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Policy Research Programme - Evaluation of the Start for Life Programme: Improving outcomes in the 1,001 critical days

Published

10 May 2022

Version

1.0 - May 2022

Contents

Timetable and Budget

Description

Deadline/Limit

Deadline for Stage 1 Applications

14 June 2022, 1 PM

Notification of outcome of Stage 1 Application

August 2022

Deadline for Stage 2 application

28 September 2022, 1 PM

Notification of outcome of Stage 2 Application

End December 2022/Early January 2023

Project Start

February 2023 

Budget 

 Upper call limit of £2 million - see detailed budget section below

Introduction

The Start for Life (SfL) programme is a £170 million package announced in the 2021 Spending Review. This package will be used to transform support for families in 75 upper tier local authorities in England during the crucial first 1,001 days, following the publication of the Government’s The Best Start for Life: Early Years Healthy Development Review in March 2021.

The first 1,001 days from conception to age 2 are critical for babies’ physical, cognitive, and socioemotional development. Despite the importance of this period, provision varies across the country and families report struggling to know what services are available or how to access them. The SfL programme is seeking to provide universal support to babies and families, and to improve outcomes in three key areas:

  • Breastfeeding support, to improve mothers’ experiences of breastfeeding and increase breastfeeding rates;

  • Perinatal mental health and parent-infant relationship support, to reduce mild-to-moderate mental health difficulties in the perinatal period and improve the quality of parent-infant relationships;

  • The publication of ‘Start for Life’ offers by each funded local area, to strengthen the join-up and visibility of SfL services for families.

The Department of Health and Social Care invites proposals for a single research project to design and deliver the evaluation of this flagship programme. This is a significant opportunity to support the Start for Life programme in its aim to improve the experience of families during the 1,001 critical days, and build a robust evidence base on what works to give every baby the best possible start in life.

This evaluation will aim to identify the impact of both the programme overall, and of each of the three strands (breastfeeding, perinatal mental health and parent-infant relationships, and Start for Life offer publication) on key outcomes related to early child health and development, including reducing disparities in developmental milestones up to age 2.

Background

The £170 million SfL package is part of a £300 million investment to support families, funded for three years in the Spending Review until March 2025. This larger funding package sits across both the Department of Health and Social Care (DHSC) and the Department for Education (DfE). It comprises £170m for the DHSC-led Start for Life programme, and £130m for DfE-led programmes on Family Hubs and parenting programmes. This invitation to tender is to evaluate the DHSC-led SfL programme, but it is expected that the evaluators will work closely with the DfE-led evaluation of Family Hubs and parenting programmes.

SfL consists of three strands of interventions to be implemented within Family Hubs settings. The funding profile across each element of the programme is as follows:

  • Breastfeeding support in 75 LAs (£50m).

  • Perinatal mental health and parent-infant relationship support for parents in 75 LAs (£100m).

  • The publication of Start for Life offers in 75 LAs, including the use of Parent Carer Panels to inform user-centred service design (£10m).

  • There is an additional £10m to run workforce trials in 5 local authorities, but this is a separate programme for which we are commissioning a standalone evaluation.

The 75 local authorities eligible for funding broadly comprise the most deprived areas in the country. The Government listed those local authorities eligible for funding in the Infants, children and families to benefit from boost in support press release, and the Department for Education and Department of Health and Social Care detailed the methodology used to pre-approve these local authorities for funding within the Family hubs and start for life package. The approach to funding allocation across LAs is currently being decided, and is likely to be weighted by several factors.


Within this group of eligible local authorities, it is anticipated that existing provision and capacity to implement each of the three SfL strands will vary substantially. For this reason it is expected that a small group of approximately 12-15 ‘ready to implement’ Trailblazer local authorities will receive funding and begin implementing the full SfL programme in Year 1 (from Autumn 2022), with other local authorities preparing and then implementing from Year 2 and Year 3.


