct as the High/Scope group at age 15.
  • At age 23 the direct instruction group had three times as many criminal arrests per person, especially relating to property crimes
  • 47% of the direct instruction group were treated for emotional impairment or disturbance during their schooling, as compared to only 6% of the High/Scope group.
  • Results are attributed to the emphasis on planning, social reasoning, and other social objectives in the High/Scope curriculum.

7.4 The chart below on more recent research from Schweinhart et al (2005) [140] illustrates the long lasting effects of the High/Scope intervention for the programme group (those that received the participatory approach pre-school intervention and the non-program group (those who did not receive the intervention).

Chart 2: Findings from High/Scope Perry Preschool Study

7.5 Key findings from the above show that those who received the intervention in pre-school at age 40 are:

  • Less likely to be arrested five or more times (36% compared to 55%)
  • More likely to earn more than $20,000 (60% compared to 40%)
  • More likely to have graduated from high school (65% compared to 45%)
  • More likely to have 'basic achievement' at age 14 (49% compared to 15%)
  • More likely to have an IQ of 90 or more at age 5 (67% compared to 28%)

Costs and outcomes in services for children in need

High/Scope

7.6 In the USA a series of studies targeted at higher risk families followed up over time have estimated a payback of 3-7 times the original investment by the time the young person reaches the age of 21. A cost-benefit analysis was also carried out for High/Scope which presents a convincing argument of the benefits and cost-effectiveness of this form of pre-school education (Weikart, 2000) which showed seven times the benefit for the cost invested.

"Dividing the $88,433 in benefits per participant by the $12,3546 in cost per participant, results in a benefit-cost ratio of $7.16 returned to the public for every dollar invested in the High/Scope Perry Pre-school programme". (Weikart, 2000, p65)

Overview of costs and outcomes of children in need

7.7 A long-term approach to decisions on spending and service planning needs to be taken if resources are to be shifted towards intervention earlier in life and earlier in the development of problems for children who are at high risk. The English Government recently commissioned a programme of research on Costs and Outcomes in Services for Children in Need in which each of 14 studies included an economic component that attempted to describe the way resources were used or to link costs to the results achieved. The focus was broader than the early years but the studies included health visiting, therapeutic family support and Home-Start. Findings were drawn together into an overview report, aimed at helping commissioners and managers by illustrating the possible impacts of their decisions to spend money in particular ways (Department for Education and Skills, 2007, summarising Beecham and Sinclair, 2007 [141]).

7.8 The authors conclude on what the most rational approach to decision-making is likely to depend: Key findings from this are that we need to:

· Understand the current position - including variations in how local authorities and partner agencies uses resources.

· Plan and designing services - shifting resources from 'heavy end' higher-cost services to earlier, more preventative services.

· Link costs and outcomes - developing the kind of services that have the best chance of success, such as those targeting high risk children who are at a turning point or transition in their lives.

· Improve information about what works - supporting research and evaluation and improving monitoring data.

7.9 In terms of what we know overall about the costs and outcomes of services for children in need:

· Tightly controlled interventions with a clear rationale tend to have better outcomes than less strictly controlled 'standard' interventions.

· It is easier to improve outcomes for younger children than with older ones.

· The evidence base is stronger for specialist programmes (usually targeted work with vulnerable families - such as intensive home visiting) than on universal family support services (such as Home-Start) but universal services that have been evaluated appear to be both relatively low cost and very well received.

0-3: How Small Children Make a Big Difference

7.10 This paper, published in January 2007, takes a broad focus on the long-term impacts of addressing issues of parenting and care in the early years.

7.11 Key findings include that:

· Early engagement pays a very high rate of return. Growth modelling on early years investment by the Brooking Institute led to the conclusion that, in the USA 'using reasonable assumptions, we project that GDP would be $988 billion larger within 60 years' although, as yet, no one has modelled the dynamic and complex factors that would affect growth in the UK.

· If they receive sensitive care in the first 3 years, children will feel better in themselves, be more resilient and appreciate other people's feelings

· Costs should rise for screening and support during pregnancy, through to parenting and enrichment for children from 0 to 5, and again at 16-18 as more young people stay on at school. However, outcomes would start improving from primary year one, with children arriving at school with better behaviour, motivation and language skills

· Families and not schools are the major contributors to inequality in student performance

· Investment promotes economic growth by creating a more able workforce and reduces the costs borne by criminal justice, health and welfare system

· Remedial work for young people from an impoverished environment becomes progressively more costly the later it is attempted.

The costs and benefits of early intervention

7.12 Hallam (2008) [142] summarises the costs and benefits of early intervention in her review of the evidence:

· Early engagement pays a high rate of return. High quality longitudinal research of an innovative initiative from the US (the Perry Pre-School Project) indicates major benefits to the criminal justice system, health, education, employment and income levels and a return of $17 dollars for every dollar spent by the time participants reached the age of 40

· However, it is risky to extrapolate from studies conducted 20 or 30 years ago (and outwith the UK). The problems of the children served are likely to be more severe and the definition of particular outcomes may have changed over time

· No one has yet modelled the dynamic and complex factors that would affect growth in the UK if greater investment was made in the early years.

· Evidence on the effectiveness of parenting interventions which focus on improving educational outcomes for children is inconclusive and further complicated by lack of rigorous evaluation of many interventions, and few examinations of costs and benefits. However interventions in this area may be low cost and so the benefit-cost ratio is likely to be positive

· Home visitation interventions show some benefits, although effects across a range of child outcomes are likely to be modest. Cost-benefit analyses of the Nurse-Family Partnership indicate that the programme is most effective when serving high-risk individuals, but would be cost-effective even if aimed only at low-risk families

Models for delivering integrated services (children's centres; networks; partnerships)

Statistics on the number of childcare services per centre

8.1 The following bar chart shows the number of childcare services provided within each centre, giving a flavour of the level of integration of childcare provision within different types of centres.

Chart 3: Number of childcare services provided by centre, by centre's main service, January 2007

Source: Scottish Government, Pre-school and Childcare Census 2007

Note: The proportion of centres with only one service may be an overestimate because when a centre did not specify which services were provided it was assumed that main service was the only one.

8.2 As would be expected, children's and family centres provided the biggest range of childcare services (six), crèches provided five services, out of school clubs, nurseries and playgroups each provided four services, holiday play schemes provide three services and sitter services provided only two services.

Sure Start

8.3 Sure Start is a Government programme in England which aims to deliver the best start in life for every child. A review of services for young children, carried out 1997-98 ( http://www.archive.official-documents.co.uk/document/cm40/4011/401122.htm)

concluded that there was no single blueprint for the ideal set of effective early interventions, but that they should share the following characteristics:

· two generational: involve parents as well as children

· non-stigmatising: avoid labelling 'problem families'

· multifaceted: target a number of factors, not just (eg) education or health or 'parenting'

· locally driven: based on consultation and involvement of parents and local communities

· culturally appropriate and sensitive to the needs of children and parents

8.4 Accordingly, Sure Start in England was developed in 1999 to bring together early education, childcare, health and family support, with an emphasis on outreach and community development. Sure Start in England covers a wide range of programmes, both universal and those targeted on particular local areas. The objectives of the initiative which supports vulnerable families with very young children are to: improve children's social and emotional development; improve children's health; improve children's ability to learn; strengthen families and communities.

