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The Effectiveness of Interventions to Address Health Inequalities in the Early Years: A Review of Relevant Literature

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CHAPTER SIX: THREE TO EIGHT YEARS - EARLY YEARS EDUCATION AND CHILDCARE

Introduction

It is difficult to distinguish categorically between childcare and education for young children, since good care always has an educational value. In addition, with a range of imperatives and perspectives and a complex mosaic of provision (ranging from informal to formal care, individual to group-based provision, open access to specialist referred provision and services that are free at the point of delivery or command the market price) it is difficult to establish categorically what works, for whom, in what circumstances.

6.2 Pre-school education (The Effective Provision of Pre-School Education ( EPPE) Project)

The EPPE project, which began in 1997, is the first major European longitudinal study of a national sample of young children's development between the ages of 3 and 7 years. To investigate the effects of pre-school education, the EPPE team collected a wide range of information on 3,000 children. The study also looks at background characteristics relating to parents, the child's home environment and the pre-school settings children attended. Settings (141) were drawn from a range of providers - local authority day nurseries, integrated centres (combining education and care), playgroups, private day nurseries, nursery schools and nursery classes.) 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.

EPPE used a range of data collection methods, including standardised child assessments over time; child social/behavioural profiles; interviews with parents and pre-school centre staff; quality rating scales; case study observations and interviews.

Findings published in 2004 covered the effects of education in the pre-school period (ages 3 and 4) as measured at primary school entry (rising 5) and in years 1 and 2 (ages 6 and 7) (Sylva et al, 2004).

Weblink to summary of findings: http://www.dfes.gov.uk/research/data/uploadfiles/SSU_SF_2004_01.pdf

The aims of the EPPE project were to explore five questions:

  • What is the impact of pre-school on children's intellectual and social/behavioural development?
  • Are some pre-schools more effective than others in promoting children's development?
  • What are the characteristics of an effective pre-school setting?
  • What is the impact of the home and childcare history on children's development?
  • Do the effects of pre-school continue through Key Stage 1 (ages 6 and 7 years?)

Key findings over the pre-school period include the following:

Impact of attending a pre-school:

  • Pre-school experience, compared to none, enhances all-round development in children
  • Duration of attendance is important; an earlier start (under age 3) is related to better intellectual development
  • Full-time attendance led to no better gains for children than part-time provision
  • Disadvantaged children benefit significantly from good quality pre-school experiences, especially where they are with a mixture of children from different social backgrounds
  • Overall, disadvantaged children tend to attend pre-school for shorter periods of time than those from more advantaged groups (around 4-6 months less)

Does the type of pre-school matter?

  • There are significant differences between individual pre-school settings and their impact on children. Integrated centres and nursery classes are more effective than others in promoting positive child outcomes
  • Good quality can be found across all types of early years settings; however, quality was higher overall in integrated centres and nursery schools

Effects of quality and specific 'practices' in pre-school

  • High quality pre-schooling is related to better intellectual and social/behavioural development for children
  • Settings that have staff with higher qualifications have higher quality scores, and their children make more progress
  • Quality indicators include warm interactive relationships with children, having a trained teacher as manager and a good proportion of trained teachers on the staff
  • Where settings view educational and social development as complementary and equal in importance, children make better all round progress

The importance of home learning

  • For all children, the quality of the home learning environment is more important for intellectual and social development than parental occupation, education or income. What parents do is more important than who parents are.

Key findings at the end of Key Stage 1 include the following:

Duration and quality

  • The number of months a child attended pre-school continued to have an effect on their progress throughout Key Stage 1, although this effect was stronger for academic skills than for social behavioural development
  • Pre-school quality was significantly related to children's scores on standardised tests of reading and mathematics at age 6. At age 7, the relationship between quality and academic attainment was somewhat weaker, but still evident, and the effect of quality on social behavioural development was no longer significant. High quality pre-school provision combined with longer duration had the strongest effect on development

Effective settings

  • Individual pre-schools varied in their effectiveness for influencing a child's development. The advantages for a child's development of attending a particularly 'effective' pre-school centre persists up to age 7.

Vulnerable children

  • A small group of children continued to be at risk of special educational needs, with more of the 'home' children falling into this group, even after taking account of background factors
  • Multiple disadvantage continued to have a negative effect on intellectual and social development up to the end of Key Stage 1.

Home learning environment

  • The effect of home learning activities during the pre-school period continues to be evident in children's developmental profiles at the end of Key Stage 1

Although the EPPE project focused on child development and early learning per se, the study design over-sampled areas with ethnic diversity and low socio-economic status ( SES) families, and a number of findings are particularly relevant to children from disadvantaged families, as noted above.

