Government scheme to improve health and well-being of deprived families called into question

Effects of Sure Start local programs on children and families: early findings from a quasi-experimental, cross sectional study, BMJ Online First

The Government's Sure Start program, set up in 1999 to improve the health and development of socially deprived families with young children, shows some benefit for most poor families but may also be adversely affecting the worst off to some extent, says a paper in this week's BMJ.

The program targets individual families with children under four in designated deprived areas. It provides outreach or home visiting, advice about family health and development, support for people with special needs, and support for good quality play, learning and childcare experiences.

Researchers looked at families in 150 Sure Start communities, comparing them with families in 50 areas of similar deprivation. To measure the success of the programme, they looked at how many of the community services the families used and how useful they found them, the home learning environment, and the degree of supportive or negative parenting.

The study also looked at reported behavioural problems, and children's development (verbal, spatial and number skills).

The researchers found that children from the relatively less well off families but not worst off - those of non-teenage mothers - showed some benefit from the Sure Start program. But children from more deprived families - teenage mothers, lone parents, workless households - were adversely affected.

They also found that Sure Start programs led by health agencies were the most effective.

The authors warn that the results should be treated with caution at this early stage of Sure Start's implementation, and the scheme needs further evaluation. They point out that more families benefited than were negatively affected by the initiative. But since the programme resulted in some adverse effects for the most deprived - the socio-economic group involved in a disproportionately high level of society's problems - Sure Start's negative though limited effects could have considerable consequences.

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