How Wales gave Sure Start a convincing beginning

Evidence-based initiatives can be delivered very effectively through Sure Start services as long as they are properly resourced and faithfully delivered by well-trained regular staff. Considering all the arguments about Sure Start's progress in England, that's the simple message for politicians, policy makers and practitioners that has emerged from implementing and carefully evaluating The Incredible Years program in Wales.

This is how we approached the work. At the outset Sure Start services trained staff in North and Mid Wales to deliver the program; this was in marked contrast to England where the strategy was more random; in Wales 11 communities all used the same parent program.

This consistency created an opportunity for a research study, and in 2002 the Health Foundation made £315k available for a randomized controlled trial of effectiveness. Sure Start services agreed to target the intervention at identified high-risk families and they committed their staff to weekly supervision in Bangor to ensure that the program was delivered with fidelity.

The Welsh evaluation [1] indicated a 46% reduction in conduct problems among intervention children compared to 7% among those in the control group. There was also a reduction in violent incidents and parental criticism, and significant improvement in positive parenting and parental mental health. Significant improvements were also found among the siblings of the target children.

In short, Wales took a program developed in Seattle, trained Sure Start staff to deliver it faithfully in regular service settings and by so doing obtained outcomes comparable to those achieved in the original Seattle research study.

The Welsh Assembly Government (WAG) followed the work with interest and, when the preliminary findings emerged, they had a compelling argument for including the program in their Parenting Action Plan. From April 2006 Assembly funding was provided to train staff from all 22 Welsh authorities and to provide them with materials.

As a preliminary to claiming training places, local authorities agreed to deliver the program and to give their staff appropriate supervision time. The longer-term aim is to develop a staff member in each local authority as a local mentor to train, supervise, and support local staff.

This should ensure continuous and consistent evidence based delivery. Meanwhile, WAG has continued to acknowledge the benefits of The Incredible Years program by making it part of its new Flying Start scheme – an even earlier intervention program.

So why have things worked so well in Wales?
The fact that there was already an Incredible Years center operating in Wales was one important factor; it provided an underpinning commitment to the value of evidence-based early intervention in the prevention and control of conduct problems.

Secondly, this commitment was successfully translated to the delivery of effective programs in service settings, in terms of training staff, supervising the delivery and addressing issues of parent access, materials, and so on, to ensure fidelity.

Finally, establishing the program inside a number of services made it possible to fund a high quality randomized controlled trial of effectiveness the findings from which provided the Assembly Government with a convincing argument for more investment. The findings from this Welsh Sure Start study triggered the positive response from WAG after recognizing that The Incredible Years program works well in Wales.

The study findings and the response from WAG may have contributed to the decision by the Westminster Government to fund a multi-million-pound Pathfinder Project to evaluate the effectiveness of three evidence based program in eighteen services, one of which is The Incredible Years.

See also:
Sure Start made more credible by success of Incredible Years [2]
Learning the moral of the Sure Start story [3]