Best Start in Life Review Research Team

Date of Publication 7 September 2017

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1.0 Introduction

1.1 Background In April 2016 Newham restructured its early years offer for 0-4s integrating early education/ childcare, children’s centres and early years’ health provision (midwifery and health visiting) into the new Best Start in Life (BSiL) programme. This new service focuses on evidence based delivery to improve parenting skills and outcomes around health and social and emotional development. The three key outcomes the service is designed to achieve are:

1. improvements in school readiness to ensure children are school ready by age 5 2. improvements in child and family health and life chances 3. improvements in parenting aspirations

The restructure included moving Newham’s children’s centres to a neighbourhood model, with at least one school-led registered children’s centre in each of the eight Community Neighbourhood areas and further provision delivered at other community sites across the neighbourhood. Central to the BSiL programme is Newham’s Best Start in Life Guarantee, which outlines Newham’s commitment to providing a free, universal and local offer to families with children aged 0-4. Alongside approving proposals for the service, Newham’s Mayor committed to a public facing review to assess whether there is adequate, accessible provision in each Community Neighbourhood to meet need and fulfil the Guarantee. This report presents findings from the review, which concludes that the Best Start in Life Guarantee is being met. It is based on an independent evidence review conducted by NatCen (this looked at both evidence for the BSiL model and the most effective interventions for achieving BSiL outcomes), 33 interviews with parents carried out by Public Perspectives, a questionnaire completed by BSiL managers and analysis of service data conducted by the Research and Data Warehouse teams at LBN.

Best Start in Life Guarantee Point 1:15 hours of free eligible childcare, with this increasing to 30 hours when the Government’s proposals are rolled out Point 2: regular Stay and Play sessions every week in each Community Neighbourhood Point 3: programmes, workshops and sessions offering evidence-based advice and guidance to improve parenting capacity in each neighbourhood

Point 4: regular employment advice sessions will be available in each Neighbourhood; and Point 5: in each Neighbourhood, a range of family health and development sessions including: antenatal support; the transition to parenthood; the early weeks of life; perinatal wellbeing; breastfeeding initiation; health weight and nutrition; managing minor ailments and reducing accidents; and supporting speech and language development

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2.0 Guarantee Overview

All elements of the Best Start in Life Guarantee are being met. The number of sessions offered across the year was consistent with planned delivery, at an average of 17 sessions per week per Neighbourhood. Table 1 below shows the total number of sessions, and the average number of sessions per week by Community Neighbourhood. Around two fifths (38%) of children aged 0-4, attend children’s centres. This is relatively consistent between Neighbourhoods. Table 1

Total and average number of sessions by location

Community Neighbourhood Estimated number of 0-4s

No of sessions (year)

Average per week

Beckton & Royal Docks 2589 666 12.81

Custom House & Canning Town

4046 1159 22.29

East Ham 4638 1215 23.37

Forest Gate 2807 868 16.69

Green Street 4315 226 4.35

Manor Park 4628 812 15.62

Plaistow 2967 1175 22.6

Stratford & West Ham 2979 1036 19.92

Newham 28969 7157 137.63

Source: admin data

NatCen Evidence Review Summary

Overall, there is strong evidence to support the BSiL model.

The intervention most directly effective for school readiness is early education. Universal support delivered through the Healthy Child Programme (HCP) is also important for school readiness through enabling parents to support positive child health and development. Targeted parenting interventions where children have specific needs have beneficial outcomes relating to school readiness.

Parenting aspirations, self-esteem and parenting skills are effectively supported by midwives and health visitors from before birth. The most effective interventions for addressing difficulties with parenting are targeted at early signals of risk and include Triple P, Incredible Years and Family Nurse Partnership. Delivering evidence-based programmes according to the model is essential for effectiveness.

Interventions aimed at child and parent health and life chances delivered by health visitors within the ‘4-5-6’ health visiting model have a strong evidence base, reflected in NICE guidelines.

