Young families under stress: outcomes and costs of Home-Start support

The evaluation of Home-Start one of the largest family support organisations in the UK took place in Northern Ireland and the south of England with funding from the Joseph Rowntree Foundation. Progress among a group of 80 families who received home visits from trained volunteers for an average of two hours a week over 11 months was compared with the experiences of a group of 82 similar families who had access to the NHS and other generally available services.

The research team, led by Dr Colette McAuley of Queen's University Belfast and Prof. Martin Knapp of the London School of Economics, found that:

• A majority of mothers in both groups were under severe stress when the research started, affecting their capacity to parent their children. Many had experienced trauma related to pregnancy and their baby's birth, and depressive symptoms were widespread. Feelings of inability to cope were intensified for many by having to care for several young children. Problems affecting children's emotional and social development were also evident.
• Home-Start volunteers provided a combination of emotional support, practical assistance and help with family outings over an average of nine months. The mothers appeared to have little social support from friends or extended family and Home-Start was often the only non statutory service in their area.
• Four out of five mothers in the group visited by Home-Start told researchers that it had made a difference to the stresses they had been experiencing and that they valued the support and friendship of their volunteer.
• Eleven months after they were first interviewed, the situation of most mothers in the Home-Start group had improved. They were experiencing less parenting stress and showed fewer symptoms of depression. They had higher self esteem, more social support and there was evidence that their children's emotional adjustment had improved. However, mothers in the comparison group, who only had access to the NHS and other statutory services, showed a similar level of improvement.
• Mothers interviewed in both groups felt they had gained more control over their lives and referred to progress in overcoming short term health problems and their growing confidence as parents. In some cases, disputes with ex-husbands or partners had also been resolved. Many women said they felt less pressured because their children were older, and were able to attend a playgroup or school. Some had returned to work, leading to a more equal share of parenting responsibilities with their partner as well as more income.
• An analysis of cost effectiveness showed that many families had been using health, education, child care and other formal services before the research started, and after 11 months there was no significant difference in the costs of using these services between the Home-Start families and the comparison group. However, the additional costs of Home-Start support meant total service costs for that group were higher overall. In other words, Home-Start did not appear to be a cost-effective alternative to standard services using professional health visitors. 

Colette McAuley said: “We have learned a great deal from this study about the day-to-day lives of young families under stress and their support needs. The mothers who took part were facing multiple, interconnected problems that had a serious impact on the capacity to parent. There was a strong sense of their being overwhelmed at times by the intensity of the demands place upon them and a lack of any respite that made the situation worse.”

She added: “The vast majority of mothers in this study were convinced that Home-Start visits had played a positive part in helping them to cope. Nevertheless, the outcome measures used in this evaluation did not support the view that Home-Start had made a significant difference to their lives over and above the improvements also experienced by the comparison group of mothers who were not supported by Home-Start.

“This lack of effects that can be positively attributed to Home-Start may have more than one explanation. For example, mothers even when they appreciated the support they received - felt the visiting programme could have been more intensive.”

She added: “It is also worth emphasising that this evaluation was assessing the effectiveness of Home-Start after an initial year, which is a relatively brief period in studies of early years interventions. With a community based initiative such as Home-Start, which does not aim to provide a structured, intensive programme, a follow up study after a number of years might well prove valuable.”

Dylan Harrison, Chief Executive of Home-Start, said: “Last year Home-Start supported over 30,000 families in the UK. It is gratifying that the research endorses the tremendous popularity of Home-Start with families who genuinely value our support. The fact that 4 out of 5 mothers in the study felt Home-Start support had made a difference to them in relation to the stress they were under at the outset is an endorsement of the benefits of our work.

“The study provides a number of useful discussion points for Home-Start as we continue to develop our support services and will be a tremendously useful starting point for researchers as their work in this area develops.”