8.5 The initiative represents an effort to change, expand and enhance existing services, rather than providing a specific service. Funding has been allocated to local authorities to spend on Sure Start Scotland since 1999, distributed on a weighted basis to reflect population, deprivation and rurality. The target is for 15,000 vulnerable children aged 0-3 to receive an integrated package of care involving a range of services.

8.6 In England, a programme of evaluation has found that, where Sure Start is implemented as intended, there is some evidence of effectiveness, but that it is too early to see the expected long-term benefits. To date, the initiative has experienced difficulties reaching and engaging the most disadvantaged families.

Sure Start Local Programmes

8.7 Sure Start Local Programmes (SSLP) in England differ from other interventions undertaken to enhance the life prospects of young children in that they are area based, with all children and their families living in a prescribed area serving as the 'targets' of intervention. This has the advantage that services within a SSLP area are universally available, thus avoiding any stigma that could result from the targeting of individuals. However, it may also mean that families in greatest need are not accessing or engaging with services.

8.8 A new report on the National Evaluation of Sure Start (NESS) report has recently been published in March 2008 [143].

8.9 It found that living in a Sure Start Local Programme (SSLP) area was associated with positive impacts on 5 of the 14 outcomes investigated. Children living in SSLP areas showed more positive social behaviour and greater independence/self-regulation, whilst parents made greater use of support services, showed less negative parenting and provided a better home-learning environment. The analysis showed beneficial effects for almost all children and families living in SSLP areas and provided almost no evidence of adverse effects on population sub-groups, such as workless or lone-parent families.

8.10 These results are very different to those from the first phase of the Impact Study, which was published in 2005 and is outlined below. Although methodological variations may account for differences in findings, the researchers argue that it is eminently possible that the contrasting results accurately reflect the contrasting experiences of SSLP children and families in the two phases. They argue that the three-year olds in the latest study have benefited from exposure to more mature and developed local programmes throughout the course of their young lives.

8.11 The 2005 evaluation of SSLP found the following [144]:

· Do children/families in SSLPs receive more services or experience their communities differently than children/families in comparison communities?

There is little evidence that SSLPs have achieved the goals of increasing service use and/or usefulness, or of enhancing families' impressions of their communities. Among families with 36-month old children, mothers in SSLP areas rated their communities less favourably than those in comparison communities

· Do families function differently in SSLP areas than in comparison communities?

SSLPs seem to enhance growth-promoting family processes to some extent, though many family outcomes appear to be unaffected by SSLPs.

· Do the effects of SSLPs extend to children themselves?

Relatively less disadvantaged children/families seem to benefit, while relatively more disadvantaged children/families seem to be adversely affected.

· Are some SSLPs more effective than other SSLPs?

8.12 There is some evidence that programmes led by health agencies have certain advantages. This may be because such SSLPs have immediate access to birth records; also their health visitors, who visit every infant, are likely to be better integrated with SSLP services and can direct needy families to relevant SSLP services.

8.13 In the short term, the intervention appears to have produced greater benefits for the moderately disadvantaged than for the more severely disadvantaged. It is suggested in the paper that the utilisation of services by those with greater human capital left others with less access to services than would have been the case if they had notlived in SSLP areas. Special efforts may need to be made to ensure that those most in need are not inadvertently deprived of assistance, due to the way in which SSLPs operate. Less disadvantaged families are likely to find it easier to access services and information about services, whereas the most disadvantaged families remain, at least in the shorter term, harder to reach and to engage.

8.14 In an evaluation of the variations in effectiveness among SSLP it was found that [145]:

· Programmes that scored well showed better results in some parenting outcomes and, to a lesser extent, in child development outcomes

· High scores in empowering users and providers of services were related to:

o Higher levels of maternal acceptance when child was 9 months old

o A more stimulating home learning environment when the child was aged 3

· A stronger ethos and better overall scores on the 18 dimensions were related to higher levels of maternal acceptance for families with 3 year olds

· Better identification of users by programmes was related to higher non-verbal ability in 3 year olds

· Having a greater number of inherited parent-focused services was related to less negative parenting

· Having a greater number of improved child focused services was related to higher maternal acceptance

· Having a greater proportion of staff that was health related was associated with higher maternal acceptance

· Reach figures were disappointing. Those who used services often used several, and reported satisfaction. But services offered at traditional times and in conventional formats did not reach many fathers, BME families, working parents. Providers found barriers to attracting 'hard to reach' families difficult to overcome

· Few programmes demonstrated proficiency in systematically monitoring, analysing and responding to patterns of service use or rigour in measuring the impact of treatments

· Multi-agency teamwork, including effective ways of sharing information, and clarity about the cost effectiveness of deploying specialist and generalist workers strategically, proved difficult to manage and operate.

What do we know about the effectiveness of SureStart Scotland?

8.15 The impact of SureStart Scotland has yet to be evaluated in Scotland, but a mapping exercise carried out in 2004/05 found that some SureStart Scotland services had formal evaluations in place and the majority of local authorities carried out formal consultations [146]. Five thousand and seventy five children were found to be in receipt of an integrated package of care, but numerical information was only received from 7 out of 32 local authorities, and it was not clear that all children being supported were necessarily from disadvantaged families. The Scottish Executive target of 15,000 vulnerable children receiving an integrated package of care may have been met, but this is not known for certain, as less than a third of returns had data on this. Sure Start Services were found to be reaching pre-birth services as well as children in the 0-3 age group.

8.16 Key findings relating to SureStart Scotland services:

· SureStart Scotland contributes to extending and enhancing services rather than replacing existing services with new services

· Services for which data were collected were meeting the range of SureStart Scotland objectives. Fewer claimed to be meeting the objective 'to improve children's health' although data suggest that it is in the area of health that some of the most innovative developments were taking place

· Improvements in joint working between professional groups (health, social work and education) although progress still needs to be made on this

· Services aiming to serve the hardest to reach groups reported success (individual examples are noted in the report)

· Some services had formal evaluations in place and the majority of local authorities carried out formal consultations

· Impacts of services related to improved child behaviour and development, increased self-esteem of the parent, preventing more intensive social work involvement as well improving health. Evidence from the case examples showed the impact of single, short term interventions as well as longer term, integrated interventions

8.17 The following concerns were raised around SureStart Scotland:

· demand for Sure Start Scotland services outweighs supply

· how to ensure provision of support beyond age three?

· how to balance the needs of the highest priority families with preventative work with other vulnerable families

· support may become intrusive

Sure Start Children's Centres in England

8.18 The Sure Start Children's Centre programme in England is based on the concept that providing integrated education, care, family support, health services and support with employment are key factors in determining good outcomes for children and their parents [147].

8.19 A 2008 report outlines the impact of services provided by extended schools and Sure Start children's centres in England on children and young people from birth to 19 and on their families. It follows an earlier evaluation of the national roll-out of extended services [148].

