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Evaluating the Programme model

When evaluators analyse large volumes of data to assess the impact of a programme, many questions arise which impinge not only on the interpretation of the analyses, but more fundamentally concern the whole approach to the way in which the statistical judgements on programme effectiveness are reached.

A comprehensive programme offers many more challenges than a simple focus on a few identifiable targets. Aiming at the development of the 'whole child', what should be the target measures, and what are the predictive models?

The essential concept underlying the Child Development Programme is that the intervening home visiting agent - the health visitor, public health nurse, para-professional or community parent - should focus entirely on the parent, and should aim to motivate and empower the parent so that she (or he) in turn can have a permanent influence on the child.

Changing parents' behaviours can be difficult and involves empowering parents rather than imposing professional ideas for change; it is for these reasons that most intervention work at the pre-school level has focused rather on short-term identifiable changes which can be brought about in the children fairly quickly, such as increasing their ability to carry out problem-solving tasks and do other forms of mental gymnastics for which they are trained, indirectly, by many child-based programmes.

The CDP's approach is slower in its effects because it is targeted on the chief agents of change in the pre-school years, namely the parents. It takes time to change adults; indeed it is basic to the CDP that the parents must be helped to change themselves rather than expecting them to respond to formal pressures from outsiders to change their behaviours. Giving parents dignity, helping them to feel in charge of their own lives and recognise the primary responsibility for influencing their children's development, are not achieved by high-powered professionals offering advice and direction..

It is difficult to gain acceptance for this approach, which in many ways threatens modern society's rather authoritarian approach to its constituent families, and in particular to its most disadvantaged families; it is even more difficult to establish the effectiveness of that approach, and to prove it statistically, no matter how credible it may seem as ethically desirable and no matter how acceptable it may be to the parents who experience it and to those community home visitors who are its committed exponents.

Intervention should target family environment

The analyses undertaken on the massive volume of data from over 1,000 children and their families in the first research phase provide strong evidence for the Programme Model described in section 6.70 of the research report listed at the end. It was found that Intervention or other forms of family support have their principal effects on the home environment and only indirectly on the target children. Thus, it is the parents and the caring environment with which they surround their young children that should be the main concern of both policy-makers and service-providers.

It was interesting to note that the regression analyses on those data indicated that the common analytical focus on socio-economic status variables such as unemployment or employment status, housing and other economic status variables as the prime indicators of positive or negative influence on families, may be misplaced; most of the home variables assessed in this study proved more powerful predictors of later home and child development outcomes than did the socio-economic measures. Quantitative research attention is seldom focused on the multiple reality of home life and its operational environment, which are themselves only partially influenced by the socio-economic variables.

Having said that, it has to be recognised that the influence of the unintentional sample bias in one of the areas was pervasive in that area. It is always interesting to examine the implications of the fact that one of the areas, in an otherwise highly successful programme, has achieved only modest results in changing some variables, and no results in changing some other variables. The principal conclusion is that, as could be expected, a two-year support programme cannot bring a disadvantaged sample up to the level of functioning of a considerably less disadvantaged sample. What it can do is to reduce the gap between them, and also to reduce the level of potential failure in the home environments of the disadvantaged.

A more profound observation concerns the ultimate target of programmes such as this. Given the dominant effect of cultural and economic advantage on the development of children, is it not legitimate that State and health authority investment in this programme should remain focused on disadvantaged areas rather than expanding the programme to cover both advantaged and disadvantaged areas, as has frequently been suggested? To expand the programme to cover advantaged parents would effectively ensure that the gap between disadvantage and advantage remained the same, though each group would probably be functioning at a higher level.

With the wealth of resources available to advantaged parents - an educational background enabling them to abstract and utilise information from countless books on child-rearing, combined with a culturally in-built achievement orientation on behalf of their children and a skill in utilizing State services effectively, it would seem appropriate that the Child Development Programme should be expanded to cover all communities living in areas of social stress or disadvantage, but not beyond that.

As a form of cost-effective State investment in prevention and development the programme is probably without parallel. Its problems are related to the human challenge it poses to professionals, who are asked to empower those who often appear the least capable of using power effectively, even with their own children.

Cumulative value of small intervention effect over time

At another level it is necessary to assert the strength of what has been discovered in the analyses of the Child Development Programme results. As R.P.Abelson (1985, A Variance Explanation Paradox: when a little is a lot Psychological Bulletin 97 1 129-133) has emphasised, concern about the small size of the variance contribution of a programme grossly understates the possible variance contribution in the long run, because of the cumulative effect of the explanatory factor over time.