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Table 2 Number and proportion of attendees by location

Community Neighbourhood Children Parents (adult) Total number of attendees

% of borough's attendees

Beckton and Royal Docks 1028 1171 2229 8.38

Custom House and Canning Town 1477 1642 3171 11.92

East Ham 2110 2422 4567 17.16

Forest Gate 1263 1578 2883 10.83

Green Street 1615 1850 3504 13.17

Manor Park 2030 2326 4408 16.57

Plaistow 1173 1325 2525 9.49

Stratford and West Ham 1320 1969 3322 12.48

Newham 12016 14283 26609 100

Source: admin data and ONS 2015 mid-year estimates

Have families been able to access all elements of the Guarantee?

Awareness of the BSiL services was generally high (lower for parenting and employment). All parents who took part in interviews with Public Perspectives stated that the Best Start in Life offer met the needs of their family in its first year.

Families were turned away on the door from a small proportion of sessions (1%, 168 sessions) across the year, the majority of which were stay and play. 927 service users (3.5%) were turned away in total, with the vast majority turned away on one occasion only (84%). This did not compromise delivery of the Guarantee, because alternative sessions were available and staff at BSiL venues signposted to these sessions. No persistent barriers to accessing the Guarantee were identified.

Have EYFS been maintained at 69% achieving a good level?

The early year’s foundation stage profile (EYFS) is an assessment of children’s development and learning undertaken by schools at the end of the reception year (when children are aged 5). EYFS scores have improved over the last two years, with three quarters of children now achieving a good level of development (a 6 percentage point increase since 2015). This is also above the national average of 71%. Particular improvements have been made in literacy (77% of children now achieve a good level of development) and mathematics (81% of children now achieve a good level of development). Future monitoring of EYFS scores will support evaluation of BSiL outcomes.

What do parents think of delivery in the community venues?

Moving to a Neighbourhood based hub-and-spoke delivery model was another key change introduced with Best Start in Life. This model includes one lead centre in each of the 8 Community Neighbourhoods, 4 additional registered children’s centres across the borough, and delivery from a range of community venues including schools, libraries, former children’s centres and community centres. Parents were positive about the delivery in community venues because sessions were more accessible. They also said that they would like to see more sessions (mainly stay and play) in libraries and schools.

“It’s a really good idea. It makes it easier for some people, including me to do things. I think they should do more of it.” (Green Street Community Neighbourhood area, Interviewee 33)

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“I really like that they do things at libraries and in schools. It means there is always something happening near you and gives you choice.” (Custom House and Canning Town Community Neighbourhood area, Interviewee 24)

Neighbourhood managers were also positive about the use of community venues for BSiL delivery, emphasising that these sessions are well attended and they had extended their reach to families who would not usually attend children’s centres. However, feedback from managers also identified difficulties around finding suitable spaces (clean, with outdoor space etc.) in specific areas of their Neighbourhood, and scheduling activities alongside other community uses. “Stay and Play sessions in [the] Library are well attended and have helped us to develop good links with the library including shared registration for library cards”

“Some venues do not have outdoor space- much needed as lots of families in bed/breakfast accommodation”.

3.0 Guarantee Point 1: Childcare

3.1 Evidence

NatCen Evidence Review Summary

There is a strong evidence base for improving school readiness through early education. Early education for three and four year olds is associated with consistent positive effects on cognitive, language and social development. Outcomes of two-year-old early education are more mixed with some negative as well as positive outcomes.

The effectiveness of early education is strongly influenced by two factors: the child’s home environment and the quality of the Early Childhood Education and Care (ECEC) provision. Children from disadvantaged backgrounds benefit the most from high quality early education and provision, while poor quality provision can have neutral or negative effects.

Evidence for the particular benefits of the government funded part-time places for two, three and four year olds is not yet established although research designed to specifically address that question is underway. The effects on children of the forthcoming extension to 30 hours is also not yet clear. However, if the policy results in higher incomes for disadvantaged families, the children will be likely to benefit from improved family context as well as through the early education.

