Evaluation and value of Sure Start
Evaluation and value of Sure Start
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DOI：
10.1136/adc.2009.161018
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发表时间：
2010-03-01
影响因子：
5.2
通讯作者：
Barnes, J.
中科院分区：
文献类型：
--
作者：
Melhuish, E.;Belsky, J.;Barnes, J.
十年前，幼儿服务跨部门检讨得出结论，幼儿的弱势情况日益严重，如果及早介入，更有可能防止不良后果。1审查还注意到，目前的服务不协调、不连贯，建议改变服务的设计和提供。委员会建议，方案应由所有有关机构联合规划，并以地区为基础，以一个地区的所有4岁以下儿童及其家庭为服务对象。1998年7月，当时的财政大臣戈登·布朗推出了“扎实起步”计划，旨在为4岁以下儿童及其父母提供优质服务。2方案设计的初衷是侧重于20%的最贫困地区，其中包括收入低于国家中位数（官方贫困线）60%或更低的家庭中约51%的儿童。[3]在三年内，提供了5.42亿英镑，其中4.52亿英镑指定用于英格兰。在英格兰，到2001-2002年，计划实施250个项目，为187，000名儿童提供支持，其中18%为4岁以下贫困儿童。通常情况下，一个方案包括800名4岁以下的儿童，在资金高峰期，每个儿童每年获得1250英镑。方案将至少实施10年，资金在第3年达到高峰，从第6年开始下降，到第10年没有资金。部分资金将由地方当局通过“重塑”服务提供。这项投资彻底改变了年初的服务业，但从财政部的角度来看，贡献相对较小仅占公共支出的0.05%。在这个简短的摘要中，我们涵盖了这一雄心勃勃的计划的历史和影响。40多份报告和同行审查的出版物记录了“扎实起步”国家评价的不同阶段及其相应结果，本报告概述了“扎实起步”方案的演变和影响。作为参与评估总体倡议的个人，我们试图提供迄今为止学到的东西的摘要。社区控制是通过地方伙伴关系实施的，包括与儿童有关的每一个人，包括卫生、社会服务、教育、私营和志愿部门以及父母。资金从中央政府直接流向独立于地方政府的方案，尽管地方教育、社会服务等部门和保健信托基金通常是伙伴关系的一部分。所有方案都应提供：（1）外联和家访;（2）对家庭和父母的支助;（3）为儿童提供高质量的游戏、学习和育儿经验的支助;（4）初级和社区保健以及有关儿童健康和发展以及家庭健康的咨询;以及（5）为有特殊需要的人提供支持，包括帮助他们获得专门服务，但没有具体指导如何获得服务。4虽然从具有明确无误的服务议定书的方案中获得的证据被用来证明“扎实起步”方案的合理性，但“扎实起步”方案并没有规定的“议定书”，可以自由地按照自己的意愿改进和创造服务。5这与用来证明“扎实起步”合理性的具有明确提供模式和可证明有效性的干预措施的例子形成对照。6-8在一个以前缺乏支持的部门，融资的速度往往是压倒性的。1999年拨款中只有6%在当年使用。尽管起步缓慢，而且没有任何关于该倡议成功的信息，财政部还是从......
A decade ago, the Cross-Departmental Review of Services for Young Children concluded that disadvantage among young children was increasing and it was more likely that poor outcomes could be prevented when early intervention was undertaken. 1 The review also noted that current services were uncoordinated and patchy, and recommended that there should be a change in service design and delivery. It suggested that programmes should be jointly planned by all relevant bodies and be area based, with all children under 4 years old and their families in an area being clients. In July 1998, the then Chancellor of the Exchequer, Gordon Brown, introduced Sure Start, which is aimed at providing quality services for children under 4 years old and their parents. 2 The original intent of the programme design was to focus on the 20% most deprived areas, which included around 51% of children in families with incomes 60% or less than the national median (official poverty line). 3 Over 3 years,£ 542 million was made available, with£ 452 million designated for England. In England, 250 programmes were planned by 2001–2002 to support 187 000 children, 18% of poor children under 4 years old. Typically, a programme was to include 800 children under 4 years old, with£ 1250 per annum per child at the peak of funding. Programmes were to run for at least 10 years with funding peaking at year 3 and declining from year 6 to none at year 10. Some funding would fall to local authorities, made available by “reshaping” services. This investment utterly transformed early-year services while representing a relatively small contribution from the perspective of treasury—just 0.05% of public expenditure. In this brief summary, we cover the history and impact of this ambitious initiative. While more than 40 reports and peer-reviewed publications have documented the different phases of the National Evaluation of Sure Start with the corresponding findings, this report provides an overview of the evolution and impact of the Sure Start programme. As individuals involved in the evaluation of the overall initiative, we attempt to provide a summary of what has been learnt thus far. Community control was exercised through local partnerships, comprising everyone concerned with children, including health, social services, education, private and voluntary sectors, and parents. Funding flowed from central government directly to programmes, which were independent of local government, although local departments of education, social services, etc, and health trusts would typically be part of the partnership. All programmes were expected to provide (1) outreach and home visiting;(2) support for families and parents;(3) support for good quality play, learning and childcare experiences for children;(4) primary and community healthcare and advice about child health and development and family health; and (5) support for people with special needs, including help getting access to specialised services but without specific guidance as to how. 4 While evidence derived from programmes with clear unambiguous protocols for services were used to justify Sure Start, Sure Start programmes did not have a prescribed “protocol” and had freedom to improve and create services as they wished. 5 This was in contrast to examples of interventions with clear models of provision and demonstrable effectiveness used to justify Sure Start. 6–8The speed of funding was often overwhelming in a sector previously starved of support. Only 6% of the 1999 allocation was spent in that year. Despite this slow start, and without any information on the success of the initiative, the treasury expanded Sure Start from …