Each area receiving funding will be expected to deliver a minimum level of provision across each of the breastfeeding, perinatal mental health and parent-infant relationship support, and Start for Life offer strands. In addition to this minimum expectation, each area will select what additional breastfeeding, perinatal mental health, and parent-infant relationship support to provide in order to best meet their population needs and build on existing provision. It is anticipated that each eligible area will select from the below additional options to spend their funding on:

  • Examples of breastfeeding support options:
    - One-to-one support from specialists of peer support
    - Antenatal breastfeeding classes offered to underserved groups
    - Expanded peer support service
    - Drop-in breastfeeding advice located in Family Hubs
    - A dedicated Infant Feeding Team in maternity units
  • Examples of perinatal mental health and parent-infant relationship support options:
    - Specialist parent-infant relationship services
    - Peer support services with trained peer supporter to provide early help intervention for mild to moderate perinatal mental health needs
    - Perinatal mental health support for dads and partners
    - Perinatal mental health training for frontline workers working with families

Research priorities

This evaluation has three key objectives:

  • A process evaluation: To understand the implementation of the SfL in a selection of local authorities, how this varies across contexts, and what works for who, where, and why.

  • An impact evaluation: To identify the impact of the programme on key outcomes related to early child health and development, including reducing disparities; and using quasi-experimental methods to assess this impact in a selection of local authorities where possible.

  • To synthesise these strands to build the evidence base on what works to support families in the first 1,001 critical days, and inform the most effective implementation both the current £170 million and any future funding. This should explicitly seek to use evidence across the evaluation programme to understand what works for who, where, and why; and potentially incorporate a value for money evaluation if feasible (see para 17 below).

We therefore require both a process and impact evaluation of the Start for Life programme. These will assess the programme overall and across the three elements: the bolstering of breastfeeding support, the provision of infant and perinatal mental health support, and the publication of joined-up Start for Life offers in local authorities and their ability to shape offers around the local needs of babies and families. This also includes assessing the effective use of Parent Carer Panels to meet local needs.

The research questions to address across the evaluation programme are:

Overarching research questions:

  • What factors impact local variation in service delivery?

  • What factors impact outcomes for babies?

  • Are there examples of best practice that can be applied across the 75 funded areas, with lessons for the rest of England?

Implementation research questions:

  • How are services being delivered (including local areas’ understanding of their population needs, use of different workforce models and training, and outreach to families)?

  • What kind of SfL delivery models work well in different local contexts and for different populations?

  • What are the barriers and enablers of effective delivery, including within different Family Hub models?

  • What is the usage anduptakeofSfL services?
    1. How are families accessing services (or being identified for support)?
    2. What are the characteristics of families getting support, particularly for breastfeeding, perinatal mental health and parent-infant relationship support?
  • What are families’ perception of the visibility and quality of services?

  • What is the workforces’ perception of service join-up and systems change?

Impact research questions:

  • How effective are the breastfeeding interventions in achieving improvements in key outcomes? These could include:

    1. intention to breastfeed and awareness of benefits
    2. positive experiences of breastfeeding support
    3. breastfeeding initiation rates
    4. breastfeeding rates at 2 weeks
    5. breastfeeding rates at 6-8 weeks
  • How effective are the perinatal mental health and parent-infant relationship support interventions in achieving improvements in key outcomes? These could include:

    1. Increased parent/carer awareness of perinatal mental health and the importance of high quality parent-infant relationships
    2. Increased workforce awareness of mild-to-moderate perinatal mental health needs in parents of all genders, and of the importance of parent-infant relationships
    3. Improved identification of perinatal mental health and parent-infant relationship needs
    4. Improvement in levels of mild-to-moderate anxiety and depression following mental health support options (for parents/carers of all genders)
    5. Improvement in parental sensitivity/attunement following parent-infant relationship support intervention
    6. Improved infant socioemotional development
  • Improvements in wider infant health and developmental outcomes.

The process evaluation should focus on implementation, and families’ and workforce experiences of services, for example through surveys and qualitative case studies. In doing so the process evaluation will aim to understand the mechanisms by which the interventions are effective, for who, and in what contexts – and to tie this understanding to the impact of the programme.

  • In doing this the process evaluation should also aim to inform effective implementation in LAs’ ongoing rollout. This could be, for example: learning from what works to get families to engage with SfL services, particularly in more deprived areas; which types of breastfeeding support get positive feedback from mothers in the first two weeks postnatally; and using frontline workforce experiences of perinatal mental health training to most effectively identify families needing support.

  • Within the process evaluation there are two further points to note. The first is that it is important to emphasise that many of the policy investments are around workforce training, so a key strand will be assessing whether the training is working and has had an impact. Second, a critical overarching question is how Start for Life and Family Hub services interact to support families and whether accessing SfL services through Family Hubs helps improve outcomes. We therefore strongly encourage approaches that not only assess the individual components of the service offer but also how the whole becomes more than the sum of its parts through service join up, and the experience of babies and families.