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3.2 Delivery and access

Have the additional places for 2 year olds been created? (how many additional childcare places have been created overall?)

LBN’s commitment to improving the availability of childcare in the Borough as part of the Best Start in Life programme has been achieved, with an increase of 11% in the number of full time equivalent1 places for 0-4s between the start of the school year in 2015/16 (4341 places) and the start of the school year in 2016/17 (4832 places). This means that supply of two year old places is at its highest level ever, and is sufficient to meet increased take-up (outlined in Figure 1). However, there remains a shortfall in particular wards.

What is the take-up of 2-year-old childcare places?

Take-up of two year old childcare places in Newham shows an upward trend over time, with a peak of 67% take up in Autumn 2016, and an increase between Spring 2016 and Spring 2017 of 7%.

4.0 Guarantee Point 2: Stay and Play

4.1 Evidence

1 FTE places= 50 hours. This includes funded and chargeable hours.

NatCen Evidence Review Summary

The review found very little high quality evidence on stay and play. The informal nature of the provision means that it is not well-suited to large-scale, robust impact evaluations. However, recent evidence from the national evaluation of children’s centres confirms the value of stay and play as a way for children’s centres to engage vulnerable families. In the same evaluation, children’s centre staff spoke about the importance of stay and play for identifying needs, providing additional support and modelling positive parent-child interactions. The positive effects of stay and play on parenting and home environment outcomes provide some evidence to support this. Overall, evidence suggests that stay and play is not the most effective intervention for promoting school readiness and parenting outcomes but may help to build the relationships with families that enable them to participate in other, more focused interventions.

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4.2 Delivery and access

How many sessions run per week at 1) the BSiL hub 2) other BSiL venues?

A total of 5071 stay and play sessions took place across the year.

Table 3 Average number of sessions per week by location

Community Neighbourhood All venues Lead centres Registered ccs* Other venues

Beckton & Royal Docks 12.7 6.8 5.9

Custom House & Canning Town 11.8 3.6 3.7 4.5

East Ham 15.0 8.5 5.8 0.7

Forest Gate 10.9 5.5 4.4 1.0

Green Street 6.2 6.2 0.0

Manor Park 9.2 7.7 1.4

Plaistow 18.4 6.7 11.7

Stratford & West Ham 13.2 7.5 2.1 5.4

Source: admin data

*Registered children’s centres

Are any sessions under/ over capacity?

Overall, there was adequate capacity to meet demand for stay and play. Between a third and a half of sessions ran over capacity in each Neighbourhood but correspondingly, half of sessions across the borough were under capacity. It is inevitable that some sessions will be more popular than others when sessions are delivered on a first come first served basis. Parents value choice and convenience, so maintaining open-access alongside continual review of the programme is important.

Who accesses stay and play and how regularly?

Over half of active registered users 2 (62% or 16476 people) attended stay and play in the first year of the Best Start in Life programme. The average number of sessions attended by children was 8. The average was highest for two year olds (pre nursery age) at 11 sessions. The average number of weeks children attended stay and play was six.

What is the average distance travelled to a stay and play session?

The average travel distance attendees travelled to a stay and play session was just over one kilometre, with the average pram push at just over 20 minutes based on a slow walking speed. This indicates that many service users chose to travel further than they needed to, as the average required travel time to the closest stay and play available was much shorter at 10.5 minutes. This is consistent with patterns of travel before the BSiL programme was introduced.

2 Service users who have attended a session since April 2016.

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5.0 Guarantee Point 3: Parenting 5.1 Evidence

5.2 Delivery and access

What programmes are offered?

