Helping parents earlier

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How a home-visiting programme could help prevent inequalities in child development and health by supporting families early on

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Christine Farquharson and Sarah Cattan, Institute for Fiscal Studies

The earliest years of life can shape a child’s life chances. Recent evidence suggests that inequalities – in child development and in health – are already obvious by age two or three. While the Government has increased spending on the early years, most of these resources are targeted at three- and four-year-olds.

To help prevent inequalities from opening up in the first place, policymakers need to focus on even younger children. But engaging the most disadvantaged families can be hard.

In our new research report – conducted by researchers from the Institute for Fiscal Studies, UCL and the National Institute of Economic and Social Research, alongside Peterborough City Council and with advisory support from the Stefanou Foundation – we analyse whether a new programme of home visits to support parents with children under age two in providing a safe, nurturing home learning environment could have a role in the UK early years landscape. We find a strong case – and local support – for a full trial of the programme.

A new intervention

There is a big body of research showing that supporting parents in providing a nurturing and stimulating home learning environment can have long-lasting impacts on children’s development. The benefits can include better attainment in school and later education, better health, higher earnings and less crime.

These interventions can also benefit the public purse: higher earnings and better education can lead to higher tax revenues and lower spending on programmes such as welfare, remedial education or incarceration. In some cases, these financial benefits have outweighed the programme costs. But there are big limitations in the UK evidence base that leave open questions about the effectiveness, scalability and long-run value for money of these kinds of intervention.

In our study, we assess the feasibility of adapting, implementing and evaluating a home-visiting programme in England. Our programme is based on the Reach Up and Learn curriculum, which has been successfully delivered in countries such as Jamaica and Colombia.

Scalable and sustainable

Peterborough is an ideal case study for this project; it shares many of the risk factors, such as poverty, common to other disadvantaged areas. Its children perform relatively poorly in early child development tests. And the council is committed to developing and evaluating an intervention to support parenting in the earliest years of life.

One of our priorities has been to ensure that the programme is designed in a way that is scalable and sustainable. It is important that the evidence any future trial contributes is based on a realistic model that can – if effective – be adopted at scale and in different local authorities. This is why we have integrated the programme within the landscape of national services.

It is also important that the programme is designed with cost-effectiveness in mind. A full-scale trial is the ideal vehicle to evaluate this; by collecting data on outcomes such as development, behavioural problems and health, we will be able to evaluate the short-term benefits as well as link them to longer-run outcomes and their impact on public spending.

Promising feedback

The Reach Up curriculum supports parents through a programme of frequent, regular home visits. By building up parents’ knowledge of child development and confidence in playing with the child, the programme supports stronger parent-child interactions and a more stimulating home environment, which in turn promote children’s intellectual and social development.

Parents in focus groups and our pilot study were enthusiastic about the programme and strongly motivated to take part. Practitioners felt that it offers something different from existing services and would help them to support vulnerable families more effectively.

In keeping with this enthusiasm, parents in the pilot programme made a significant effort to participate in the visits. Many of the parents were dealing with challenges such as housing instability and safeguarding concerns, but nevertheless only one of the 20 pilot families dropped out by choice.

Parents and home visitors told us that their commitment to the programme was because they felt that it was effective. Many parents in the pilot sessions reported improvements in their child’s focus and behaviour over just a few weeks. Practitioners reported significant changes in parents’ behaviour over the course of the short pilot, and (particularly encouragingly) early years workers who were not aware of the pilot picked up on improvements in parent-child interactions among pilot families.

Next steps

Our study sets out the conclusions of a careful process to analyse the local context in Peterborough and how a new programme could best complement existing strengths, address parents’ needs and support the home learning environment and child development.

But without an evaluation, the crucial question – whether the programme is actually effective at improving children’s life chances – remains unanswered. The next step, therefore, is to carry out a randomised controlled trial to evaluate the programme’s effectiveness and to support analysis of its cost-effectiveness.

Such an evaluation would add to the international evidence base about the potential of home-visiting interventions to strengthen the home learning environment and provide policymakers with robust evidence on a promising intervention that can reduce developmental gaps between children born into disadvantaged backgrounds and their more affluent peers in England.

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