8.20 The survey was conducted between September 2006 and April 2007. Inspectors visited 30 children's centres and 32 schools in 54 local authorities that had established, or were developing, extended services. [149] Inspectors evaluated the effect of services on promoting the outcomes of the Every Child Matters agenda, including the impact of services on the development of young children. [150] They sought evidence particularly of the impact of services on vulnerable groups. They also assessed how far the schools and children's centres were meeting their respective 'core offers' that comprised a range of services.

8.21 Key findings included:

· Over three-quarters of the children's centres were classified as providing at least 'good' services and all integrated early education and childcare very effectively.

· Thirteen of the 32 schools inspected were providing their core offer in full, and the others were making good progress towards it. Almost all provided varied activities out of school hours. Children and young people enjoyed these activities and were motivated them to develop new skills and interests.

· The majority of the schools, however, found it difficult to provide year-round care or to support families in finding such provision.

· In 23 of the 30 children's centres, children's progress was rated at least 'good' in the sessions inspectors observed although, impact of the provision from their starting points had not been measured. Schools reported that children joining them from children's centres had positive attitudes and were well prepared for and enjoyed learning.

· The extended provision was having a positive impact on children's and young people's achievement and personal development, especially for the more vulnerable.

· Schools that provided the most effective services integrated these within their planning for whole-school improvement, because they were clear about the overall outcomes they wished to achieve for their pupils. There was also some evidence of schools radically rethinking their ways of working to provide better access to services. In particular, these schools had set up teams of staff from different professional backgrounds to support vulnerable pupils. This enabled swift action to be taken, preventing difficulties becoming more serious. In one school, case studies showed that this approach had reduced exclusions and improved attendance. School governors and managers were aware of their responsibilities and took an active interest in ensuring the provision of good quality childcare on their premises.

· Schools and children's centres were not always sufficiently active in reaching out to groups, including fathers and some minority ethnic groups, who did not use the provision. Some schools recognised that services were not used enough by the families beyond the immediate school neighbourhood but they were not effective enough in widening participation.

· Local authorities provided strategic guidance to help children's centres and schools extended services across an area. Only a small minority of schools and children's centres were gathering and using evidence on outcomes so it was difficult for local authorities to know if these services provided value for money. Support from local authorities for monitoring and evaluating impact was limited. The survey, however, found specific examples of provision having contributed substantially to outcomes for individual children and adults.

· Users valued the services provided in children's centres and schools highly. Take-up was better where provision was carefully co-ordinated, including access to a range of health services and where transport difficulties were considered. However, uncertainties about the sustainability of longer-term funding for partner agencies threatened services and staffing, particularly in children's centres.

Early Excellence Centres (EECs)

8.22 EECs are Government run 'one-stop-shops' where families and children below school age can gain access to high quality, integrated care and education services within a single centre in England. Dickson et al (2007) [151] discuss two key evaluations that were carried out on this type of provision in the UK, 'The Hackney Project' and the 'Early Excellence Centres Pilot Programme Evaluation'.

The Hackney Project

8.23 This study attempted a randomised controlled trial of daycare in an Early Excellence Centre in Hackney in London. Findings were that no effects were found on child development as a result of the provision. The methodology of the study was, however, flawed there were insufficient numbers of participants and the numbers of mothers assigned to either the control or intervention groups were uneven, making real differences difficult to identify.

Early Excellence Centres Pilot Programme Evaluation

8.24 Twenty-nine EECs were established in England between 1997-1999. These were evaluated, from 1999-2002, using a qualitative case study approach of 315 EEC providers and service users and data on the performance and progress of the children and families. The findings from this evaluation showed perceived positive impacts upon child and family outcomes.

8.25 Key findings [152] included:

· 59% of case studies reported enhanced children's social competence and dispositions

· 29% reported enhanced child cognitive development

· 41% reported reduction in isolation for families

· 41% reported improved family relationships

· 39% reported less stress and improved mental health

· 36% reported higher self-esteem and confidence

· 29% reported improved parenting skills

8.26 Dickson et al (2007) also provide a useful table summarising the three key strands of UK evidence that they reviewed.

Summary of UK Evaluations of Interventions

Hackney Project

Randomised experiment

120 families, disadvantaged area. Children birth to 3 years old

Early Excellence Centre versus control group (who also received day care)

Hackney, London, late 1990s

Nothing of significance due to methodological problems.

Sure Start Local Programmes National Evaluation

Quasi-experiment design

16,502 families in 150 areas amongst the 20% most deprived areas; 2,610 families in 50 comparison areas Children birth to 4 years old

SSLP children versus children in similar, soon-to-be SSLP communities

England, 1999-ongoing

3 year olds of non-teen mothers exhibit fewer behaviour problems, greater social competence in SSLPs.

Negative effects of SSLP on 3 year old children from teen mothers - verbal ability, social competence, increased behavioural problems; negative effects of SSLP on children from workless households or lone parents - verbal ability.

Early Excellence Centre National Evaluation

Case study

315 case studies from 29 EECs, 2/3 of which are in the poorest 20% of population wards; children birth to 4 years old

No comparison group

England, 1999-2002

Only qualitative rather than quantitative effects reported by case study evaluation: in 59% of case studies parents and practitioners reported enhanced child social competence and in 29% of case studies they reported enhanced cognitive development.

Strategic planning by local authorities

9.1 This following section was adapted from a summary report by Hutton et al (forthcoming 2008).

9.2 Most authorities are developing strategic plans to make services staged or tiered and progressive from universal to specialist targeted provision for those at high risk. Progress on this varies and no authority has yet provided a model of best practice. A few authorities are, however, beginning to shape their strategies in ways that recognise the different needs of families according to vulnerability, the kinds of difficulties they experience and by age across the life course.

9.3 Few have clear criteria for entry or exit to different tiers of provision or have matched their provision tiers to capacity/demand data (gap analysis) or the availability of trained staff to provide the service to meet the demand.

9.4 There is strong evidence of a multidisciplinary approach to strategic planning in most authorities. The evidence at this stage is less convincing that delivery is multi-disciplinary or co-ordinated although there were some good examples of attempts at multidisciplinary approaches with high-risk adolescents.

9.5 Each authority seems to be working in relative isolation and is to some extent inventing its 'strategic wheel'. It may be useful for some authorities who have exemplary models of good practice to provide consultancy support from which other authorities can draw and apply to their own situation.

9.6 Data generated from health provision seems more refined in differentiating methods and age. The Hall 4 framework for health practitioners, though not without its critics, supports an age-stage approach. Evidence of this in many of the local authorities' provision was that it was still in its early stages. Also, evidence of specific educational provision was limited and seemed often subsumed within the general provision led by social work. The Hall 4 model adopted by health provides, in principle, universal contact points with children and their families across the life course ages 0-14. These are complemented by universal educational assessment on numeracy, literacy and personal management at primary 1 and primary 7, approximately ages 5 and 11. While social work has no equivalent structure, these universal stages broadly match the age-stage structures in the literature as crucial 'pick up' points for vulnerable children allowing for strategic links to various 'levels' of multi-disciplinary preventive or early intervention as a key element of any strategy for the provision of parenting services and support.

