The Social Care Institute for Excellence’s weekly analysis of research findings behind specific social work practices
The 2006 Childcare Act requires local authorities to work with their NHS partners to improve outcomes for all children aged up to five years and to reduce inequalities by ensuring services are integrated to maximise benefits to families.
The Centre for Excellence and Outcomes in Children and Young People’s Services (C4EO) reviewed studies of integrated services. It found that early years centres that integrate childcare, nursery education and healthcare and provide advice and support for parents can improve many aspects of children’s lives.
Children benefit from all types of early years provision but integrated care and education centres have been shown to improve their behaviour, social skills and learning. Children who gain most from an integrated service include those at risk of neglect and abuse and those who attend such centres at an early age.
● Child learning Improved learning in early years also continues into school. Building links between schools and early years centres can ease the transition between the two. For children who are not supported at home, full-time attendance at an integrated early years setting can be beneficial.
● Child development Children can experience personal and social benefits from attendance at an integrated early years centres. There are also benefits to health – and when children are healthy there is a positive impact on their education.
● The family Integrated centres frequently provide both direct and indirect services for parents. For example, having more hours of childcare available can lead to increased employment choices as well as more time to look for work. A study on a “wraparound” care pilot in five areas of the UK found that 56 per cent of parents taking up childcare provision said it gave them more choices with regard to work or study and 32 per cent were able to look for jobs. The knock-on effect in terms of finding a job or training can help families move off benefits and improve their finances. Some provision of the integrated centre can also reach further and strengthen communities.
● Service development In integrated centres the opportunities to work with other professionals can improve the quality of staff practice. Expertise and best practice can be shared, for example between health workers and teachers, leading to improved standards in both sectors.
A US study that investigated joint working between mental health professionals and day care and pre-school staff found that the collaboration had a positive impact. Working with mental health professionals made teachers more empathetic and interested in the deeper meaning of behavioural problems and they had a greater level of control over, and responsibility for, behaviour in their classrooms. An integrated approach also has benefits in terms of efficient and cost-effective service delivery.
Integrated centres that perform well use a range of approaches and often demonstrate effective practice in the following areas.
● Links with parents and the home Integrated centres that work closely with parents can help them support their children at home with activities and materials that complement the childcare and educational aims.
● Staff training and development Central to good practice is the training and professional development of staff. Training can be a way of strengthening integrated teams. The opportunity for staff from different agencies to come together is beneficial for their development and ultimately for the children in their care. Training on integrated practice or by bringing together professionals can help staff develop common ways of working.
● Collaborative working. Collaboration is a key component of successfully integrated services. All staff should be committed to integrated working with managers playing a key role in sustaining an effective team. Successfully integrated teams need to share a common philosophy and aims and agree on working practices and responsibilities of all members of the team. Within this common framework individuals should work flexibly and pay attention to the needs and expertise of others. Working together improves collaboration but there should still be frequent, formal opportunities for professionals to meet and improve communication.
● Involvement of children and parents.
Children and their families benefit from a “one-stop shop” approach. The involvement of the widest possible range of agencies and services means their needs are more likely to be met directly or through referral. Parents should be involved in the centre because they often have a clear idea about what they and their children need.
Hindrances to integration
There are several problems that could hinder the successful integration of early years services, including ineffective or damaging management and supervision. At all levels, trust and communication are key to effective working and without provision for face-to-face contact through meetings, training and shared offices as well as collaboration in service planning, development and delivery it can fail.
The integration of services at a managerial level does not always ensure the effectiveness of professionals working together on the frontline. Therefore protocols and agreements that all staff agree to are essential for integrating work.
Whatever the problems in implementing the integration of early years services, the literature points to many benefits for children that with the right support can carry through to when they are of school age.
● Centre for Excellence and Outcomes in Children and Young People’s Services Scoping Review 1: Improving development outcomes for children through effective practice in integrating early years services
Research abstracts: integrating early years services
Author: Hanson L, Deere D, Lee C A, Lewin A, and Seval C
Title: Key principles in providing integrated behavioural health services for young children and their families: the “Starting Early Starting Smart” experience.
Reference: Washington, DC: Department of Health and Human Services, Substance Abuse and Mental Health Services, 2001
This paper focused on the implementation of the Starting Early Starting Smart project, a US early intervention programme for families and children (from birth to seven years).
Author: Smith T, Sylva K, Mathers S, et al
Title: National evaluation of the Wraparound care pilot project
Reference: Department for Education and Skills, 2004
This source sets out the key findings of the Wraparound care pilot projects in five areas of England: Cornwall, Ealing, Kirklees, Lancashire and York. The methods involved an impact study (parent surveys, parent focus groups and quality assessments) to look at parent outcomes, child outcomes and quality assessments and an implementation study (quantitative and qualitative work on implementation and processes and on costs and finances).
Author: Hellerich-Tuttle L, Kirkland E S, and Rankes H
Title: The Nebraska Head Start/public school early childhood transition demonstration project
Publisher: Paper given at the third Head Start National Research Conference, Washington, DC, 20-23 June 1996
This US transition project aims to address the fading of gains by children by the third grade from early years programmes such as Head Start. The transition project involves Head Start-like services for families with children in elementary school, kindergarten and through to third grade. School staff, health and social services support children’s health, family wellness, and income. Education, health, social services, and parent involvement are addressed.
Author: Sylva K, Melhuish E, Sammons P, Siraj-Blatchford I, and Taggart B
Title: The effective provision of pre-school education (EPPE) project: final report. A longitudinal study funded by the DfES 1997-2004
Reference: Department for Education and Skills, 2004
The EPPE project explored the effects of pre-school education and care in the UK on children’s development from three to seven years of age. Six English local authorities in five regions participated in the research, which included all main types of pre-school provision. The project tracked a sample of 3,000 children from 141 centres from age three to the end of Key Stage 1.
Author: Penn H, Barreau S, Butterworth L, Lloyd E, Moyles J, Potter S, and Sayeed R
Title: What is the impact of out-of-home integrated care and education settings on children aged 0-6 and their parents?
Reference: Social Science Research Unit, Institute of Education, University of London, 2004
This international research review explores the impact of the integration of care and education in the early years on children and their parents. It assesses 113 reports, and identifies nine for in-depth review. While the studies selected for in-depth review are not from the UK, the researchers note that their findings are relevant to current UK policy debates.
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