Leave well alone?

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