Evaluating the Young Mothers’ Service using contribution analysis: lessons learned

From 2014 to 2015, CRFR's co-director Sarah Morton and PhD student Cara Blaisdell worked with West Lothian Council’s Early Intervention Team to develop a framework for evaluating their suite of services, using contribution analysis. In this blog post, Cara reflects on their work with one of these services - the Young Mothers’ Service. This is a keyworking programme in West Lothian that supports pregnant and parenting women under the age of 25.

What is contribution analysis?

In a contribution analysis approach, evaluators identify the outcome that a service hopes to improve, and develop a ‘theory of change’ about how the service will bring about that improvement (Better Evaluation 2015). This theory is expressed visually, in the form of a results chain showing how each stage of the project links to the next. Our CRFR briefing on the project goes into more detail about how we used contribution analysis in this evaluation. Other resources on contribution analysis are linked to at the end of this post.

 

What were the results of the evaluation?

The evaluation showed positive results about how the keyworkers supported the young women. Feedback from young mothers indicated that they found their keyworkers supportive and had improved confidence:

‘They took everything I was going through into consideration.’

‘I’m very much more confident by myself and all the support I needed was met’.

‘Don’t think I’d be where I am today without my keyworker’s help. Thanks a lot!’

Other results from the evaluation showed:

• A high level of take-up of the service, with only one young mother declining when the service was offered 
• Young mothers experienced reduced depression and anxiety 
• 10 children removed from the Child Protection Register 
• Mothers were more aware of support that was available to them—for example, help with accessing benefit entitlements, help with finding a secure place to live, or attending local parenting groups for peer support 
• Eight mothers were supported to enter full-time employment, with 14 others working toward this goal
• All young mothers were approached about experiences of domestic and sexual abuse—revealing a 75% prevalence rate. Support was offered in partnership with the Domestic and Sexual Assault Team.

 

What did we learn about using contribution analysis?

• Working collaboratively with keyworkers and the service manager put the emphasis on learning through evaluation, rather than external judgement.  
• The service manager and keyworkers said that the evaluation prompted useful reflections about their work.  
• Training in contribution analysis and ongoing support were important. 
• Collecting quantitative data was straightforward, but it was more challenging to compile qualitative data in a systematic way. 
• We needed to work within the constraints of high workloads. 
• We needed to offer multiple routes for service users to give feedback, including finding ways to take into account the informal feedback that arose from relationships between young mothers and keyworkers.

For more about this evaluation, and further reflections on what we learned about using contribution analysis, see CRFR Briefing 79: Evaluating the Young Mothers’ Service using contribution analysis: lessons learned.

Additional (open access) resources about contribution analysis: John Mayne, who developed the approach, has written a short briefing about contribution analysis. Sarah Morton, who has developed a specialism in contribution analysis at CRFR, has spoken and blogged about her experience with the approach. There are also useful literature reviews available from Better Evaluation and IRISS.

Supporting Dads in the context of gender inequality

Sarah Morton, CRFR Co-Director, and Gil Viry, CRFR Associate Researcher and Chancellor's Fellow in Sociology at University of Edinburgh

There is a lot of recent interest in supporting dads. However, this focus on just one gender of parents poses some interesting questions and challenges in the context of ongoing gender inequality.

Dads often feel that general parenting services, like parent and toddlers, or parenting classes are not aimed at them and may feel excluded from these services. But young mums, older mums, women from ethnic minorities, same-sex mothers or women with disabilities might also feel that services are not ‘for them’. This is not only about gender.

Dads are getting more involved in family responsibilities than in the past – that’s a great step forward, but it’s not yet a revolution (see Giddeon Burrows blog). In most households (though not all), women continue to do the vast majority of childcare and housework. In particular, women fit their employment around the perceived needs of their husband and children more often than do men. This is one main reason why women account for 75% of part-time workers in Scotland.[i]

Because of this, it is likely that early years services, like parent and toddler groups will have more women than men using them. Services focus on those who need them, and the vast majority of those caring for young children on a day to day basis are women. Of course services should, where appropriate, make particular efforts to include all kinds of parents.

