• By Dartington SRU
  • Posted on Tuesday 01st May, 2007

Sure Start made more credible by success of Incredible Years

Introduction of an American parenting program to parts of Wales, under the aegis of the well-established UK prevention initiative, Sure Start, has produced encouraging results. So much so that the latest evaluation findings, reported in the British Medical Journal by the principal investigator, Judy Hutchings, pose important challenges to makers of UK policy.The Welsh results are based on an experimental evaluation of 153 parents living in socially disadvantaged areas, whose children, aged between three and five, were considered to be at risk of significant behavior problems. Children on the Incredible Years program displayed significantly reduced anti-social behavior compared with those placed on a comparison waiting list. There was also a strong indication of reduced hyperactivity, and of improvements in self-control among their parents.Parents were asked about the intensity of problems they faced in bringing up their children. Those on the program consistently perceived their problems to be less severe 18 months later at the end of the follow-up period. The study also found a lessening in parental stress and depression.The research focused on outcomes for a single child in each family, but there were also indications that behavior among closest-aged siblings also improved.The findings support the broad underlying 'logic model' for Incredible Years, which argues that providing parents (or, in other variations, teachers) with the skills to manage children's behavior will reduce parental stress in a family and lead to improvements in behavioral and emotional problems for at least one young child.On most measures, the recipients of Incredible Years were at high risk of being diagnosed with conduct disorder at the beginning of the study, but not at follow-up. The Wales evaluation also suggests wider benefits, not least in reduced public expenditure as a result of benefiting families' reduced dependency on other children's services.The results are significant in several respects. From a scientific perspective they confirm the potential for children's behavior to be mediated through parent behavior and better parenting skills. It is one among several possible mechanisms and it can explain only a relatively small degree of behavioral change; nevertheless, it is an important tool in any services 'kit'. Introduced in the wake of Tony Blair's 1997 landslide election victory, Sure Start is the UK government's flagship prevention program. It has been introduced to disadvantaged areas across England, Wales and Northern Ireland and allowed to propagate itself despite mixed evaluation results. It is now incorporated into what are called 'children's centers'.A distinctive element of Sure Start, which focuses on pre-schoolers living in disadvantaged areas, has been its willingness to allow projects to be developed locally, leading to wide regional variation between types of services and timing.Results of a major national evaluation of Sure Start have so far been unimpressive, but it is difficult to know whether the lukewarm findings reflect badly on the efficacy of Sure Start or on the failure of government to commission an experimental evaluation. In this context, Judy Hutchings's findings are particularly significant. Incredible Years has been developed at the University of Washington by Carolyn Webster-Stratton and has previously been evaluated on several occasions, generally with positive results. However, the Wales trial is the first time it has been integrated into mainstream children's services so far from its American home. The findings build on Webster-Stratton's own work and on other work by Stephen Scott at the Institute of Psychiatry, London, and they precede major evaluations about to begin in Ireland. From a policy perspective, Hutchins and her team pose several challenges. Their rigorous evaluation demonstrates that Sure Start can be effective if is combined with a proven model, when Sure Start as a whole has been shown to have limited impact on child outcomes, and potentially to have negative effects. One good lesson may be that broad-based prevention programs are more effective when organized around a single approach or menu of proven models. The impact may come from the models included in the menu, and from the consistency of response. Put simply, the work goes better when staff know what they are supposed to do, and why, and with what result.In the Wales experiment, the beneficiaries were children at risk of a conduct disorder. What about children whose behavior is in the normal range, or who carry with them a series of low level risks. Perhaps the less focused, more broadly based approach to prevention is more effective for them?As political administrations change in UK, hard questions will be asked about the future of Sure Start and its successor children's centers. The easy answer would be to accept the evaluation results and withdraw funding. Judy Hutchins's work will at least make policy makers stop and ponder. It may even persuade them to invest more on strengthening existing programs and taking more time to work out how the variety of resource now available can best be used to reverse the negative trends in well-being among Britain's children the UK.

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