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Home Publications A home-visiting programme for disadvantaged young children: final report for the feasibility study

A home-visiting programme for disadvantaged young children: final report for the feasibility study

Angus Armstrong, Orazio Attanasio, Sarah Cattan, Christine Farquharson, Emla Fitzsimons, Elaine Fulton and Sally Grantham-McGregor
Report

The earliest years of life are a crucial period for children’s development. Experiences during these years can shape a child’s life chances; while many social problems (such as deprivation, poor health and economic inactivity) have their roots in the first few years of life, interventions during this period can also have long-lasting benefits. Research from around the world shows that well-designed early childhood programmes, particularly those that target disadvantaged children, can promote healthier long-term development and help to mitigate inequalities.

These programmes can deliver benefits not only to participants, but also to the public purse. Better development in childhood is linked to long-term benefits such as greater attainment in school and later education, higher earnings, better health and lower levels of crime. This in turn can benefit the government through higher tax revenues and lower spending on programmes such as remedial education or welfare. Equally, intervening ‘late’ to address problems such as hospitalisations or crime is often a costly approach. In some cases, these financial benefits of and prevented costs from early intervention programmes have more than compensated for public spending on these interventions.

In England, the preschool years have received increasing funding over the past two decades. But the bulk of these resources are still targeted at children aged 3 and 4. At the same time, there is increasingly strong evidence that inequalities – in child development and in health – are already obvious by age 2 or 3. This means that programmes for 3- and 4-year-olds need to compensate for the gaps that have already appeared, and current evidence suggests that they are only somewhat successful in this.

The evidence for early intervention

There is therefore both a social and an economic case for earlier intervention to help improve the life chances of vulnerable children and to level the playing field for children entering formal childcare in England. Existing research points to programmes that support parents’ interactions with their child as a particularly effective way to promote child development, with benefits that can last into mid-life.

But as it stands, there are big limitations in the UK evidence base that leave open questions about effectiveness, scalability and long-run value for money. Policymakers, including the Department for Education and the Education Select Committee, have recently highlighted the need for better evidence on how to promote a richer ‘home learning environment’ in the early years.

The feasibility of a new intervention in England

We have established a new partnership between academics, local government and early years practitioners to develop, implement and evaluate a home-visiting programme for parents with very young children in England.

We take as our starting point the ‘Reach Up and Learn’ curriculum, which has been shown to benefit children’s development in many low- and middle-income countries. Reach Up focuses on providing parents with practical information and support to enhance their interactions with their child. In turn, this richer and more stimulating home learning environment supports children’s development.

While this curriculum has been notably successful at improving child development abroad and has proven itself adaptable to a wide range of cultural contexts, there is no guarantee that the programme would be appropriate or effective in an English context.

In this feasibility study, we research local priorities and existing services to evaluate the need for a new early childhood intervention in England. We also outline how our findings influence the design, implementation and evaluation plan that we would use in a future trial of this programme. This will ensure that any eventual trial evaluates the most promising version of the programme and therefore offers the greatest contribution to the English evidence base. We set out to answer five questions:

  1. What is the need for a new early childhood intervention in England?
  2. How should the curriculum be adapted to the English context?
  3. Who should the intervention target?
  4. How should the intervention be delivered?
  5. How could we measure the benefits of the intervention for children, families and the public purse?

Importantly, we do not provide any quantitative evidence about the effectiveness of the programme.

One of our priorities throughout this feasibility work has been to ensure that the programme is designed in a way that is scalable, sustainable and cost-effective. Although these are not immediate concerns for this project, it is important that the evidence any future trial contributes is based on a realistic model that can – if effective – be adopted at scale and evaluated not just for its effectiveness, but for its value for money.

Peterborough as a case study

The goals of this feasibility study are ambitious and achieving them requires knowledge of and strong relationships with the local community. We therefore focus on a single local authority to assess the feasibility (and, in future work, the effectiveness) of this programme.

Peterborough is a particularly appropriate setting to develop and test this programme. A city of about 200,000 in East Anglia, it faces many of the socio-economic risk factors (such as poverty and low pay) that threaten children’s healthy development in disadvantaged communities all around England. Moreover, Peterborough City Council’s exemplary commitment to developing and evaluating this programme is critical to the project’s success.

Key findings

We use a variety of techniques to gather information from parents, practitioners, policymakers and researchers to answer the questions for this feasibility study. We have reviewed the evidence on the factors that contribute to previous successful home-visiting programmes and have held discussions with current practitioners. We have analysed local demographics and existing programmes. Through focus groups and interviews with parents, we have built an understanding of the existing strengths of local parenting practices as well as parents’ needs and priorities. We have assessed different implementation models and conducted a five-week pilot programme with 20 families to test the feasibility of delivering the programme and its acceptability to parents. And we have worked with leading researchers to develop a plan to evaluate a future trial of the programme.

Based on these activities, the findings of our study are clear:

  • There is a gap in services that a home-visiting programme targeted at very young children’s development might help to fill. At the moment, early years services in England are primarily targeted at children aged 3 and older, while inequalities in child development open up earlier. Services that are available for younger children tend to have relatively low take-up rates (like Children’s Centres), to target outcomes other than child development (like health visiting) or to focus on specialist intervention in families where children are at risk (like safeguarding programmes).
  • Parents and practitioners in Peterborough are eager for such a programme and strongly motivated to take part in it. Parents in both focus groups and our pilot study strongly supported the rationale behind a programme to support them in interacting with their children. Practitioners felt that the programme offers something different from existing services and would help them to support vulnerable families more effectively.
  • There is promising qualitative evidence of the programme’s effectiveness. Many parents in the pilot sessions reported improvements in their child’s focus and behaviour over just a few weeks, motivating them to continue. Practitioners reported significant changes in parents’ behaviour over the course of the short pilot, and in one case an early years worker who was unaware of the pilot reported significant improvements in a pilot family’s parent–child interactions during a group session.
  • Undertaking a rigorous evaluation of the intervention via a randomised controlled trial within Peterborough is feasible and has strong support among both the council and local practitioners. Through the collection and linkage of adequate data, such a study would make a substantial contribution to the evidence base on early intervention in the UK and internationally, by providing a unique opportunity to understand whether and how such an intervention can lead to both private and social benefits even in the short run.

Next steps

This feasibility study sets out the conclusions of a careful process to explore, document and analyse the local context in Peterborough and how a new programme could be best designed to complement existing strengths, address parents’ needs and priorities, and support the home learning environment and child development. But without an evaluation, the crucial question – whether the programme is actually effective at improving children’s life chances – remains unanswered. The next crucial step, therefore, is to carry out a randomised controlled trial to evaluate the programme’s effectiveness and to support analysis of its cost-effectiveness.

Such an evaluation of the intervention would not only add to the international evidence base about the potential of home-visiting interventions to strengthen the home learning environment, but also provide policymakers with robust evidence on a promising intervention that can reduce developmental gaps between children born into disadvantaged backgrounds and their more affluent peers in England.