As part of the wider study, the EPPE team was commissioned to conduct an investigation into children who might be 'at risk' of special educational needs ( SEN). The Early Years Transition and Special Educational Needs ( EYTSEN) project was a sub-study within EPPE. EYTSEN focused on children from ages 3-6. The study used a range of information to identify children 'at risk' of developing SEN (child assessments, parental questionnaires, and 'child profiles' completed by primary school teachers). The major findings are included in the summary above, but more detail is provided below:

  • For cognitive outcomes, children with multiple disadvantage (in terms of child, family and home environment characteristics) were much more likely to be identified as 'at risk'
  • Background characteristics showed weaker links with social/behavioural development
  • The quality of the home learning environment (related to parents' reported activities with their pre-school child) showed a strong relationship with 'at risk' status. A more stimulating home learning environment benefits both cognitive and social/behavioural development.
  • The home learning environment was only moderately related to parents' education and SES
  • A third of the sample showed low cognitive attainment at entry to pre-school and were classified as 'at risk' of SEN in relation to national norms. By entry to primary school, this figure had dropped to a fifth, suggesting that pre-school has a positive impact on young children's cognitive development (in both language and non-verbal skills
  • Those children who had no pre-school experience were more likely to be 'at risk' of SEN in terms of their cognitive development, even taking into account this group's higher levels of multiple disadvantage. Findings thus suggest that pre-school may be an effective intervention for the reduction of SEN, especially for the most disadvantaged and vulnerable groups of young children
  • Certain forms of provision were of particular benefit to children 'at risk' of SEN for different reasons. For those 'at risk' in terms of poor cognitive development, integrated centres and nursery schools were seen to be particularly beneficial. For those 'at risk' in terms of poor social behaviour, integrated centres, nursery classes and playgroups were particularly beneficial.
  • Longer duration of pre-school was beneficial, with every extra month over two years of age being associated with better cognitive development

Summary: what do we know about the effectiveness of pre-school education from the EPPE project (and EYTSEN subsample)?

  • Duration of attendance is important: an earlier start (under age 3) is related to better intellectual development. However, it does not appear to be important whether children attend full-time or part-time
  • High quality pre-schooling is related to better intellectual and social/behavioural development for children
  • Settings where staff have higher qualifications have higher quality scores, and their 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
  • The number of months a child attended pre-school continued to have an effect on their progress throughout Key Stage 1
  • High quality pre-school provision, combined with longer duration, had the strongest effect on child development
  • 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 integrated centres, nursery classes and playgroups

6.3 The High/Scope Perry Pre-school Study and other evidence from the US

As children become more 'social', associating with other children in pre-school settings and then in school itself, so hyperactivity, attention deficits, aggression and other anti-social behaviour become more obvious. In objective terms, too, severe conduct problems are relatively stable and easier to identify by the age of three. There is a relatively rich seam of research concerning effective preventive interventions for this age group.

The most influential programme to date in public policy terms has been the US High/Scope Perry Preschool Study. This study has three strengths essential to a valid longitudinal experiment:

  • Random assignment of study participants to a programme group and a no-programme group
  • Virtually no attrition of study participants and very little missing data
  • A plausible, consistent pattern of causes and effects that links the pre-school programme to childhood, adolescent and adult outcomes

The study, which began in 1962, examined the lives of 123 African Americans born in poverty in a disadvantaged area of Michigan, and at high risk of failing in school. At ages three and four, these individuals were randomly divided into a programme group (who received a good preschool programme that emphasised child-initiated learning activities) and a no-programme group, who received no preschool programme. The curriculum 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.

The programme evaluated successfully, both in the short- and long-term, and its success has been attributed to the fact that it focused not just on improving language and literacy levels among young children, but also on enhancing their social relations, motivation and logical abilities. The follow up study of the High/Scope children as adults at age 27, in relation to controls, showed that they had:

  • Significantly higher monthly earnings (29% versus 7% earned $2000 or more per month) and significantly higher proportions of home ownership (36% versus 13%)
  • A significantly higher level of schooling completed (71% versus 54% completed 12 th grade or higher)
  • A significantly lower percentage receiving social services at some time in the last 10 years (59% versus 80%)
  • Fewer arrests in relation to crimes of drug taking or drug dealing (7% versus 35% with five or more arrests) (Schweinhart, 2000)

Cost-benefit analysis has shown that the pre-school programme was a worthwhile investment to society, with a return of $7.16 on every dollar spent. (For discussion of the cost-effectiveness of the Perry programme, see Chapter Eight.)