Across the borough the main evidence based programme offered is Triple P (including Stepping Stones, the SEND version), which includes Parent Protect and sessions on toileting and sleep routines. The Triple P offer is augmented locally with Parents Involved in the Children’s Learning (PICL) in Custom House and Canning Town, and Bookstart which is tailored to local delivery. Neighbourhoods also run their own programme of sessions focused on different aspects of child development and parenting (for example, E-safety, FGM awareness, early communication) as well as targeted family support, which includes outreach.

How regularly is each type of parenting session offered?

551 group Triple P sessions took place across the year, supported with telephone calls (105), one to one advice/ sessions (30) and sometimes crèche spaces to facilitate attendance. Triple P ran every week of the year in the Borough, but not every week in each Neighbourhood.

Triple P is offered on a universal basis across the borough, and parents either self-refer or are referred by BSiL staff or a partner agency. The evidence review (outlined above) showed that Triple P is most effective for families with specific needs, meaning that the targeted element of delivery is the most important.

NatCen Evidence Review Summary

For most parents, the universal health services provided through the Healthy Child Programme (HCP) are sufficient to achieve positive outcomes but parents who are disadvantaged are more likely to need additional support. The evidence is strongest for parenting interventions that are targeted at early signals of child development risk such as attachment, behavioural self-regulation and language development. A number of programmes have been shown to be effective when targeted at specific needs and are widely delivered in the UK. Example effect sizes from individual studies include: Triple P (0.61), Incredible Years (0.63), Family Nurse Partnership, Family Foundations (0.21-0.46 across different outcomes) and Empowering Parents, Empowering Communities (0.38) Areas identified as requiring further research include the impact of universal methods of parenting support (through leaflets, apps and websites), interventions focused on specific groups including fathers and parents with learning difficulties and the long-term effectiveness of parenting support.

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6.0 Guarantee Point 4: Employment

6.1 Delivery and access

What other employment advice and guidance is offered through BSiL in each neighbourhood?

Across the year, there was a total of 1282 employment sessions (excluding sessions providing crèche facilities). Support or training for childminders accounted for the largest number of sessions (505, 39%), and the only element of the offer available in all Neighbourhoods. ESOL was the second most common session (287, 22%), available in all Neighbourhoods with the exception of Forest Gate (Forest Gate will be re-introducing the offer following building works). Centres also refer parents to libraries and Learning Zones for ESOL courses. Other sessions offered under Guarantee Point four varied by Community Neighbourhood.

How frequently are the sessions offered in each neighbourhood? Table 3

Number and frequency of employment sessions by location

Community Neighbourhood No of sessions No of weeks offered

Average number of sessions per week

Beckton & Royal Docks 76 39 1.46

Custom House & Canning Town

377 36 7.25

East Ham 139 40 2.67

Forest Gate 75 45 1.44

Green Street 191 40 3.67

Manor Park 126 41 2.42

Plaistow 107 38 2.06

Stratford & West Ham 132 41 2.54

Newham 1223 51 23.52

Source: admin data

How effective is delivery of the programme?

In quarter four the BSiL programme established stronger links with Workplace. Workplace has now created an engagement team which attends settings with vacancy and training lists, as well as general Workplace information. The aim of this initiative is to allow parents to build a relationship with Workplace before they attend, to increase referrals and improve attendance at Workplace.

What are the outcomes for parents registered with Workplace?

Two-fifths of BSiL service users registered with Workplace have found employment through the service, including 54 in the last year.

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7.0 Guarantee Point 5: Health & Development 7.1 Evidence

7.2 Delivery and access How frequently is each session offered in each of the neighbourhoods?

Two kinds of health sessions/ services (including health promotion activities) were delivered across the borough in the first year of Best Start in Life. Health services, delivered by a health professional, and health and wellbeing sessions, delivered by Best Start in Life staff.

In line with the Guarantee, all Neighbourhood areas delivered sessions and support for families around the six healthy child programme areas through designated health sessions. Health sessions and services ran nearly every week in Newham throughout the year, with an average of 65 health services a month and 41 health and wellbeing activities. Therefore, despite changes to the commissioning of health services under the new model, the majority of health sessions offered through the BSiL programme continue to be provided by health service professionals.