The longitudinal nature of the analyses conducted here also has considerable merit when compared with ad hoc or cross-sectional studies. As I.Lazar and R.Darlington (1978, The persistence of pre-school effects Community service Laboratory, Cornell University) point out, longitudinal data provide the most valid and direct way of assessing the cognitive, social, emotional and familial outcomes of programmes for young children, and although policy-makers are rarely content to wait for findings, children's growth cannot be hurried.

The findings from the second phase of the programme, the ongoing field phase, are particularly important and relevant as they are pointers to the present success and future potential of this programme. At a time when parents are the scapegoats for many of society's own limitations, and are blamed for parenting failures whose roots lie in an unsupportive community milieu, it is essential that the work and goals of parent support should be greatly widened, with parents being empowered and capacitated rather than made to conform to outside standards and demands.

A particular example of the success of the ongoing programme in fostering parenting skills is shown by the greatly reduced levels of child abuse in this programme. The rates of inclu¬sion of programme children on child abuse registers and the rates of physical injuries to these children were shown to be exceptionally low. With some urban levels of abuse injuries reaching as high as 4.5 per 1,000 young children per year, the CDP figures of 0.65 per 1,000 per year, on one count of 7,000 programme children across a number of disadvantaged areas, are a tribute to the programme‘s methods of empowerment and capacitation.

(It should be noted that in a major report subsequent to the 1988 report on the Thousand Family intervention study referred to above, a follow up of 31,000 children whose parents had been involved in the CDP, in disadvantaged areas of 24 health authorities and units across much of the UK, showed a 50% reduction in physical abuse and a 40% reduction in placement on the Child Protection Register, when comparing those children with children across the whole of the 24 health authorities which by definition were not as disadvantaged as the targeted programme areas. See Child Protection: the impact of the Child Development Programme, ECDC, 1994.)

Assumption that nearly all parents willing to learn

Rather than following the modern service practice of labelling families as being 'at risk' of abuse and keeping a watchful eye on them, the programme assumes good will and a willingness to learn on the part of nearly all parents, and helps to bring out these qualities.

At yet another level, the increasing quality of the programme training over recent years is a particular strength, to back up the expanding awareness of the programme goals and philosophy.

A great deal of material waits to be analysed, both from the first phase and from the current programme work. Increasingly the collaborating health autho¬rities are being involved in the evaluation of what their own health visitors are achieving. Preliminary findings not only confirm what is already evident about parents' achievements as a result of the current programme, but also offer insights on how it needs to develop in the years ahead, widening its remit geographically and bringing in other groups, facing different kinds of disadvantage, who have not yet been involved.

With a health service spending of over £80 billion a year (2007 figures) to cope with illness in society, and a pitifully small group of 10,000 health visitors serving as the principal agents of preventive health, development and parent support in the community, it is time for new priorities to be set within the health service and in society at large - empowerment and capacitation being the only means by which less advantaged parents can hope to achieve the child-rearing goals that are expected of them.

This is not an easy goal. The biggest challenge facing modern societies is not how to improve marginally the skills of those children who will in any case succeed moderately well. The challenge is what to do about those young children in the bottom 25 per cent who are destined to provide a major part of the educational and social failures of later years, and whose numbers include most of those who will become a burden on the State in the competitive and individualistic environments of this and other Western economies.

A low-cost initiative such as the Child Development Programme has shown that it can reduce the number of children who fall into educational and social failure, and can improve the mean overall functioning of most of the children living in social stress areas. With the present improved training methods in the CDP, the success in achieving these goals is undoubtedly well beyond the levels achieved in the first, experimental phase.

As the programme becomes more widespread it can help reduce the differences between the extremes of success and failure which arise as a result of present circumstances. Its particular strength is that it does not 'educate' or 'instruct' parents, but helps them to recognise and develop their own skills, so that they in turn can become part of a more effective community and a more caring society.

The research period occupied nearly four years, while the statistical analyses and writing of the final report took a further four years. The detailed 120 page report, published in 1988 and entitled The Child Development Programme: an evaluation of process and outcomes, as well as the subsequent study referred to above, Child Protection: the impact of the Child Development Programme, can be ordered from the ECDC. (See Contacts page on this website for the address.)

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