Health Plan Indicator (HPI)

9.7 Under the Hall4 core programme, every child is reviewed by a public health nurse at 10 days old (known as the public health nurse first visit) and then most commonly by a public health nurse and a GP at 6-8 weeks old. Information gathered in this early period should provide the basis for establishing the nature and frequency of further contacts. This should assign the family to one of the models of continuing contact and support:

  • CORE - The universal programme.
  • ADDITIONAL - The universal programme + structured additional support
  • INTENSIVE - The universal programme + intensive inter-agency support

9.8 The health professional records which model of continuing contact and support the family has been assigned to i.e. 'Core', 'Additional' or 'Intensive'. This is known as the Health Plan Indicator (HPI). Health professionals can amend a child's HPI as necessary in line with changes in the child's health/family circumstances. Beyond the universal programme of contacts the health professional uses their professional judgement to decide on the nature and frequency of further contacts with the family for review of child development.

9.9. The table below shows the current picture (at December 2007) of HPIs by the year of a child's birth.

Current HPI breakdown by Year of Birth

Source: ISD

Extract from CHSP-PS at December 2007

9.10 Newborns and younger children are more likely to have an 'Additional' HPI than older children. At December 2007, 48.1% of children under 1 year of age (born in 2007) had an 'Additional' HPI, compared with 16.6% of children aged 4 (born in 2003). This is to be expected as parents tend to need more support in the earlier weeks and years. The proportion of children on 'Intensive' is broadly similar in each age group. a higher percentage of the younger children born in 2007 are classified as having 'additional' HPI than older children, for example, born 2003.

Problems Recorded

9.11 From data recorded on Child Health Systems Programme Pre-School system (CHSP-PS) it is not possible to provide a comprehensive summary of the problems associated with children assigned to an 'Additional' or 'Intensive' HPI. There is the facility for the public health nurse to record problems on the review form, however this section of the form is poorly completed. There may be a reluctance on the part of the public health nurse to record social concerns in particular, given that the assessment is shared with parents.

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DEVELOPING A SUITABLE WORKFORCE TO SUPPORT THE STRATEGY

Introduction

1.1 This chapter summarises the evidence on the early years and early intervention workforce. The evidence covers some of the key pieces of research on the topic, both from a Scottish and an international perspective. Key statistics will also be summarised in relation to the Scottish workforce on the whole as well as more specific sectors (pre-school, childminders, and social care workers).

1.2 The first section in this chapter looks at qualifications, pay and characteristics of the early years workforce on the whole. Then more specific evidence/research on the pre-school teacher workforce will be covered, followed by research on pedagogy and other working models. The chapter will conclude with a look at broader trends in the workforce, including the total workforce in Scotland as well as specific sectors.

Importance of the Workforce

2.1 The workforce is the most essential part of early years intervention. Whether it's working directly with children or those with a more strategic overview, the workforce will be essential for taking forward the framework. The services provided by the early years workforce helps to influence how children learn and develop and can help raise children out of poverty. The early years workforce is diverse and covers not only pre-school teachers but also childcare, family centre workers, nursery staff, out of school clubs and much more. It is important to recognise the challenges and opportunities that this diverse workforce face.

Qualifications, characteristics, pay and conditions

3.1 This section covers qualifications, pay, working conditions and other characteristics of the early years workforce (both pre-school and other). There is a vast body of literature on the benefits of having well qualified staff in early years education/care. The benefits extend beyond academic improvements (reading, arithmetic) to wider cognitive/behavioural benefits. The knowledge and skills of the adults working with children (including pre-school teachers) are amongst the most important factors in determining how well a child learns.

3.2 There are 10,477 childminders and child care centres. 68% of these are private sector, 18% are public sector and 14% voluntary. However, if childminders are excluded (6020 centres) 42% are public sector, 24% private sector and 33% voluntary.

3.3 There are a total of 27,984 paid staff working directly with children in pre-school and day care centres. There are 799 vacancies (3% for the workforce) for this cohort which is not far off the national vacancy level (which is around 2%). The vast majority of the workforce is female (around 96%).

3.4 The graph below shows the age breakdown of the workforce in several sectors, including the economy as a whole. It should be noted that the data for childminders and preschool/daycare staff is taken from the Scottish Government pre-school and childcare statistics and the age breakdown is not exactly the same as the other job categories (where the data comes from the Labour Force Survey). Pre-school/daycare staff are generally younger than the other sectors and the Scottish labour force on the whole. A vast proportion of childminders are in the 34-45 age cohort.

3.5 The current level of qualifications held by the preschool and daycare workforce in Scotland (excluding childminders) is as follows: 80% have a childcare qualification, of which 76% have a qualification at SVQ level 2 or above and 65% at SVQ level 3 or above. Only 8% of the workforce has a degree level childcare qualification. Public sector staff have a higher level of qualification than the private sector staff. For the childminder workforce the level of qualifications are as follows: 34% have a childcare qualification, of which 18% have a childcare qualification at SVQ level 3 or above. 1% of the childminder workforce has degree level childcare qualifications. See table 1 in the appendix for more details.

3.6 The UK seems to lag behind some other developed economies in terms of level of training of the early years work force. A report prepared for DfES by Cameron et al (2003) [153] highlights that "a three year+ training at higher education level is becoming the norm in Nordic countries for early years and childcare work, and elsewhere for early years education with children from age 3 years upwards. This level of training also applies to the 'core' early childhood worker in New Zealand and Spain. Otherwise, training for work in childcare services is at a lower level". This report also points out that internationally teachers are generally trained to a higher level and have better pay and working conditions than childcare workers in the UK. The national review of the early years and childcare workforce [154] highlights this more specifically for Scotland, stating that "critically, the single most significant factor in determining the quality of the centre is the level of qualification of the manager of the centre, and to a lesser extent the level of qualification of the wider workforce". The review recommends a new qualifications structure for the sector, focusing on the following main attributes:

- One framework for the whole sector;

- Services to be led by SCQF level 9 (ordinary degree or work-based equivalent) qualified professionals;

- Entry and exit points at each level - supporting flexibility and movement;

- College, university and work-based routes - supporting flexibility and inclusion;

- Recognition and accreditation of prior learning - supporting flexibility and inclusion;

- Supports progression and continuing professional development (CPD);

- Supports identification of shared skills/knowledge base across children's services.

3.7 DCFS [155] have put together national standards for under 8s daycare and childminding. This includes qualifications standards, for example, all supervisors in daycare centres must have a level 3 qualification and at least half of all other child care staff must hold an appropriate level 2 qualification. The (Scottish Executive) national review of the early years and childcare workforce also has a qualifications framework although they are not official standards as such. The proposed qualification structure is more flexible and takes account of the fact that workers may be working in more integrated settings. The national review also recommends one framework for the whole sector (whereas the DCFS standards changes slightly depending on the sector). On the whole the basic DCFS and Scottish executive qualifications requirements are fairly similar.

3.8 Some research suggests that it is insufficient for a pre-school teacher to just have a general teaching degree, they should also have had specialised training and a child development knowledge in order to be a more effective teacher or pedagogue.

