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Family support services are a central plank in the government's approach to tackling disadvantage and enhancing children's life chances. In September, the government announced a £2.5 m increase in funding for Home-Start, a charity offering emotional and practical support through volunteer home visiting to some 30,000 families under stress with a child under five. Margaret Hodge, minister for children said, "Home-Start makes a dramatic difference to parents who need that extra support to see them through a challenging period in their lives."

Yet just days after the minister's announcement, research funded by the Joseph Rowntree Foundation found that 11 months on families receiving a weekly Home-Start visit were doing no better than families in a control group not getting the support.(1)

The study followed 162 families over an 11-month period. Half the families received Home-Start home visiting once a week for around two and a half hours. The needs of the mothers and level of depressed symptoms were high in both groups and families were matched for variables such as age, income and their use of other services.

All of the mothers were interviewed at the beginning and end of the study and levels of parenting stress, mental health, self-esteem, social support and the emotional and social development of their children were measured.

Eleven months later the mothers in both groups were feeling better. They were less stressed and depressed and their children's emotional and social development had improved. They also had more social support. Mothers nonetheless valued the support and friendship offered by the Home-Start volunteers and 80 per cent said it had made a difference to the stresses they had been experiencing.

Previous studies have shown that Home Start does make a significant difference to mothers' mental health and confidence and reduces isolation. But what is different about the Joseph Rowntree research is that it involved a random controlled trial, regarded as the gold standard in research, whilst earlier studies were qualitative and did not include a control group.

People who get results they don't like are inclined to rubbish the research and it is to Home-Start's credit that they are looking at what they can learn. Dylan Harrison, chief executive of Home-Start, says, "The fact that the study didn't show everything we might have hoped for means we can't be complacent."

Even mothers who appreciated the Home-Start service said the intensity of the service could have been greater and Harrison reports that the charity is now exploring whether more intensive help could be offered, possibly through groups or a telephone-based service.

But he was not surprised to learn that a weekly visit had no significant effect on maternal depression. "I would never claim that the home visits are a treatment for depression. We're about giving friendship and support and breaking down isolation."

It is tempting to assume that the outcomes would have been different if the volunteer had visited three or four times a week or if they had been specially trained to support depressed mothers.

But as the researchers acknowledge, our understanding of support services for children and families and how best to evaluate their effectiveness is at an early stage.  It's even possible that for some families, receiving a service - however comforting and reassuring - actually diminishes their capacity to bounce back from difficult circumstances and feel in control of their lives.

If we are serious about ensuring that public money is spent effectively and that interventions make a real difference to people's lives, more services need to follow Home-Start's example and open themselves to evaluation with random control trials. The results may not always make comfortable reading.

References

(1) McAuley, Knapp, Beecham, McCurry and Sleed, Young families under stress: Outcomes and costs of Home-Start support, JRF, 2004 www.jrf.org.uk/knowledge/findings/socialpolicy/954.asp