Intended for healthcare professionals


Effects of Sure Start local programmes on children and families: early findings from a quasi-experimental, cross sectional study

BMJ 2006; 332 doi: (Published 22 June 2006) Cite this as: BMJ 2006;332:1476
  1. Jay Belsky, professor of psychology and director (j.belsky{at},
  2. Edward Melhuish, professor of human development1,
  3. Jacqueline Barnes, professor of psychology1,
  4. Alastair H Leyland, director2,
  5. Helena Romaniuk, chief statistician1

    National Evaluation of Sure Start Research Team

  1. 1 Institute for the Study of Children, Families and Social Issues, Birkbeck, University of London, London WC1B 3RA
  2. 2 MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow G12 8RZ
  1. Correspondence to: J Belsky
  • Accepted 9 May 2006


Objective To evaluate the effects of Sure Start local programmes (SSLPs) on children and their families. To assess whether variations in the effectiveness of SSLPs are due to differences in implementation.

Design Quasi-experimental cross sectional study using interviews with mothers and cognitive assessment of children aged 36 months who speak English.

Setting Socially deprived communities in England: 150 communities with ongoing SSLPs and 50 comparison communities.

Participants Mothers of 12 575 children aged 9 months and 3927 children aged 36 months in SSLP areas; mothers of 1509 children aged 9 months and 1101 children aged 36 months in comparison communities.

Outcome measures Mothers' reports of community services and local area, family functioning and parenting skills, child health and development, and verbal ability at 36 months.

Results Differences between SSLP areas and comparison areas were limited, small, and varied by degree of social deprivation. SSLPs had beneficial effects on non-teenage mothers (better parenting, better social functioning in children) and adverse effects on children of teenage mothers (poorer social functioning) and children of single parents or parents who did not work (lower verbal ability). SSLPs led by health services were slightly more effective than other SSLPs.

Conclusion SSLPs seem to benefit relatively less socially deprived parents (who have greater personal resources) and their children but seem to have an adverse effect on the most disadvantaged children. Programmes led by health services seem to be more effective than programmes led by other agencies.


  • contributions JB helped plan the national evaluation and interpret results, guided data collection, supervised data analysis, was the main writer of the manuscript, and is guarantor. EM helped plan the national evaluation, interpret results, write the manuscript, supervise data analysis, and guide data collection. JB helped plan the national evaluation, edit the manuscript, design and direct collection and analysis of community level data. AHL designed and oversaw the multilevel modelling used to analyse the data and helped to interpret results and edit the manuscript. HR analysed the data and helped interpret the findings and edit the manuscript.

  • Funding The Department for Education and Skills (DfES) funded the research, after competitive tender. DfES shaped the research design by ruling out a randomised clinical trial and designating SSLPs as serving entire communities, thereby necessitating a quasi-experimental, intention to treat design. The DfES's Sure Start unit and the unit's scientific advisory board reviewed all major research decisions (instrumentation, sampling, analysis) and helped interpret the findings, but those presented here represent the views of the authors. The government reviewed this report before submission, for accurate representation of findings only.

  • Ethical approval multi-regional ethics committee and Birkbeck's ethics committee.

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