3.9 Higher levels of qualification for pre-school teachers were found to be strongly related to a variety of child outcomes including: child behaviour, school readiness, language skills and the types of activities that they expose children to (for example, more academically and cognitively challenging activities such as literacy and maths). Conversely, teachers who had lower levels of education had more negative beliefs, for example, lower confidence in their own abilities to work with parents, which resulted in poorer quality teaching for children.

3.10 Another issue in the early years workforce is status. This is backed up by the national review of early years and childcare workforce, which highlights that working in early years is often seen as low skill work when in reality this is not the case. Moss (2003) [156] points out that this is an issue at the UK wide level: "cross-national comparisons illustrate the lowly position of childcare workers in the UK". The workforce is already moving towards a more professional basis but there needs to be more of a focus/greater communication on career development from the outset.

3.11 There is no official collection/data source on salaries of the early years workforce. While there is anecdotal evidence that salaries are low there are no official source on which to make concrete claims.

3.12 A DfES report [157] on recruitment and retention, whilst not covering Scotland, points to some important messages in relation to pay and status. Many providers covered in the study reported difficulties recruiting staff, particularly day nurseries, out of school care and pre-school/playgroups. Providers explained their recruitment difficulties with reference to pay, hours of work, image of the sector, competition from other sectors and their location. The report also highlights the importance of recruiting the right people: "Nursery workers in particular enter at a young age straight from school or college and research on turnover in the childcare sector suggests that younger and less experienced staff are more likely to leave than those with more experience. It is possible that new entrants have inaccurate expectations of the work. Research on young people's expectations of working in childcare might help to identify possible misconceptions and help to improve information and guidance for childcare careers. Such information would also be useful in recruiting older people".

3.13 The national family learning network (a UK organisation) offers free training resources/sessions for early years workers who work with families. This is a good example of how to help early years workers better engage with families.

Pre-school Teachers

4.1 Although there are overlaps between the different occupational groups, the role of pre-school teachers will be addressed before other occupations/working models.

4.2 As of September 2007 the full-time equivalent number of pre-school teachers registered with the General Teaching Council for Scotland (GTCS) was 1,514. Sixty five per cent of pre-school education providers had access to at least one GTCS registered teacher.

4.3 Pre-school teachers may impact positively on the training levels and confidence of other early years staff in Children's Centres, for example, one study found they are more likely to work towards a childcare qualification or specialised training if there is a pre-school teacher to help motivate or encourage them.

4.4 In terms of adult-child ratios, having more adults per children were found to lead to positive adult-child interactions and impact positively upon overall centre quality and child developmental outcomes.

4.5 Staffing issues (for example, high staff turnover, long shifts); environment; resources (investment in the accommodation and materials) and the size of the setting are likely to lessen the impact of a pre-school teacher.

4.6 There may be significant challenges for the pre-school teacher to change practices if they have been long established. However, long serving staff and an emphasis on staff development were factors in good early years centres that may enhance or facilitate the impact of a pre-school teacher.

4.7 Several literature sources identify key practical or 'harder' skills, related to experience and knowledge, that a pre-school teacher should posses:

1. curriculum planning

2. record keeping

3. organisation skills

4. an ability to use space, time and material to best effect for children's learning

5. an ability to enable children to work at their own pace

6. having clear principles that underpin their practice.

7. being a team leader who can employ a range of leadership styles appropriate to the situation.

4.8 High/Scope USA evaluations have shown that a child-initiated early years model, which views children as 'active learners' is the most successful in terms of positive impacts later in life (less criminal activities and emotional impairment/disturbance during school). Conversely, children taught under direct or programmed forms of teaching show more stress and anxiety behaviours and lower self-esteem.

4.9 Reflective teacher practices where time is spent planning, evaluating and reflecting upon the progress of individual children (such as under the Reggio Emilia approach [158]) are a critical aspect of teacher quality.

4.10 Several studies point to the closeness of the teacher-child relationship as being critical in positively impacting upon children's academic skills (language, academic, cognitive and social skills) in the pre-school setting. It is not enough for a teacher to just be highly qualified, they also need to be able to teach in a style that is appealing to the children (more child-centred and less didactic) and have the skills to build up good and close relationships with the children they are teaching, in order for those children to learn better.

Pedagogues and other Working Models

5.1 Effective pedagogues do several key things: they asses children's performance to ensure that challenging yet realistic experiences are provided; they provide feedback during activities; they 'model' (i.e. show by example) appropriate language, values and practices. Effective pedagogy is both teaching and the provision of instructive learning and play environments and routines.

5.2 The national review of the Early Years and Childcare Workforce states that "In Scotland we have already started the process of professionalising the early years and childcare workforce. However, we have barely started the debate on what the new profession might look like" (p49). Hence it is a key issue and one which is yet to be resolved. The current understanding of pedagogy in the national review is taken as "about learning, teaching and development, influenced by the cultural, social and political values and principles that we have for children in Scotland, and underpinned by a strong theoretical base" (p49).

5.3 There idea of a pedagogue role appears to be gaining support, as illustrated by the review: "The developing role of the pedagogue seems to reflect well the widening range of roles and responsibilities and the growing interconnectedness of Scotland's early years and childcare workforce with others in improving outcomes for children and their families" (p50).

5.4 The review also emphasises a need to shift the focus away from a one-way relationship to a two-way process with children and young people as they engage in and develop throughout their childhoods.

5.5 In their response to a DfES consultation, the Daycare trust outlined their vision for a pedagogical approach to the reform of the early education and care centre workforce. They see the need for a core professional trained at graduate level as a pedagogue, with around 60% of the workforce having graduate-level qualifications comparable to those of a primary school teacher, with salary and benefits to match. The remaining 40% of the workforce, assistant pedagogues, should have level 3 qualifications. Currently only 8% of the preschool education and daycare staff workforce (excluding childminders) have a childcare related degree level qualification [159]. 65% of the workforce has a qualification at SVQ level 3 or above. Hence, the current situation is a long way off these qualification recommendations.

5.6 Although moving to a more pedagogical system will require increase spending and a cultural shift, the Daycare trust assert that the current lack of a British pedagogical tradition should not be considered an obstacle to developing a pedagogical profession.

5.7 Moss (2003), outlines a three tier model of the childcare/early years education workforce at the UK level: "At the top is a relatively well trained and paid tier of teachers, a graduate profession mostly employed in the public sector, which gives access to various employment benefits such as a final salary occupational pension scheme. At the bottom is a poorly trained and paid tier of home workers, in particular childminders. In between are centre-based childcare workers and educational assistants, rather better trained and paid than childminders, but still far behind teachers". While teachers are the main part of the school workforce, the care commission data shows that class 2 and class 3 workers [160] (who are not teachers) make up the majority of day care staff for children (see table 2 in the annex for more details).

5.8 A report by Bell et al. (2002) [161] found that less qualified early years staff were found to be significantly better pedagogues when they were supervised by qualified teachers. The article also argues that effective pedagogy in early years involves a balance between a teacher directed, programmed learning approach and an open framework approach where children are provided with 'free' access to a range of instructive learning environments in which adults support children's learning.

