An exploratory study into the experiences of women using the Home Start service
Laing (1971) maintains that problems in the family create problems in the wider society. There has, however, been a largely ‘laissez-faire’ attitude to family policy (Harding, 1996) whereby agencies respond to identified family needs. This requires the co-operation of both statutory and voluntary organisations such as Home Start. There is little evidence, however, as to how effective this kind of working actually is, especially as voluntary projects have to justify their existence and may thus make claims that are not easy to substantiate (Shinman et al, 1996).
Home Start began with an initial project in Leicester more
than thirty years ago. It is now a national organisation comprising
some three hundred projects. National Office provides a link and
support for the various neighbourhood voluntary projects. Home Start
was formed to give help and advice to mothers with young children,
particularly those who were away from family and friends. The
organisation provides a place where mothers and young children can get
together and individual projects will sometimes have days out and other
activities. Home Start trains its volunteers to help families dealing
with specific problems such as mothers with post-natal depression,
parenting problems, and those who just can’t seem to manage or who feel
themselves to be isolated. Volunteers will visit parents in their homes
and can offer friendship and practical help to those families with at
least one child under the age of five. This paper will look at
identified sources of stress experienced by some mothers. It will also
look at the role of volunteers in providing practical help and support.
Finally it will attempt to establish what effect this may have on
families and whether it may be said that this works in the long term.
Reasons for Referral
Home Start projects and volunteers do some work with children who
are deemed to be at risk but they are only a small part of the case
load. The largest number of referrals and calls for help are for
mothers who are lonely and are finding it difficult to cope. This may
be because they are disabled, or have children who are disabled, or
they may be new to the area and unused to coping without family help
(Oakley et al, 1998). Families are also likely to be referred if they
are living in poverty and in some cases if domestic violence is
suspected. Mothers who have children with behaviour difficulties may
also be referred and in some cases they just need to hear that there
are others whose children behave in the same way. Referrals are usually
made by social workers and by health visitors but not all of them will
abide by the referral.
Children and Care in the Community
The Tory Government of the 1980s and early ‘90s introduced a marketing
approach to health and social welfare and this saw a corresponding
growth in the number of voluntary organisations who offered to provide
support in the community. Fox-Harding (1996) argues that cutbacks in
benefits payments and in the welfare state generally has resulted in
increased familial responsibility e.g. other family members looking
after children while their mother works. However, those who do not, for
whatever reason, have such a family structure are often referred to
voluntary parenting initiatives such as Home Start for advice and
support. Since the 1989 Children’s Act local authorities and voluntary
organisations are required to collaborate in assessing children’s needs
and providing support where needed. However this inter-agency
co-operation does not always involve effective working relationships
and this can result in children’s needs being overlooked (Sutton,
1995). Oakley et al (1998) maintain that the necessity of such
organisations to compete for funding may sometimes lead to an
overstatement of the benefits such support might bring.
Mothers
Many of the mothers who are referred to Home Start have problems coping
with their children and quite a few of them are referred for
depression, either post-natal depression or the mild depression
associated with a young mother on her own all day with toddlers.
Mothers who use Home Start often have non-supportive partners, some of
them are lone mothers who have little social contact and may attend
drop-in centres to have some contact with other mothers, or in some
cases to get time for themselves.
Many pressures can affect the quality of family life-poverty,
isolation, relationship breakdown or bereavement, as well as
disability, mental and physical ill health and multiple births. The
stress of coping with these problems can prevent even the most
committed and loving parents from giving their children the start in
life that they deserve (Homestart, 2003:5).
Oakley et al (1998) state that the service is aimed generally at women
and that most women who use Home Start are referred by their health
visitor and some by their G.P. They say that being socially isolated is
one of the most common reasons for referral and that child behavioural
difficulties are also a reason for referral. Health professionals tend
to see social support as the main reason for referring to organisations
such as Home Start. Genuine child protection concerns or women with
severe depression would be referred to a statutory authority or for
counselling/psychiatric advice. The level of help a woman receives will
depend on whether there is an available volunteer in her area, if not,
then it will be limited to attendance at the drop in centre. If a woman
needs some support at home because of a lack of support structures, or
because she is depressed and finding it difficult to cope with a new
baby and there is no volunteer available then she may have to go on a
waiting list. It is arguably the case that it is in this type of
situation that families can fall through the net and the collaboration
between agencies to ensure the family’s and particularly the child’s
welfare goes wrong. While Home Start will inform health visitors and
GPs once a referral has been taken up, if they cannot then provide the
appropriate help, mothers can quickly become disillusioned (Oakley et
al, 1998).