How do families access health support through BSiL?

Almost all parents who took part in interviews with Public Perspectives were aware of the health and development support available through the BSiL programme. Parents were aware of the programme due to a combination of word of mouth the lead centre / neighbourhood programme and also staff (including health visitors) promoting workshops at other sessions or directly to parents. All participants, including those with babies born in recent months, say their health visitor had referred them to their local children’s centre. “My health visitor told me about it [the children’s centre] . . . they also called me to come along.” (East Ham Community Neighbourhood area, Interviewee16)

“My health visitor told me about some of the things I could do to help me and my child. I think they called me and booked me on lots of different workshops.” (East Ham Community Neighbourhood area, Interviewee 1)

NatCen Evidence Review Summary

The healthy child programme (HCP) is supported by a strong evidence base, focusing on six high impact areas where health support is considered to be most effective and structuring interventions around four levels of service across a spectrum from universal to targeted support. The evidence for effective interventions is probably strongest for maternal mental health with clear guidance on when facilitated self-help approaches, high intensity CBT or medication is required. There is also strong evidence for the impact of specific health programmes supporting early attachment, the instigation and continuation of breastfeeding; promoting healthy weight and increasing home safety. The evidence is less strong for the impact of antenatal classes on pain in labour, low birthweight and the onset of maternal depression. Overall, a strong case has been made for early intervention based on evidence from the UK and other countries over decades. Since inequalities are established early in a child’s life and become self-reinforcing, early intervention can help alter a child’s trajectory.

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8.0 Conclusions NatCen’s literature review identified strong evidence to support the BSiL model, and the review overall showed a good first year of delivery for the Best Start in Life Programme. The Best Start in Life Guarantee was met, offering families of children aged 0-4 free eligible childcare, stay and play, parenting programmes, employment advice and support and a range of health services in every Neighbourhood. For the majority of families the full offer could be accessed within a very short distance from their home, although parents also chose to travel to access some sessions (as was the case before BSiL launched). Future planning for the Best Start in Life programme will include a detailed review of parenting interventions, recently commissioned by the Mayor.

Summary table of key findings Guarantee Point

Meeting the Guarantee?

Key evidence Key areas to consider

Childcare Yes

• Almost all parents were aware of the 15 hour offer • Maintaining provision of 2 year old places across the borough with the introduction of the 30 Hour Offer in September 2017

• Full time equivalent places for 0-4s increased by 11%

• Take-up of two year old places peaked at 67% in Autumn 2016

Stay and play Yes

• Overall capacity to meet demand with between 6 and 18 sessions delivered each week per Community Neighbourhood

• Addressing the balance of attendance to capacity to reduce the number of over-capacity sessions while maintaining choice and flexibility for families

• Some variation in the ratio of staff to children • Identifying optimal ratios of staff to children and ensuring consistency of ratios across the borough to support moving families towards targeted support where appropriate

• On average families could reach a stay and play session within 10.5 pram push minutes from their home

Parenting Yes

• Evidence based Triple P delivered in every Neighbourhood throughout the year, as well as a range of parenting support sessions

• There will be a review of parenting programmes, commissioned by the Mayor. This will look at effective targeting of Triple P

Employment Support

Yes

• In each Neighbourhood employment support took place on average at least once a week

• Maintaining and improving joint working with Workplace

• 11% of service users over the age of 16 are or have been registered with Workplace

Health Yes

• Almost all parents were aware of this element of the Guarantee. Parents who had had babies born in recent months said their health visitor referred them to their local centre

• Continued development of this offer with Health Visitors now in-house

• The majority of health sessions offered through the BSiL programme continue to be provided by health service professionals. 777 sessions and activities were led by health professionals throughout the year, with an additional 486 sessions/ activities delivered by BSiL staff