Other Issues/Potential Challenges

6.1 If the sector continues as it is in terms of salary, conditions, qualifications etc it will be increasingly difficult to recruit enough workers. Given that women make up the vast majority of the early years workforce, as women become better educated and have wider employment opportunities, it will become increasingly difficult to sustain these occupations.

6.2 As Moss (2003) points out, the early years workforce is facing a fundamental challenge; supply is falling while demand is increasing. Primarily demand is increasing due to rising parental employment. Supply is decreasing due to less reliance on informal carers (especially grandparents) who are more likely to be employed. Also, during this decade the number of young people entering the labour market will fall below the numbers leaving the labour market at retirement. Moreover, the number of women in the labour market with low qualifications - the main source of entrants for many forms of 'care' work - is falling as levels of education rise.

6.3 There is also the commitment to decrease class sizes to 18 for P1-3. Naturally this will require extra teachers and based on the assumption that schools will maximise the use of composite classes to reduce class sizes most efficiently, we estimate that an additional 2,900 teachers would be needed for P1-P3. This could put pressure on the wider early years workforce.

Employment/Population Trends

7.1 In order to create a fuller picture of the early years workforce the following section analyses some of the key workforce statistics. Firstly the broad employment trends in Scotland as a whole will be outlined before looking at employment patterns in particular sectors (social care, preschool, health). More specifically the sector (public/private/voluntary) breakdown and population trends will also be analysed.

Total Workforce

8.1 In terms of total employment levels, Scotland is in a relatively positive position. As can be seen from the charts below, employment levels are high (above the UK average) and ILO [162] unemployment levels are low. This basically means that there is not a large amount of excess labour available if, for example, there was a need to expand the early years workforce.

8.2 It is also worth looking at the demographic profile of the Scottish population. The graph below shows the population projections for Scotland from the GRO [163] (General Register Office). The ageing population (as can be seen from the projected increase in over 65s) means that there will be a smaller pool of labour available. However, the child population is also projected to decrease as well and this may offset the effect of a reduction in the working age population.

Employment in Specific Sectors

9.1 The chart below shows the number of people employed in primary education, human health and social work activities. The numbers employed in each of these three sectors has been generally increasing over the last ten years. This especially true for primary education (which has increased by 81% over the period) and to a lesser extent social work (which has seen an increase of 38%). Human health activities have seen an increase of 11% over the period which is very similar to the increase in the number of people employed across all industries in Scotland (10%). Therefore the sectors of interest, primary education and social work activities (of which early years is a part), have seen above average increases in employment levels over the last decade.

9.2 The chart below shows the sector breakdown of the social services workforce. The large increase in the size of the workforce is due to the increase in private/voluntary employment, with Local Government employment fluctuation over the period. This has important implications for any workforce strategies as the private and voluntary sectors are playing an increasing large part in the social work sector (part of which is early years).

9.3 The table below gives a breakdown of Scottish Social Work Service Staff by client group [164]. It should be noted that this is different from the number of staff working in social work activities (as shown in the chart above). In 2006 there were 7,102 staff working with the children client group, which account for 15% of the social work services staff in Scotland.

Social Work Services Staff by Client Group, 2006

Client Group

Total

% of staff

Children

8,124

15%

Adults (Community Care)

Older People

7,978

15%

People with Physical Disabilities

610

1%

People with Mental Health Problems

225

0%

People with Learning Disabilities

4,860

9%

Adults (not separately identified)

22,165

41%

Offenders

1,843

3%

Generic provision

3,971

7%

Management/ Administration

4,000

7%

Total

53,776

100%

9.4 The table below shows the number of community nursing and midwife staff by service delivery [165]. These figures may be a slight underestimate (there are some hospital staff who also work in the community).

Community Nursing and Midwife Staff by Service Delivery, 2007

Service Delivery

Total

Health visitors

1,271

District nurses

476

Public health nurses

134

School nurses

312

Children

59

Mental health

1,709

Learning disabilities

530

Midwifery

165

Other nurses

5,571

Blood transfusion service

220

Family planning nurses

54

NHS 24

530

Treatment room nurses

126

Other nurses

4,641

Total Community

11,408

Annex 1 - Childcare qualifications and job function breakdown tables

Table 1 shows the highest childcare qualification of the pre-school and childcare workforce (excluding childminders). This table is taken from the Scottish Government Pre-school and Childcare Statistics 2007.

Table 1 - Childcare Qualifications by sector/service type, 2007

Highest childcare qualification

Any childcare qualification

Any childcare qualification at SVQ3 or higher

None

SVQ1

SVQ2

SVQ3

HNC

SVQ4

Degree

Other

Unknown

TOTAL NUMBER

4,930

270

3,040

7,380

6,140

2,070

2,220

680

550

21,790

17,810

Percentage of all staff

18

1

11

27

23

8

8

3

2

80

65

Main service type

Nursery

13

1

8

29

26

9

11

2

1

85

75

Playgroup

27

2

13

32

11

4

4

6

2

71

51

Out of school club

34

2

22

18

9

4

2

4

5

61

33

Other

18

2

11

25

28

5

6

3

2

79

64

Management sector

Public

9

0

5

27

28

13

16

2

1

90

83

Private

21

1

14

30

22

5

3

2

2

77

60

Voluntary

27

2

17

24

15

4

4

4

3

70

48

Table 2 is taken from data provided by the care commission on the social services workforce. It shows the job function breakdown of the day care workforce. It should be noted that the daycare workforce in the care commission data is not exactly the same as the preschool and childcare workforce covered in the Scottish Government statistics.

Table 2 - day care for children staff by job function and sector, 2007

Table 2 of ST by funcat

Administrative/Support Worker

Ancillary Worker

Class 2 Worker

Class 3 Worker

Class 4 Worker

Unit/Project Manager

Group Manager

Director/Chief Executive

Unknown

Total

Total (%)

Health Board

2

4

58

44

8

4

5

0

4

129

0.4%

Local Authority

938

1161

2827

2538

1105

1057

364

11

1395

11396

36.1%

Other

4

0

6

11

0

0

0

1

0

22

0.1%

Private

486

706

3774

4193

634

664

432

165

961

12015

38.0%

Unknown

2

1

16

24

1

9

1

0

1

55

0.2%

Voluntary

462

426

2994

2043

370

666

430

42

543

7976

25.2%

Total

1894

2298

9675

8853

2118

2400

1232

219

2904

31593

100.0%

Total (%)

6.0%

7.3%

30.6%

28.0%

6.7%

7.6%

3.9%

0.7%

9.2%

100.0%

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[60] The National Audit of Parent Antenatal and Postnatal Education Provision in Scotland, 2005 quoted in Hallam (2008).

[61] Webster-Stratton, C., Mihalic, S., Fagan,A., Arnold, D., Taylor,T. and Tingley, C. (2001) 'The Incredible Years Parent, Teacher and Child Training series'in Elliott, D.S. (Series Ed.) Prevention (Book 11), Boulder, CO: Blueprints for Violence University of Colorado.