Whilst men are getting more involved with kids at home, they tend to focus on the fun things, and less on the hard work of caring, feeding, cleaning, doing the washing and ensuring children eat healthily and get enough sleep[ii].

Men face discrimination at work when asking for parental leave because we perpetuate the ‘father as breadwinner’ model. We need to tackle this, but not in isolation. Women still struggle to get their basic rights at work when pregnant, including not getting sacked, and face a barrage of assumptions and obstacles in their role as parents. Employed women are overrepresented among clerical workers, personal service workers (including care) and sales staff. This perpetuates gender stereotypes that caring and serving others (also within the home) are female tasks. All these issues are interrelated so that that they need to be addressed together.

Good parenting matters, but also good co-parenting – that is how parents coordinate and cooperate in their parenting roles – that benefits children’s wellbeing. Mutual support and good communication between both parents is likely to create a supportive environment within the whole family. High-quality co-parenting is also fundamental in the event of a separation or divorce. Fathers who were significantly committed to their co-parenting role before the separation are more likely to stay actively engaged in their children’s lives after the separation. In this situation, mothers are also more likely to trust and promote fathers having frequent contact with their children.

In most families, it is desirable that fathers are involved with their families and children, but it is also important to acknowledge that a number of fathers are destructive, abusive and violent forces in family life. In these situations, fathers often do more harm than good for children’s wellbeing.

What does the evidence say?

Evidence shows children need at least one loving and attentive parent. Having two parents helps to share this difficult and time-consuming task, but there is no clear evidence that the gender of either of these matters to children's outcomes[iii].

However the broader evidence on parenting is unclear about gender. Most research on parents focuses on mothers by default rather than intention as mothers as the main carers are usually more available to researchers to provide details of family life[iv] When research does look at fathers there is often no comparable data on mothers, so it is hard to identify a 'father' effect.

For separated families we know that good relationships both between parents and between fathers and children (in particular high support, responsive fathering and non-coercive control) are fundamental to children's wellbeing[v]. Some children regret not being in touch with absent fathers, other children feel coerced into continuing contact with fathers who are causing them distress (see Morrison, 2009).

In any case, tackling gender inequality within the home and at the workplace requires actions and changes from both genders.

Initiatives for just one gender of parent

What are we trying to achieve in developing and funding work aimed specifically at dads or mums? Do we want to get men more involved with their children? Or are we interested in getting men to play a full role in family life and share half of the homecare tasks enabling women to achieve greater equality in public life? Or is the aim that any parent should feel supported and enabled in their role regardless of gender?

If we are offering services to solely dads or mums, we need to be careful that they do not reinforce gender stereotypes and perpetuate gender inequalities. The following questions may act as a guide:

• Why are we offering services to a specific gender, rather than parents? Are there specific barriers we seek to overcome? For example, antenatal services must focus on women, or support for absent parents should be thinking mainly about dads.
• What is the aim of the gender specific service? Is it addressing inequalities issues or perpetuating them? For example, do services for mums emphasise attachment, whilst those for dads emphasise having fun with their kids? To tackle inequalities do services for men need to emphasise their role within the home, whilst those for women help them find employment?
• Are services for dads ensuring that they are not aiding coercive and violent fathers to continue to control their partners post separation, or enabling contact that children do not want?
• Are all parenting services building on the evidence that strong relationships between parents is a key factor in children's outcomes, rather than focusing separately on mums or dads relationships with their children?
• When we deliver gender-specific services for parents, do we avoid gender stereotyping? Are gender specific groups and organisations careful about the language they use to talk about men and women to avoid reaffirming gender-based assumptions (like men are not skilful at childcare, or women are naturally more caring?)
• Are we careful when talking about gender-specific parenting not to offend and upset children who have different family structures due to bereavement, separation, adoption, assisted conception or lone parenthood or same sex parenting?