The impact evaluation will establish the impact of the programme on key outcomes. This will be primarily on ‘upstream’ or proximal outcomes, of the sort we anticipate should be directly benefited by the interventions and that we should be able to observe change within the 2-3 evaluation year window. (For example, in the case of breastfeeding this may be positive attitudes to breastfeeding, awareness of the benefits, and increased rates of breastfeeding initiation). We are also interested in measuring more ‘downstream’ outcomes such as child development at age 2; but recognise that it may be challenging to observe reliable changes in these measures within the current time window. We encourage applicants to consider the level of impact assessment that would be appropriate.

Within the impact evaluation we would also like applicants to think about how to pick up on potential negative impacts; for example, in the perinatal mental health strand a potential outcome might be more parents seeking mental health support but without specialist services being able to meet demand. Similarly, with more families going into poverty through the living cost crisis we are aware that certain outcomes may be on track to get worse over the next few years – so the impact of SfL and FH services may only be to make them decline less than they otherwise would. We encourage thinking about these issues in approaches to impact evaluation.

We recognise that the 2-3 year time window for evaluation is initially short, and therefore encourage the evaluation to focus on the growth in ‘capacity to implement’ in LAs and the achievement of initial ‘upstream’ outcomes. These could include outcomes such as workforce training, numbers of families using services and/or a changing demographic profile (such as more disadvantaged families using SfL services), and improved perceptions of services.

We anticipate that the research methodology will take the approach of focusing on between 10 and 20 appropriately sampled local authorities which receive funding and conducting in-depth process and impact evaluation in these LAs. It is key that this sample of “evaluator areas” is chosen to allow a representative picture of implementation and impact under different circumstances. We appreciate that data capacity and methodological challenges may only make robust impact evaluation possible in a smaller subset of areas, and encourage proposals to consider how areas could be chosen for robust impact evaluation. We anticipate that these evaluator LAs will overlap partially, but not completely, with ‘Trailblazer’ local authorities.

Alongside this in-depth process and impact evaluation in a subset of local authorities, the DHSC SfL team will also be collecting monitoring data across all 75 funded local authorities, tracking factors such as service usage, workforce development, system change, and high-level outcomes. It is anticipated DHSC analysts will analyse these data internally to generate high-level insights across all 75 funded LAs, but we welcome proposals that also incorporate analysis of all 75 LAs into their approach.

Where possible, we would like to use quasi-experimental methods to assess the impact of Start for Life funding, potentially through establishing an appropriate counterfactual. Options to do this could include:

  • Comparison of funded LA-level outcomes or outcome trajectories with matched statistical neighbour LAs

  • Comparison of outcomes at the individual level for babies/families receiving SfL interventions compared to similar individuals not receiving intervention, for example due to being on a waiting list to receive interventions or in a funded LA not yet implementing services (with appropriate adjustment such as propensity score matching)

  • Pre-post intervention measures for breastfeeding and mental health interventions, where appropriate.

We are open to proposals with alternative and/or additional methodological approaches to the above if applicants feel these are suitable.

It is expected that the successful applicant will work closely with the DfE-led Family Hubs, Parenting Programmes and Home Learning Environment evaluation programme to ensure a joined-up approach to cross-cutting research questions and maximise the value of evidence across the overall programme.

We are interested in the longer-term outcomes of areas and individuals who receive SfL services, and particularly on longer-term child health and development outcomes (such as age 2 child development, childhood infections, obesity, school readiness, socioemotional development). To this end we strongly encourage the exploration of options for data linkage as part of the proposal to track the longer-term outcomes of babies and parents/carers receiving SfL interventions. This project is anticipated to end by around June 2026 (under ‘Budget and Duration’ below) so we anticipate the tracking of longer-term impacts through linked data will be a separate, later project. However, we are open to proposals considering additional shorter to medium-term impact assessment up to June 2026.

We would welcome inclusion of an economic evaluation once sufficient data has been collected. This is not an essential component of the research as this may not be feasible within the duration of the project; however, we encourage bids that consider forms of data collection that would make subsequent economic evaluation possible.