[62] Sanders, M.R., Montgomery, D., and Brechman-Toussaint, M. (2000) 'The mass media and the prevention of child behaviour problems: The evaluation of a television series to promote positive outcomes for parents and their children', Journal of Child Psychology and Psychiatry, 41(7), 939-948 quoted in Penman (2007); Sanders, M.R., Cann,W. and Markie-Dodds, C. (2003), 'The Triple P-Positive Parenting Programme: A Universal Population Approach to the Prevention of Child Abuse' Child Abuse Review, 12 (3):155-171.

[63] Developed in the US, See Gordon (2002) 'Intervening with families of trouble youth: Functional Family Therapy and Parenting Wisely" in McQuire, J. (ed) Offender Rehabilitation: Effective Programmes and Polices to Reduce Re-offending, London, Wiley.

[64] Developed in the US. See Patterson, G.R. (1976) Living With Children, Champaign IL, Research Press.

[65] Mockford, C. and Barlow, J. (2004) 'Parenting Programmes: some unintended consequences', Primary Health Care Research and Development 5:219-227, Moran , P., Ghate, D. and Van der Merwe, A. (2004) 'What Works in Parenting Support?: A Review of the International Evidence', London, HMSO quoted in MacQueen et al (2008).

[66] Hallam 2008 op.cit.

[67] ODPM (2005) Mainstream Public Services and their Impact on Neighbourhood Deprivation, London. It should be noted that this finding was based on 7 case studies across England and Scotland.

http://www.crsis.hw.ac.uk/formatteddoc.pdf

[68] Destinations of Leavers from Scottish Schools 2006/07. Scottish Government.

[69] Social focus on deprived areas 2005. Scottish Government.

[70] Social focus on deprived areas 2005. Scottish Government.

[71] Social focus on deprived areas 2005. Scottish Government.

[72] Technical notes for the 2007 Spending Review. Scottish Government.

[73] Family Resources Survey, Households Below Average Income 2005/06 dataset

[74] Taking Forward the Government Economic Strategy: A Discussion Paper on Tackling Poverty, Inequality and Deprivation in Scotland.

[75] Scottish Index of Multiple Deprivation 2006; General Report

[76] Jamieson, L et al (2008) Growing up in Scotland: Growing up in Rural Scotland, Scottish Government.

[77] Scottish Social Attitudes Survey (2006)

[78]Trikha, S (2003) Children, young people and their communities: summary of top level findings from the 2003 Home Office Citizenship Survey. http://www.communities.gov.uk/documents/communities/pdf/452493

[79] Family and Parenting Institute (2007) Families and Neighbourhoods, YouGov

[80] Social focus on deprived areas 2005. Scottish Government.

[81] Bailey, N. and Hastings, A. (2002) Public services in deprived neighbourhoods: evidence of 'neighbourhood effects' in mainstream public services. Paper presented at the Social Policy Association conference Localities, regeneration and welfare, University of Teeside, 16-18 July 2002.

[82] Duffy, B (2000) Satisfaction and Expectations: Attitudes to public services in deprived areas, CASE Paper 45.

[83] ODPM (2005) op cit; p.107.

[84] These represent responses from families in the 'birth cohort', i.e. the children would have been aged 1-2 years when the parents were interviewed.

[85] Family and Parenting Institute (2007) Families and Neighbourhoods, YouGov

[86] Family and Parenting Institute (2007) Families and Neighbourhoods, YouGov

[87] Duffy, B (2000) Satisfaction and Expectations: Attitudes to public services in deprived areas, CASE Paper 45.

[88]http://www.scotland.gov.uk/Publications/2006/06/20135022/12

[89] Lupton, A (2006) How does place affect education? IPPR

[90] Lupton, A (2006) How does place affect education? IPPR

[91] Refer to Lupton (2006) for references.

[92] Manwaring, B and Taylor, C (2006) The Benefits of Play and Playwork, CYWU

[93] Rogers, S (2005) Role Play in Reception Classes, ESRC.

[94] Thomas, G and Thompson, G (2004) A Child's Place: Why environment matters to children, A Green Alliance/Demos Report

[95] Youlden, P and Harrison, S (2006) The Better Play Programme 2000-20005 An evaluation

[96] Manwaring, B and Taylor, C (2006) The Benefits of Play and Playwork, CYWU

[97] Lester, S and Maudsley, M (2006) Play, Naturally: A review of children's natural play, Playwork Partnerships.

[98] Thomas, G and Thompson, G (2004) A Child's Place: Why environment matters to children, A Green Alliance/Demos Report

[99] Blake Stevenson Ltd (2003) Assessment of the Benefits and Costs of Out of School Care, The Scottish Executive.

[100]Quoted in Lacey, L 92007) Street play: A literature Review.

[101] Family and Parenting Institute (2007) Families and Neighbourhoods, YouGov

[102] Thomas, G and Thompson, G (2004) A Child's Place: Why environment matters to children, A Green Alliance/Demos Report

[103] Valentine, G (2004) Public space and the culture of childhood

[104] Transport 2000 Association of London Government Barnardo's (2004) Stop, look and listen: children talk about traffic. Essex: Barnardos.

[105] Asthana and Halliday, 2006

[106] Sports Scotland (2005) School grounds in Scotland, Research Report.

[107] Barraclough, N., Bennington, J and Green, S. (2004) Delivering Play Spaces in NDC Areas: Research Report 38. Sheffield Hallam University.

[108] Asthana and Halliday, 2006

[109]Whelan, K et al (2008) Evaluation of the national network of child pedestrian training pilot projects in Scotland

http://www.scotland.gov.uk/Resource/Doc/216775/0058109.pdf

[110] SportScotland (2006) Active Schools Netwrok Evaluation Year Two (2005-06)

[111] Youlden, P and Harrison, S (2006) The Better Play Programme 2000-20005 An evaluation

[112] Land Use Consultants et al (2007) Home Zones in Scotland: Evaluation Report, Scottish Government

[113] Gill, T (2006) Home Zones in the UK: History, Policy and Impact on Children and Youth, Children, Youth and Environment, 16, 1.

[114] Kapasi, H (2007) Neighbourhood play and community action, JRF.

http://www.jrf.org.uk/knowledge/findings/housing/1942.asp

[115] Growing up in Scotland (2008) Use of Informal Support by Families with Young Children.

[116] Growing up in Scotland (2007).

[117] Growing up in Scotland (2008).

[118]Beatty, C et al (2008) New Deal for Communities: A Synthesis of New Programme Wide Evidence

http://www.neighbourhood.gov.uk/displaypagedoc.asp?id=1930

[119] As at 2005 quoted in Brown, K Integrated working: a review of the literature. (unpublished)

evidence review in 2005.

[120] Brown, K (2005) Integrated working: a review of the literature (unpublished).

[121] Daniel, B; Vincent, S; Ogilivie-Whyte, S. (2007) A Process Review of the Child Protection Reform Programme

[122] Rushmer, R & Pallis, G. (2002) Inter-professional working: the wisdom of integrated working and the disaster of blurred boundaries. Public Money & Management. 23 (January), 1, pp. 59-66.

