Evaluation of the 'You First' Programme for Young Parents

6 IS THE PROGRAMME SUCCESSFULLY REACHING ITS TARGET GROUP?

The target group

6.1 You First is intended for first time parents who:

• are aged 21 or under
• have a child of less than one year of age
• live in the 15% most deprived areas of Scotland.

6.2 Broadly speaking, health visitors and other professionals involved with You First felt that the target group was appropriate and that this group of parents stood to benefit from the type of support provided by You First. However, all health visitors who took part in the research felt that there were people on their caseload who would have benefited from attending the programme but who were ineligible in relation to one or more of the above criteria.

6.3 In terms of the parents' age, health visitors talked about parents who were aged 22-24 who they felt were no more mature than some of the younger parents and who needed as much support. The risk of increasing the age range is that younger parents are discouraged from attending. Health visitors did not envisage this being a problem as they felt the older parents did not look or act any older than those aged 21 or under. However, one professional commented that, from her experience of running groups, having a wider age range can mean that the group doesn't 'gel' so well. The You First management were willing to trial delivering the programme with parents aged 25 and under. The 10th programme, which is currently running in Midlothian, and is not included in this evaluation, is being run on this basis.

6.4 Health visitors also discussed the fact that many of the parents in their caseload who were aged 21 or under already had one or more older children. While the health visitors felt that they would still benefit from attending, the You First management did not feel that they could be flexible in relation to this. This was partly due to practical considerations, such as having to accommodate a greater number of children in the crèche, but it was also related to the focus of the parent and baby sessions being on the interaction between the parent and the baby; they did not feel these sessions would be successful if a parent also had an older child or children with them. One possible solution would be to have a crèche that ran all day for the older children.

6.5 Offering greater flexibility in terms of the age of the child was also suggested by health visitors. Specifically, they mentioned that the age limit could be increased to 2 years of age. For some parents, there simply may not have been any similar groups available when their child was younger. However, health visitors did report that some parents are not interested in attending groups straight after becoming a parent but that they may be when their child is a bit older. They also commented that parents were less well supported in general after their child had turned 1 as they no longer see their health visitor. Again, the You First management did not feel that they could offer more flexibility in relation to this criterion. This was due to the emphasis placed on encouraging interaction with babies from a young age. Another professional also cautioned that parents with young babies prefer to go to groups where other parents also have young babies as they do not tend to feel as confident as parents with older children.

6.6 Finally, although You First was pitched at parents as opposed to just mothers, no fathers have attended. You First staff and other professionals commented that, on reflection, the programme would have been very different with fathers there and felt that it may be better to look separately at what support could be provided to young fathers.

Referral to the programme

6.7 As mentioned above, the programme is intended for parents living in the 15% most deprived areas of Scotland, based on the Scottish Index of Multiple Deprivation (SIMD). Local health visitor teams advised You First facilitators on the most appropriate locations in which to run the programme. Health visitors were then asked to approach all parents in their caseload who lived in the selected area.

6.8 SIMD is a classification which takes into account a range of factors in order to provide a measure of deprivation for a given area. As it is calculated at the individual postcode level, it is possible for neighbouring streets to have different SIMD scores. The SIMD scores of the individual postcodes of parents approached to take part in You First were not considered in the referral process; once an area had been selected, health visitors could approach all parents who lived within reasonable travelling distance of the venue. As part of the evaluation, the research team reviewed the SIMD classifications of the postcodes of all parents who had been approached about attending You First. This analysis showed that the vast majority of parents did not, in fact, live in the 15% most deprived areas of Scotland; just 9 of the 85 parents approached about You First did.

6.9 This is a consequence of fact that the referral process used in the pilot involved the selection of broad areas of deprivation as opposed to the selection of individual parents whose postcodes were in the 15% areas of Scotland as defined by the SIMD classification. This issue was only identified by the research team at the end of the evaluation. Therefore, You First facilitators were unaware of this issue throughout the pilot. Nonetheless, it is unclear what could have been done differently. If the criteria had been strictly adhered to, there would not have been sufficient numbers of eligible parents to allow the groups to go ahead. Furthermore, as discussed in more detail below, the parents who attended did, on the whole, need the support provided by the programme. One of the potential problems with the use of SIMD data to target services/resources is that, while the most deprived areas may have the highest proportion of individuals in need of the service, many (even most) of the target group may live in other areas¹⁶. So it is entirely possible for an individual living in a relatively non-deprived area to be vulnerable in the sense that, for example, they have a low income, are isolated or lack access to services.

