Introduction
The research review assessed the evidence available on ‘what works’ for improving young children’s development outcomes through the integration of service provision. Little direct evidence of the impact of integrated working was identified at the scoping stage of the review (Lord et al, 2008). The review therefore attempted to provide a thematic overview with illustrations drawn from selected themes/programmes
and considered theoretical work.
The main review was broadened to include the integration of services beyond early years settings, and beyond child outcomes. The review therefore identifies the most promising directions for future research and practice development as well as for regional and national government.
Whilst every effort has been made to ensure that the evidence drawn upon is the best currently available, much of it is quite weak. Most of this literature is based on relatively small-scale studies or survey data that is concerned with the processes of integrated working, rather than with its outcomes. Much of the evidence should therefore be considered as essentially indicative, although efforts have been made to ensure appropriate standards of reliability and validity.
Key messages
In practice, Every Child Matters is best understood as an ecological, integrated system that is centred on the child and their family, served through service coordination, and supported through integrated organisations and agencies.
There is currently no direct and definitive evidence of the effectiveness of service integration at a systemic, organisational or service coordination level, nor of the impact on outcomes for children and families, but there is some indirect and
partial evidence of effectiveness.
What do we know with some certainty?
The review found that:
- There is robust evidence that suggests combined approaches to intervention (focusing on both children and family members) are effective, and this may be considered to provide indirect evidence of effective integration
- there is strong evidence that high-quality pre-school provision, that integrates childcare and education, benefits children in terms of cognitive and behavioural outcomes up the age of 11.
There is also some evidence to suggest that the quality rather than
the type of integration is what matters in terms of improving outcomes.
We need, therefore, to have a clear and shared understanding of what we mean by ‘quality’ in integrated delivery of early years services, and to ensure that services adopt agreed quality standards.
Various studies suggest that leadership training, the participation of stakeholders, and participatory planning processes are all characteristics of successful integrated working.
There is a need for specific training for staff managing and delivering integrated
services to ensure common understanding of how integrated services can deliver the Every Child Matters agenda.
Implications from the research for local service improvement
For action by local decision makers and managers
The review findings indicate that the development of multi-disciplinary and interdisciplinary approaches to delivery should be considered a high priority. Based on the evidence gathering to date, we would suggest that:
- there is a need to clarify the objectives of integrated working for all those involved in service management and delivery
- an approach to service assessment and intervention is needed that provides a common language and greater agreement on service thresholds and tiers of need
- services should involve people who use services in planning and delivery
- there is a need for training at all levels to develop: leadership for integrated services; a shared philosophy and vision; better communication systems; a clear staff review and supervision system; and shared understanding of roles
- there is a need for training of service coordinators to ensure they have an adequate knowledge of the full range of services available in supporting the Every Child Matters agenda.
Implications for regional and national government
There is a need to provide further clarification of the core objectives of the Every Child Matters policy, in relation to:
- the respective needs of, and policy responses to, children and of families
- the roles of universal, targeted and preventative services.
An overall strategy for service assessment and intervention is needed that provides a common language and greater agreement on service thresholds and tiers of need .
Better provision needs to be made for workforce development nationally and regionally to support effective integrated delivery in the early years services.
There is a need for more robust research to be carried out in this area to address the evidence gaps identified below. Further local research and development efforts also need to be supported. The identification and promotion of agreed outcome measures and standardised research instruments may be helpful.
Research
What does research show?
What works in improving outcomes?
Despite a generally weak evidence base, the review sought to identify the most promising directions for future development and research, and to inform the processes of linking future research more clearly with policy and practice. Two research findings closely associated with the development of effective service integration have been identified:
- The adoption of combined approaches to intervention (i.e. focused on both children and family members) are effective.
- High-quality pre-school provision which integrates childcare and education is beneficial.
Many other effective practices have been identified in the C4EO reviews concerned with family-based support (Siraj-Blatchford and Siraj-Blatchford 2009) and Narrowing the Gap (Coghlan et al 2009) and wherever possible integrated service developments should be combined with these initiatives.
Gaps in the evidence base
Although there are significant challenges in designing research that could provide hard evidence of the impact of service integration on outcomes, the review points to the need for new multi-disciplinary research that investigates the processes by which successful integrated working takes place in early years services. This should be located within theoretical understandings of workplace practices and adult learning.
The review also suggests that a coherent and holistic account is needed of the early childhood developmental processes that provide the major justification for service integration.
There is a need for more studies that identify the discrete models and features of integration that are in current use and the most appropriate outcome measures for evaluating their effectiveness. Studies on the work of social care professionals in extended schools need to be replicated for children's centres.
More rigorously designed studies should also be developed to identify the specific features of effective integrated practice.
View of key stakeholders
A number of studies include, or focus on the views of stakeholders (such as staff and policy makers) concerning service delivery, and these findings indicate that:
- there is some way to go before practitioners and stakeholders develop a clear understanding of integrated services. The evidence suggests that the current guidance and terminology associated with integrated service provision need greater clarity.
- some stakeholders suggest that there is a tension between universal and preventative services for children and/or between prevention and ‘safeguarding'. Again this suggests the need for greater clarification of the Every Child Matters objectives
- some stakeholders believe that there needs to be agreed working and pay structures in multi-agency teams, and greater clarification on the continued funding of service integration.
- many stakeholders feel that the full potential of integration can only be achieved when staffing levels match case-load demands.
