Sure Start, Off To A Rough Start And Not Improving

Sure Start is another well-intended programme trapped in the revolving door of social engineering. Children's health and wellbeing can be damaged by their home environment and what is happening in their neighbourhoods. Sure Start was intended to improve children's welfare through improving parenting skills and creating a secure and happy home environment. Today's Guardian offers the bleak assessment that Sure Start 'harms children who need it most'. The scheme offers services to more than 660,000 children in England, but is said to be

setting back the behaviour and development of young children in the most deprived households.

It is not that the scheme is actively 'harming' children: the results need a fair amount of interpretation. It seems as if the problem is that

moderately deprived families fared better under the scheme, with non-teenage mothers exhibiting better parenting skills and children displaying greater social skills.

The researchers believe that moderately deprived families may be more ready to take advantage of Sure Start services, leaving the most deprived with fewer resources and less access to support.

I don't understand the criteria for judging deprivation (the criteria for greater social deprivation seem to be status-based rather than based on income or assets; i.e., the "relatively more socially deprived" are listed as teenage mothers, lone parents, workless households). However, after consulting the source article, Effect of Sure Start local programmes on children and families: early findings it is not clear that this is the case. The researchers' conclusions are more tempered than the Guardian's account would suggest.

Socially deprived families with greater personal resources may have been better able to take advantage of [Sure Start Local Programmes (SSLPs)] services and resources, which may have left those with fewer personal resources (such as young mothers and lone parents) with less access to services than would otherwise have been the case. Relatively more socially deprived parents may also find the extra attention of service providers in SSLP areas stressful and intrusive. (italics added)

There was an evaluation last December. If it is obvious that the right questions were not asked previously that would result in something other than the guesswork of may and the nebulous less access. I understand the need for tempered writing but this is an evaluation report on a project that has consumed more than £3 billion over four years. It is annoying that there is no explanation for the mechanism whereby children and families from the "relatively more socially deprived" category experience "adverse effects".

More children and families were affected beneficially than adversely, as teenage mothers formed a minority of the sample (14%), as did lone parent families (33%) and those living in households were nobody worked (38%). However, because the most socially deprived groups account disproportionately for many problems in society (such as school problems and crime), the apparent adverse effects of SSLPs might have greater consequences for society than the beneficial effects.

Maddeningly, we do not have a discussion of these "apparent adverse effects"; it is an exercise for the reader to guess what the magnitude of the "behavioural problems" might be and lower levels of "verbal ability".

Without further explanation, it is not clear if the researchers assume that the attentions of SSLP agencies are responsible for additive stress for the "most socially deprived" groups who are presumably already dealing with multi-agencies for housing costs, benefits etc. or they wouldn't be in this category. If it is additive stress, it is not particularly surprising that health-lead SSLPs were more effective than SSLPs offered by other agencies. It seems logical that health-led SSLPs benefit from better access to birth records and the already available infrastructure of Health Vistors who already make home visits: parents are already working with Health Visitors, there is no necessity to independently approach a separate agency.

The national evaluation report is dispiriting reading: as such, it seems comparable to the findings of the US Early Head Start programme. The evaluation concludes with the assertion that the study indicates that

improving parenting is one of the mechanisms by which SSLPs promote child wellbeing.

I accept that this sentiment is part of the theoretical basis for Sure Start but I'm not at all sure that this evaluation has demonstrated that it is happening. Except, of course, in those "relatively less socially deprived" groups who may be depriving others of access to services that they may experience as "stressful and instrusive". I would like the researchers to venture an opinion on whether it is the 'stress and intrusion' that is responsible for the 'harm' or the putative "less access to services": there is a case for saying that this paper has presented these two explanations without an acknowledgement that are mutually exclusive.

Despite these dispiriting findings, the Guardian reports that:

The government plans to expand the current 848 Sure Start children's centres to 3,500 by 2010, the equivalent of one centre for every community.

Why? What would it take to prove that this form of social engineering does work or doesn't work? What will be done differently to ensure value for money and value for the families and children who use SSLPs?

A long-term follow-up study of the children of depressed parents reports that:

The risks for anxiety disorders, major depression, and substance dependence were approximately three times as high in the offspring of depressed parents as in the offspring of nondepressed parents. Social impairment was also greater.

There is a growing body of evidence to suggest that environmental exposure to hostility or aggression (whether physical or verbal) is linked to poorer lung function and an increased number of asthma exacerbations in children: and the environment may be the home, school or neighbourhood. These findings may be relevant to this programme and the interpretation of its results.

It is disappointing that the authors assert that the 'harm' to the relatively-deprived families may outweigh the benefits derived by the "relatively less socially deprived" groups without explaining their thinking. There are no illustrative examples of the costs of this phenomenon. It would have been useful if this evaluation had attempted to cost the advantages of supporting "relatively less socially deprived families" who may be benefiting by increasing their resilience, with all the improved physical, cognitive, social and emotional benefits that that confers for the family and the reduced costs for society.

Interviewed for the New York Times, leading psychiatrist and resilience expert Sir Michael Rutter said:

We now have well-replicated findings showing that genes play a major role in influencing people's responses to adverse environments. But the genes don't do anything much on their own.

If Sure Start has to continue, why not do something exciting and useful like collect genetic material and test for the so-called resilience gene? Collecting data on this scale would be a valuable contribution to the work of researchers looking at the tandem effect of genetics and environment.

In 2003 Avshalom Caspi and his colleagues published a fascinating paper in Science that discussed the relationship between the gene, 5-HTT, and childhood maltreatment in causing depression. Current theories say that 5-HTT is crucial for the regulation of serotonin to the brain; and that the proper regulation of serotonin protects us against depression in response to trauma or stress.

In humans, each 5-HTT gene has two alleles, and each allele occurs in either a short or a long version. Scientists are still figuring out how the short allele affects serotonin delivery, but it seems that people with at least one short 5-HTT allele are more prone to depression. And since depression is associated with unemployment, struggling relationships, poor health and substance abuse, the short allele could contribute to a life going awry. A Question of Resilience New York Times

If we insist on experimenting with social engineering, let's gather scientific data and look at the tandem effects of genetics, environment and life experiences.