6.10 Should You First decide to try to impose the 15% most deprived criterion more strictly, the way in which suitable areas are identified would need to change. Instead of areas being selected on the basis of local knowledge of which broad areas are deprived, eligible parents would be identified. These parents would have to meet all of the eligibility criteria, including that their postcode was in the 15% most deprived areas. On the basis of where these parents lived, a suitable location for the group to be held could be selected.

6.11 However, in an interview conducted prior to this issue being identified, the You First Senior Manager did acknowledge that there had been some challenges related to the 15% most deprived areas eligibility criterion. She alluded to the fact that they would be open to trialling the programme in an area that was not in the 15% most deprived areas of Scotland and she noted that she would not want the requirement to become a 'silly rule' that stopped vulnerable people accessing the programme. She gave the example of parents who had moved to temporary accommodation, such as a private let in a less deprived area, but who were originally from, and would most likely return to, an area which was within the 15% most deprived parts of Scotland.

6.12 Apart from this issue of deprivation, the referral process was straightforward. Health visitors were provided with information about the programme and were asked to mention it to all eligible parents in their caseload. They were also provided with flyers containing information about the programme to give to parents. Parents who expressed an interest in attending were then visited at home by the programme facilitators in order to learn more about the programme and to discuss the topics they would like to cover at You First. Occasionally, when the health visitors thought it put the parent at ease, they would attend the home visit along with the facilitators.

6.13 With the exception of a small number of parents who had been recommended the programme by a friend or family member, all referrals in the pilot were done through health visitors. While the process was effective, You First staff were conscious that being over-reliant on one referral source had the potential to cause problems, for example if a health visitor was off sick during the referral period. Other potential sources of referral, suggested by You First staff and other professionals, were lone parent advisors at Job Centres, schools, other voluntary organisations in the local area and self referrals (e.g. parents who have been recommended the programme by a friend or family member).

Parents who choose not to attend the programme

6.14 Health visitors reported that the main reason given by parents who chose not to attend You First was that they were not interested in going to any groups. Sometimes, this was due to a lack of confidence, sometimes they just did not see why they might benefit from this support and other times parents had concerns that there might be particular people whom they knew from school, and didn't get on with, at the programme. Health visitors commented that those who chose not to attend tended to be among the most vulnerable parents, who they felt had the most to gain from attending. They did, however, note that some very vulnerable parents had attended. One health visitor suggested that a buddying system, whereby a parent who has already been to You First visits those who are unsure about attending, could be effective in encouraging them to go.

6.15 In terms of assessing the unmet need within the pilot areas, the You First Senior Manager discussed the fact that they do not know the number of eligible parents within the pilot areas who were not invited to attend a programme. This is linked to the way in which areas are currently identified, described earlier in this chapter. As well as ensuring that parents met the deprivation criterion, the alternative method of first identifying eligible parents and then selecting a suitable location in which to hold the group, would also be more effective in establishing unmet need.

Parents' levels of need

6.16 As discussed above, the vast majority of parents did not, in fact, live in the 15% most deprived areas of Scotland. However, the general consensus among professionals involved in You First was that, although level of need varied from parent to parent, on the whole, they did need this type of support. As discussed in Chapter 3, the ways in which parents benefited and the extent to which they benefited varied. Examples of parents who were well supported by their own parents, but who did not necessarily have any peer support, were cited by facilitators and health visitors as parents who may not have immediately appeared to need support but who stood to experience benefits, particularly around the social aspect of the programme. However, facilitators and professionals involved in running one of the programmes, in which none of the parents lived in the 15% most deprived areas, did pick up on the fact that these parents did not seem to be 'deprived' and felt that that they had less to gain from attending the programme as they were already generally doing well.