Volunteers
The majority of volunteers are women with children of their own. A few
of them however, are fathers who befriend lone fathers. They can both
offer advice and a friendly ear for someone who needs to talk. They
will deliver and collect a child from school if the parent is unwell
and will sometimes get shopping or baby sit so that a parent can have
sometime to themselves (Homestart, 2003).
Sometimes there are problems if a volunteer does not meet with the
expectations of the person who has been referred. In their study Oakley
et al (1998) found that some volunteers needed someone to listen to
them and that was not helpful. One woman reported that her child did
not like being collected from school by someone she did not know well
and that this adversely affected the child’s behaviour. Homestart’s
website and literature presents the success stories where mothers (and
fathers) describe their volunteers as good friends. Although volunteers
do undergo some training much of their usefulness to parents in crisis
is borne out of their own experience. One lone father said that he had
spent eight months struggling before he was referred to Home Start that
his volunteer had also experienced lone fatherhood and shared
experiences that prevented the father from making some of the same
mistakes (Homestart, 2003). Some families have felt so much better that
they have begun a group in their own area. This was the case for a deaf
couple who were having a difficult time but later felt that their
involvement with Home Start had totally changed things for them
(Homestart, 2004).
However it is part of the ethos of Home Start to promote themselves as
an effective component in supporting families and in preventing family
breakdown. Certainly some parents do speak of feeling happier in
themselves and thus coping better. Oakley et al (1998) do raise the
question of how far these projects are as effective as they present
themselves. While they would argue that they do effect people’s lives
positively, and the stories represented in Home Start literature would
tend to support the view that in some cases they do have a positive
effect there is no way of gauging whether this is long term.
Organisations such as Home Start do provide a support service where
statutory services are lacking but as some commentators argue families
referred to Home Start may also be accessing statutory support. Even
with statutory support however, it is not easy to measure the long term
effects of any support/intervention as once a crisis is over such
support is no longer deemed necessary, not just by the person who has
been referred, but by the service providers to whom they are referred.
Oakley et al (1998) found that some of the women in their study
reported that being involved with Home Start had not helped them at all
or had given them other problems while around a quarter of those
involved in the study reported some positive change.
Organisations are not always aware how great the non-take up of
referrals might be and this can have a significant effect on the number
of people who it is claimed have benefited from the service. Oakley et
al (1998) argue that organisations such as Home Start do not take
kindly to being objectively evaluated and that this made it difficult
because it was seen in pejorative terms. Statutory organisations will
often buy in the services of voluntary organisations and may also refer
to them but in many cases this does not involve effective collaborative
working and so it is difficult to ascertain whether all the money that
is allocated for children’s needs is well spent. A London Professor of
Child Psychology has written of such initiatives that:
… there is some evidence to suggest that beneficial changes to
children’s behaviour, and parent’s levels of stress and self-esteem
result from participating in parenting programmes. Nevertheless, a
considerable number of questions remain to be answered about the
outcomes of parenting programmes. These include the question of whether
specific short and long-term benefits are gained by children, parents
and families from which approaches (Davis, H and Day, C. no date or
page no).
Conclusion
Home Start projects are starting up in all parts of the country and a
pilot scheme is testing out projects at an international level There
are many different funded projects, Camden Family Service Unit operated
for one year helping Chinese families who had children with mental
health problems. It is unfortunate that there is no sustainable core
funding for such small projects because accessing such a project can
mean that families are then able to access other services that they
might otherwise not have used. Certainly projects like Home Start are
filling a gap in service provision and in some cases families will have
easier access to other services. Oakley et al (1998) demonstrate that
there are significant problems in assessing how effective these
projects are on a wide scale, some of this is due to the fact that
there is no clear estimate of those families who are referred but then
fail to take up the referral. Referral records are not a good way of
assessing this because although they keep a record of referrals they
fail to account for those who do not act on that referral. There is
also concern at government level over the rising cost of such services.
The authors quote the Audit Commission of 1994:
At present some £2 billion a year
is spent on services provided by community child
health and social services authorities, but little is
known of their impactÕ (Audit Commission 1994:1 quoted in Oakley et al, 1998:20).
The Commission found that only twenty five percent of authorities
operated effective co-operative working partnerships that monitored the
progress of those families who accessed parenting support initiatives
such as Home Start. Pugh et al (1994) found that this did not just
apply in the voluntary sector but was evidenced across all family
welfare and support services. There was a dearth of evidence on which
to base the effectiveness of such services and to plan for future
service delivery. Organisations such as Home Start do provide a service
that some parents have found effective. Their various web-sites do
highlight successful cases, and these are also commented on in yearly
reviews. How far these examples may be generalised remains, however, a
difficult question. Certainly there needs to be some sort of yard stick
by which agencies and funding bodies might be able to measure such
effects over a period of time.
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