Sure Start evaluator says “job done” – almost

It was regarded as something of a calamity at the time that early results from the evaluation of Sure Start, the UK’s flagship early intervention program, were so disappointingly mixed.

Several billion dollars had been invested in Sure Start "Local Programmes" but, in some respects, the children who had contact with them seemed to be emerging worse off than those living in control group areas.

Evidence of failure resulted in criticism from scientists and policy makers that too little attention had been given to service design, and that, through no fault of the investigators, the methods used to evaluate the program were insufficient to make a proper assessment its impact on child well-being.
[See: Learning the moral of the Sure Start story [1] ]

These gloomy findings came out in 2005. The second round, which emerged last year, focused on the contribution of well established Children's Centres. Children living in intervention areas were matched with those of similar age and economic disadvantage in communities yet to benefit.

The more recent results were encouraging. In terms of social behavior and self-regulation, children in the intervention group did better. Parents sending their children to the centers resorted to fewer risky behaviors, such as harsh discipline, and their homes became more conducive to children learning. Child immunization was more widespread and accidents were fewer.
[See: Sure Start’s shaky start is shored up [2]]

Ted Melhuish, co-Director of the national evaluation of Sure Start, reflected on the uncertain progress of Sure Start at the UK Michael Sieff Foundation [3]’s annual conference in Windsor Great Park, last week.

He acknowledged that some of the newer, better results might be the product of methodological artifact. But he said a consensus was emerging that modest, uniformly positive findings could be reliably attributed to the prevention program.

He attributed the change of fortune to the fact that Sure Start began from scratch. The enterprise involved building multi-disciplinary teams, putting up new buildings, training staff and making connections with a population not used to receiving help with their children during the early years.

He said it took three years for a Children’s Centre to become fully operational. The variable benefits uncovered during the first evaluation probably reflected variability in program provision.

By now there was consensus around what it was that made a good Centre. Lessons had been learned. Staff had matured and skill shortages had been reduced. It was much more likely than it was five years ago that children and families going to a UK Children’s Centre would get an effective service.

Scrutiny would continue, he said, not least because the Centres were a significant expenditure item on the accounts of a hard pressed UK government. Cost-benefit analyses were underway but, if the US Head Start experience was any guide, they were unlikely to be much welcomed by advocates of the intervention.

All the same, the job was pretty much done. The UK government was on course to build 3,500 Children’s Centres by 2010 – one in every community.

The next challenge would be to work out the cost-benefits of keeping Sure Start going. The equation would be quite different from the one that applied to getting the intervention off the ground. Methods for achieving more consistent evidence based provision within Centres would also be at a premium.

See:
Belsky J, Melhuish E, Barnes J and others, “Effects of Sure Start Local Programmes on children and families: Early findings from a quasi-experimental, cross-sectional study,” BMJ, 2006, 332, 1476-8

NESS Research Team, The Impact of Sure Start Local Programmes on Three-year-olds and their Families, Sure Start Report 27, London DCSF, 2008

Melhuish E, Belsky J, Leyland A and others “A quasi-experimental study of effects of fully-established Sure Start Local Programmes on three-year-old children and their families,” Lancet, 2008, 372, 1641-7