An Evaluation of the Experiences and Perceived Effects of Children using a Local Sure Start Programme
At the end of the last century a governmental comprehensive review recognised that changes to children's services in the UK were needed, as existing services were unable to meet the developmental needs of many children particularly those living with disadvantage. Early interventional services and programmes are designed to promote the development of children and research, much of which has been carried out in the USA, has found that the most effective interventions are holistic services able to recognise and meet the needs of communities, families and children. In the UK this knowledge contributed to the creation of Sure Start, a national early interventional programme working to promote the development of children through local agencies set in deprived areas over the whole of the country. This thesis explores the experiences of children and their families using a local Sure Start programme in Wales, and examines the perceived effects of the programme on the development and developmental environment of the children. The descriptive short-term longitudinal cohort investigation was based in Rhondda Cynon Taff Sure Start, a local programme whose services are available for all families with young children who live in the county. Thirty one families from Rhondda Cynon Taff with thirty four children aged between 3-48 months old were recruited to the study, the sample consisted of eight children (25%) from multi-risk families and twenty- six (75%) from lower-risk families. Complete data sets were obtained for 88% of the sample. The developmental progress and the developmental environments of children were measured over the time of service use using well validated, standardised instruments (ASQ, ASQ:SE, HOME). Family experiences of service use and perceptions of its effects on participant children were explored by narratives elicited by semi-structured interviews conducted with parents before and after service use. The family experiences also were set within the framework of the Developmental Systems Model for Early Intervention to discover whether this model could be profitably used to direct and evaluate the services provided by a Sure Start Local Programme. The data revealed that lower-risk families were more likely to: use universally available Sure Start activities and services; approach health professionals to request help when child or family problems arose; engage well in and remain in service use. Multi-risk families were more likely to be referred to Rhondda Cynon Taff Sure Start services to meet concerns identified by health and educational professionals, and less likely remain in service use. Inspection of the individual assessments of participant children showed that Rhondda Cynon Taff Sure Start services could be associated with beneficial impacts on the development of many children from lower-risk families. A statistically significant effect on aspects of lower-risk children's home environments was also demonstrated. Service use was found to be less effective for children from multi-risk families; all multi-risk children left service use with persisting developmental delays and no significant effect on the home environment of these families was identified. This study also supported the use of Children's Centres to provide early intervention services: the provision of Sure Start services over the wide geographical area of Rhondda Cynon Taff did not appear to promote universal local knowledge of services, and made use of the full range of services difficult for some families who were not within walking distance of services. Application of the Developmental Systems Model for Early Intervention to the experiences of participant families identified areas where changes to the current practices of Sure Start Local programmes, as illustrated by Rhondda Cynon Taff Sure Start, could be beneficial. The process suggested that adherence to the model's framework may increase the programme's ability to recognise and meet the developmental needs of the service users, and also suggested that changes to the early interventional model could increase its ability to guide the process of effective early interventional services, particularly when working with vulnerable or hard to reach families and children.
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