• By Kevin Mount
  • Posted on Tuesday 24th August, 2010

It's a simple idea – but does it really work?

If a service strategy is to be relied upon by commissioners, it is important to know that on average it will work for families and that it will be more effective than support of some other kind or no support at all. But even where thorough trials are carried out and evidence of success is found, it will sometimes be flawed because the programs under scrutiny do not touch families who are reluctant to accept them. All too often it is the ‘hardest to reach’ who are the most in need, and vice versa. In the UK, and increasingly in other countries, Home-Start schemes are promoted in glowingly simple terms Parents supporting other parents: it's a simple idea that really works. But, straightforward and attractive as it may sound, this kind of proposition may be rejected by the neediest families, possibly fearing that the volunteer, even if she is another mother, will not be sufficiently like themselves for a good relationship to develop. And when the hard-to-reach are not reached it tends to defeat the argument that mother-to-mother support is the most appropriate for ‘reluctant’ families. So, for example, a study offering Home-Start support in pregnancy to mothers-to-be identified as being at risk found that the least vulnerable were the most likely to engage with the service. Those who turned it down were socially, economically and educationally more disadvantaged and lived in poorer neighborhoods.The question then arises that if a mother who engages with Home-Start is likely to have relatively little need of it, will it make any difference to her? There is as yet rather little in the way of substantial evidence that Home-Start support has a consistent impact, even in those more propitious circumstances. It may work for individual cases – and many anecdotal studies have documented as much – but consistency is missing. One study conducted in Northern Ireland and the South of England with a comparison group found no difference between mothers receiving Home-Start support and those who received standard local services, either in the outcomes examined or in the extent to which services other than Home-Start were used. More recently, a larger-scale English study of initiatives offering Home-Start during pregnancy to new mothers, which compared their progress to that of a control group, found very limited benefits. Mothers who had received Home-Start said they experienced fewer negative feelings about their relationship with their infant over the first year, but other comparisons relating to maternal well-being and infant development failed to identify any difference between the groups.Home-Start support was praised in many cases; the relationship between the mother and the volunteer generally developed well, and appreciation was expressed for the many different roles that volunteers took on, and for their adaptability and openness. However, in a minority of cases, a mismatch between mother and volunteer caused stress, and the way support was terminated was not always successful because of administrative difficulties or personal problems in the lives of some volunteers. Home-start schemes varied in their capacity to resolve such difficulties.Flexibility was identified as an important factor in an offer of support. Some interviewees had turned down Home-Start but subsequently changed their minds. Coping with these natural uncertainties requires good administration and record keeping. Flexibility was also important in terms of timing. When Home-Start was offered during pregnancy, some mothers thought it important to have a chance to bond with the volunteer before the baby’s birth (in a similar way to the structured Nurse Family Partnership professional support developed by David Olds in the US). Others felt the support would be more welcome when their baby was more active or mobile. What can be concluded about Home-Start support? It may be a useful element of provision, but the most vulnerable may be more likely to reject it and may be more responsive to more formal support offered by a professional. Home-Start’s strength is in the collaboration between family and volunteer, but it leads to much variability in what is offered, and for how long. Questions are often asked about what takes place inside the ‘black box’ of such relationships: for this kind of support it is even harder to tell. There can be other drawbacks: volunteer help it is more likely to be buffeted by personal circumstances, suggesting that the most vulnerable should not be offered it. Further trials are required to demonstrated whether it has consistent positive impact, and, if so, for which families, and with what level (dose) of support. ReferencesBarnes, J., MacPherson, K. & Senior, R. (2006a) “Factors influencing the acceptance of volunteer home visiting support offered to families with new babies”. Child and Family Social Work, 11(2), 107-111.Barnes, J., MacPherson, K. & Senior, R. (2006b) “The impact on parenting and the home environment of early support to mothers with new babies”. Journal of Children’s Services, 1(4), 4-20.Barnes, J., MacPherson, K, & Senior, R. (2006c) Right from the Start; an evaluation of Home-Start support with mothers of newborn infants. Final report to the Health Foundation, Grant 1665/A dark art comes to the water-cooler. Part 1. Quantitative results.Frost, N, Johnson, L, Stein, M & Wallis, L (1996) Negotiated friendship: Home-Start and the delivery of family support. Leicester: Home-Start UK.McAuley, C, Knapp, M, Beecham, J, McCurry, N & Sleed, M (2004) Young Families Under Stress. Outcomes and costs of Home-Start support. York: Joseph Rowntree Foundation.MacPherson, K., Nichols, M., Dixon, S. & Barnes, J. (2006) Right from the Start; an evaluation of Home-Start support with mothers of newborn infants. Final report to the Health Foundation, Grant 1665/A dark art comes to the water-cooler. Part 2. Qualitative results.Shinman, S (1994) Family album: Snapshots of Home-Start in words and pictures. Leicester: Home-Start UK.

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