[123] Anderson-Butcher, D. & Ashton, D. (2004) Innovative models of collaboration to serve children, youths, families and communities. Children and Schools, 26 (1), pp. 39-53.

[124] van Eyk, H & Baum, F. (2002) Learning about inter-agency collaboration: trialling collaborative projects between hospitals and community health services. Health and Social Care in the Community. 10, 4, pp. 262-269.

[125] Includes families dealing with a range of issues such as mental illness, drug dependency, alcohol misuse or domestic abuse

[126] Advisory Council on the Misuse of Drugs (2003) Hidden Harm: Responding to the needs of children of problem drug users, Home Office: London.

[127] Scottish Executive (2006) 'Looking Beyond Risk' Parental Substance Misuse: Scoping Study, Scottish Executive: Edinburgh.

[128] Anderson, S & Bradshaw, P et al (2007) Growing up in Scotland: Sweep 1 Overview Report, Scottish Executive: Edinburgh.

[129] An evaluation of Phase 1 of the Working for Families Fund ( WFF) covering 2004-06.

[130] Hay, J (2007) Parents Access to and Demand for Childcare Survey 2006 Final Report. Scottish Government, Edinburgh.

[131] Currie, J (2000) Early Childhood Intervention Programs: What do We Know? Joint Center for Policy Research Working Paper, Vol 2, number 10

[132] Cooper, P & Whitebread, W. (2007) The effectiveness of nurture groups on student progress: evidence from a

national research study. Emotional and Behavioural Difficulties Vol. 12, No. 3, September 2007, pp. 171-190.

[133] On Goodman's Strengths and Difficulties Questionnaire (SDQ).

[134] Lucas, S. (1999) The nurturing school: the impact of NG principles and practice on the whole school, Emotional and Behavioural Difficulties, 4(3), 14-19.

[135] Doyle, R. (2003) Developing the nurturing school: spreading NG principles and practices into

mainstream classrooms, Emotional and Behavioural Difficulties, 8(4), 253-267.

[136] Shucksmith, J; Philip, K; Spratt, J; Watson, C. (2005)

[137] ASSIST (Aberdeenshire Staged Intervention Supporting Teaching) - an initiative to support classroom teachers dealing with low-level disruption; the 'Place2Be' - a UK charity providing therapeutic and emotional support to children in primary schools; Newbattle Integrated Community School Team; East Renfewshire Multi-disciplinary Support Team; Clydebank High School Support Services Team and the North Glasgow Youth Stress Centre - a voluntary organisation working directly on mental and emotional wellbeing and behaviour with young people in three secondary schools and community settings.

[138] The Direct Instruction curriculum model, developed by Bereiter and Engelmann (1966), is a programmed-learning approach. The model began with a pre-school program devoted to behavioural learning principles, operated by Bereiter and Engelmann at the University of Illinois-Urbana in the mid-1960s. The model later expanded to follow through primary-grade programmes and "DISTAR" materials published by Science Research Associates. The Direct Instruction program taught academic skills - specifically, the skills and content assessed by intelligence and achievement tests. Teachers led small groups of children in precisely planned, 20-minute, question-and-answer lessons in language, mathematics, and reading. Teachers' guides and children's workbooks were the only materials in the classroom because they were considered the only materials that stimulated the requisite learning.

[139] Schweinhart, L.J. & Weikart, D.P. (1997). 'The High/Scope Pre-school Curriculum Comparison through Age 23' in Early Childhood Research Quarterly, 12, pp. 117-143.

[140] Schweinhart, L. J., Montie, J., Xiang, Z., Barnett, W. S., Belfield, C. R., & Nores, M. (2005). Lifetime effects: The High/Scope Perry Preschool study through age 40. (Monographs of the High/Scope Educational Research Foundation, 14). Ypsilanti, MI: High/Scope Press.

[141] Department for Education and Skills (2007) 'Messages' briefing: Costs and outcomes - shifting to earlier intervention (from J Beecham and I Sinclair, Costs and Outcomes in Children's Social Care: Messages from Research)

[142] Hallam, A. (2008) The effectiveness of interventions to address inequalities in the early years.

[143] Melhuish, E et al (2008) National Evaluation Summary - The Impact of Sure Start Local Programmes on Three Year Olds and Their Families.

[144] Early impacts of Sure Start Local Programmes on Children and Families (2005)

[145] Understanding variations in effectiveness among Sure Start Local Programmes: Lessons for Sure Start Children's Centres (Anning et al, 2007)

[146] Second SureStart Scotland mapping exercise, carried out 2004-05

[147]http://www.surestart.gov.uk/surestartservices/settings/surestartchildrenscentres/

[148] Ofsted (2008) How well are they doing? The impact of children's centres and extended schools. http://www.ofsted.gov.uk/publications/070021

[149] Extended schools: Access to opportunities and services for all; a prospectus (DfES-1408-2005), DfES, 2005.

[150] These outcomes are: being healthy; staying safe; enjoying and achieving; making a positive contribution; social and economic well-being.

[151] Dickson, M et al (2007) A summary of the evidence for the effectiveness of early interventions in influencing children's later outcomes and ways in which vulnerable children can be indentified. CASE, Centre for Analysis of Social Exclusion.

[152] From Bertram et al (2002) reported in Dickson et al (2007).

[153] Cameron C. et al (2003). "Early years and Childcare International Evidence Project". Thomas Coram Research Institute, Institute of Education, University of London.

[154] Scottish Executive (2006). "National Review of the Early Years and Childcare Workforce - Report and Consultation" Scottish Executive. See http://www.scotland.gov.uk/Publications/2006/07/10140823/0 for the full report.

[155] See http://www.surestart.gov.uk/publications/?Document=153 for more detail.

[156] Moss (2003) 'Beyond Caring: The Case for Reforming the Childcare and Early Years Workforce', Thomas Coram Research Institute.

[157] Anderson T. et al (2003). 'Recruitment and Retention of Childcare, Early Years and Play Workers: Research Study'. National Institute of Economic and Social Research.

[158] This approach involves child-centred learning where teachers observe what interests the children and build appropriate learning around this. For more information see Valentine, M. (1999) "The Reggio Emilia Approach to Early Years Education". Scottish Consultative Council on the Curriculum.

[159] Source: Scottish Government Preschool and childcare statistics 2007

[160] Class 2 workers provide direct personal care to service users and deal with routine aspects of a care plan or service. They usually don't have any supervisory responsibility. Class 3 workers are involved with supervision of particular aspects of care/services in a particular setting (usually on a day-to-day basis). Staff may also contribute to the assessment of needs, the development/implementation of care plans and the monitoring/evaluation of the delivery of care services.

[161] Bell et al (2002). "Researching Effective Pedagogy in Early Years". Department of Education Studies, University of Oxford.

[162] The ILO (International Labour Organisation) unemployment rate is the percentage of economically active people who are looking for work and available for work.

[163] General Register Office for Scotland (2007). "Projection Population of Scotland (2006-based)". National Statistics.

[164] Scottish Government (2007). "Staff of Scottish Local Authority Social Work Services, 2006".

Scottish Government.

[165] Source: Scottish Workforce Information Standard System.