Areas out of scope for this programme of work

The Start for Life package includes a £10m investment to test innovative workforce models. This strand of the programme will be out of scope for this evaluation as we will be commissioning these stand-alone pilots separately.

The Start for Life programme is part of a larger £500m package for families announced in the last spending review which includes £170m for DHSC-led Start for Life, £130m for DfE-led programmes and a £200m uplift for the DLUCH-led Supporting Families programme. This evaluation will focus on DHSC-led Start for Life activities only, but we expect the successful applicants to work closely with the DfE evaluation team, and potentially DLUCH, as required.

The primary objective of this programme is to focus on understanding the implementation and early impact of DHSC’s £170m Start for Life programme. In time we would like to understand the longer term impacts of the programme and encourage designs that enable that, but not at the expense of a focus on the next 2-3 years.

The Start for Life programme is implemented in England only. For this reason the devolved administrations are out of scope, but we are open to comparison / learning from other areas in the devolved administrations if this is clearly justified.

Expertise required

  • Experience undertaking complex evaluations of large programmes using mixed method (qualitative and quantitative) approaches.
  • Experience working with Local Authorities, including in-depth case studies.
  • Expertise in quasi-experimental methods to identify impact.
  • Ideally experience and understanding of data linkage and Fingertips/NHS data collections.
  • If necessary, economic expertise for the economic evaluation of the Start for Life programme.

Outputs

We expect an annual evaluation report on findings, and an end of programme report.

Given the scale and visibility of the programme, we also request regular project updates; the appropriate frequency can be agreed with the successful applicants but we would anticipate updates in the region of every quarter as a minimum.

A key milestone will be the preparation for the next Spending Review, which will start in Summer 2024. At this stage we will require a report on the findings of evaluation to date which is synthesised with the findings from DfE’s family hubs and parenting programmes evaluations. In advance of this milestone we expect applicants to work closely with the evaluators of these programmes to produce a report synthesising findings across the full £300m package.

As noted above it is anticipated that a small number of trailblazer local authorities will implement as soon as possible, followed by more gradual rollout in remaining areas. Applicants are therefore asked to consider flexibility in the timing and nature of deliverables in their proposals in order to facilitate the use of evaluation evidence with policy makers. Policy makers will need evidence from the evaluation to inform decisions about ongoing rollout and implementation throughout the programme, so data collection and interpretation needs to be flexible to meet these needs.

Budget and duration

We have not specified a budget for this project, as we invite bidders to cost what they think delivering research to address the above specification to a high quality will require. However, there is an upper call limit of £2 million, which should not be exceeded. Costs for the proposed research should be justified as value for money will be a key factor in the assessment of bids.

The SfL programme funding period runs from 1st April 2022 to March 31st 2025. LAs funded through this programme will start receiving funding around Autumn 2022, and are due to finish receiving funding in March 2025. We would expect this research to be delivered within the period from February 2023 to June 2026 (allowing up to 14 months from the end date of the SfL programme for data analysis and reporting). However, applicants are invited to confirm the project duration required for delivery of their proposed research within their application.

Costings can include up to 100% full economic costing (FEC) but should exclude output VAT. Applicants are advised that value for money is one of the key criteria that peer reviewers and commissioning panel members will assess applications against.

Management arrangements

A Research Advisory Board including, but not limited to, representatives of DHSC, DfE, and other stakeholders, and the successful applicants for the research will be established. The advisory group will provide guidance, meeting regularly over the lifetime of the research. The successful applicants should be prepared to review research objectives with the advisory group, and to share emerging findings on an ongoing basis. They will be expected to:

  • Provide regular feedback on progress

  • Produce timely reports to the advisory group

  • Produce a final report for sign off.

Research contractors will be expected to work with nominated officials in DHSC, its partners and the NIHR. Key documents including, for example, research protocols, research instruments, reports and publications must be provided to DHSC in draft form allowing sufficient time for review.

References and key documents

  1. Department of Health and Social Care (2021). The best start for life: a vision for the 1,001 critical days. [Accessed April 2022].
  2. Department for Education, Department of Health and Social Care, Department for Levelling Up, Housing and Communities (2022). Infants, children and families to benefit from boost in support. [Accessed April 2022].
  3. Department for Education and Department of Health and Social Care (2022).Family hubs and start for life package: methodology for pre-selecting local authorities. [Accessed April 2022].