A few studies have produced evidence of long-term effects similar to the Perry programme (reduced criminality, increased high school graduation) but the results still do not match the achievements of children from better-off homes with no pre-school intervention programme, suggesting the need for a more comprehensive policy programme to reduce the range of socio-economic equalities.

The Seattle Social Development Project successfully combined training to improve children's social competence and thinking skills with a parenting programme and a classroom management programme for teachers. This 'multimodal' programme was sustained over six years of primary education with changing components as the children grew older. Promising long-term outcomes, measured at age 18, included less violent, criminal behaviour and less heavy drinking than a control group, as well as stronger attachment and commitment to school. However, there was no significant difference between the intervention and control groups in the reported use of cannabis or heavy smoking The Seattle researchers highlighted the finding that a 'late intervention' programme did not produce the significant long-term effects achieved by the full interventions (Hawkins et al, 1999).

Other rigorous US studies provide further evidence (Currie, 2000). The Early Training Project, the Carolina Abcderian Project and the Milwaukee Project all found positive effects on school and college attainment. Each project varied in the degree to which it involved parents, the age at which children started and the curriculum content. However, the conclusions reached are broadly the same: there is little lasting improvement in IQ (except in the Abcderian programme, which started when children were only 4 months old), but a noticeable improvement in social skills and behaviour. Over time, motivation and social skills reduce the impact on criminal justice services and improve health and job market performance.

In each of the above examples, a set of model conditions exists in programme delivery and research rigour. Overall, the number of children involved is small and what works for a small group might not translate well to a larger setting. In addition, the model programmes were generally staffed by people who were highly trained and motivated to show that their particular intervention worked. The programmes all come from the US and it is not clear whether they would transfer to the Scottish context. Finally, although all the programmes operated in deprived areas, it is not clear whether outcomes for the most disadvantaged children were as encouraging as for those with fewer risk factors.

The Promoting Alternative Thinking Strategies ( PATHS) programme (Greenberg et al, 1998) is an example of a strongly evaluated curriculum used in countries across the world (including UK primary schools) to promote social competence, self-control and problem-solving, and to reduce aggression and problem behaviours. PATHS lessons include instruction in identifying, labelling and expressing feelings; assessing the intensity of - and managing - feelings; understanding the difference between feelings and behaviours; controlling impulses and understanding the perspectives of others. PATHS has been shown to improve protective factors and reduce behavioural risk across a wide variety of elementary school-aged children. Findings have shown cross-rater validity as they have been true of teacher reports, self-reports, as well as child testing and interviewing. A critical component to these findings is the use of well-matched control groups; this is critical because all children tend to improve as they develop, and thus programmes may only look effective due to general developmental progress.

These programmes provide evidence that, through enrichment in the early years, children from disadvantaged backgrounds can be given a good start in life - a start that endures, even if there is some fade out, thanks to improved social skills and motivation.

Summary: what do we know about the effectiveness of pre-school education from the High/Scope Perry Pre-school Study and similar projects in the US?

  • The High/Scope Perry Pre-school Program is the best known and most influential of all preventative programmes. It has been the subject of high quality evaluation and is unique in following up child participants, not only to adulthood, but to middle age
  • Children received a programme that included five key groups of experience, followed the curriculum for two years and received intensive input from highly trained workers
  • The programme evaluated successfully (in the short- and long-term) and its success is likely to be due to the broad focus of the curriculum, which included the enhancement of social relations, motivation and logical abilities, in addition to improving language and literacy levels
  • The programme has been shown to be 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 US studies 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
  • 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
  • However, it is not clear whether outcomes for the most disadvantaged children matched those with fewer risk factors, and it is not known whether these programmes would be transferable to the Scottish context
  • The PATHS programme is an example of a strongly evaluated curriculum used in elementary schools in countries across the world, and in the UK, to promote social competence, self-control and problem-solving, and to reduce aggression and problem behaviours. The programme has been shown to improve protective factors and reduce behavioural risk across a wide variety of young schoolchildren.

6.4 Systematic review of day care

Childcare enables parents, particularly mothers, to go out to work, or increase their working hours, thereby potentially contributing to efforts to lift their families out of poverty. A systematic review of day care for pre-school children in disadvantaged populations reported positive effects on mothers' education, employment and interaction with children (as well as an increase in children's IQ and beneficial effects 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 (Zoritch et al, 2000).

However, most of the trials combined non-parental day care with some element of parent training or education (mostly targeted at mothers) and failed to disentangle the possible effects of these two interventions, among other methodological weaknesses. In addition, all the contributory studies were conducted in the US, so the transferability of findings to the Scottish context is uncertain.

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Page updated: Tuesday, July 8, 2008