If we want to move to a world where mothers and fathers are enabled to do the best for their children and families, gender-specific services need address inequalities. In imagining a Scotland that is the best place in the world to grow up, shouldn't any parent get the support they need to fulfil their role to the best of their ability regardless of gender, age, ethnicity or social background?

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[i] http://www.closethegap.org.uk/content/gap-statistics/
[ii] Growing Up in Scotland 2008 Chapter 7 'Parenting Styles and Parenting Responsibilities' in: http://www.scotland.gov.uk/Resource/Doc/212225/0056476.pdf
[iii] Bromley (2009) Growing up in Scotland: the impact of children’s early activities on cognitive development. Edinburgh Scottish Government
[iv] http://aboutfamilies.files.wordpress.com/2013/05/aboutfamilies_gaps-in-research-all-topics.pdf
[v] Mooney, A Oliver C and Smith M (2009) Impact of Family Breakdown on Children’s Well-being. London DCSF

Teenage parents: moral problem, social problem or no problem at all?

Dr Sally Brown from Durham University recently visited CRFR to present a seminar on her qualitative research with teenage mothers and mothers-to-be. She recounts her findings in this blog.

Many people will be familiar with headlines and newspaper stories about the UK having high teenage pregnancy rates; they may be less familiar with recent statistics showing that rates have fallen dramatically and are now at their lowest since records began. Indeed, when Tony Blair made his famous comment about teenage pregnancy leading to “blighted lives and shattered futures” in 1999, teenage pregnancies were at their lowest for 30 years. Nevertheless, teenage pregnancy, and teenage parenting, are still perceived as problematic, either a moral problem or a social problem, or possibly a combination of both. The paper I gave recently at CRFR focusses on whether teenage parenting is a problem, and if so, who sees it as such. Hilary Graham and Elizabeth McDermott have shown how quantitative research on teenage pregnancy and parenting highlights the “problem” side of the argument, demonstrating that teenage parenting is a route to social exclusion, whereas qualitative research shows the opposite, that it can be a route to social inclusion.

My paper is based on qualitative interviews with teenage mothers and mothers-to-be from different generations, from one who had her baby in 1955, through those who had their children 15-20 years ago, to some who had their babies in 2013. What was interesting in the interviews was how almost all of them talked about the shock of being pregnant, being upset, and being scared of telling their parents, but happy about having a baby. Almost as if the pregnancy and the baby were two different entities, the parents talked about having “wanted more” for their daughters, but also about the joy of new life being brought into their family, and how they were looking forward to, or enjoying being, grandparents. The context of these young women becoming mothers, then, is a context where they are part of a loving family where a baby, although unexpected, is welcomed. Some of the young women described situations where they had been estranged from their parents, or grown up in very challenging circumstances, and the baby in these situations had brought families back together.

It seems, then, that there is a mismatch between the way policy-makers, politicians and the media view teenage pregnancy, and the way the families experiencing it view it. From a policy point of view, teenage pregnancy still leads to blighted lives, and life on benefits. For young parents whose college careers were interrupted by pregnancy, there was a determination to go back to studying; for those who had been unsure of where they were going in life, a baby provided an incentive to get qualifications and a good job. Instead of pillorying young parents, we should be supporting them to make the best of their lives for themselves and their babies, which is, after all, what they said they wanted to do.

Breastfeeding improving most among mums from disadvantaged backgrounds

Mothers who breastfeed are managing to breastfeed for longer, a trend particularly noticeable among mothers from disadvantaged backgrounds. Dr Valeria Skafida used data from the Growing Up in Scotland to investigate whether rates of breastfeeding amongst mothers in Scotland between 2004 and 2011 may have been influenced by public health policy. Here she talks us through the key findings.

The findings are based on Growing Up in Scotland (GUS) data of more than 5000 mothers, which assessed their breastfeeding habits in the first 10 months of their babies’ lives. It compared results from 2004 and 2011.

• Mothers from more advantaged backgrounds are far more likely to try breastfeeding at least once, when compared to mothers from disadvantaged backgrounds.
• While the total number of women who breastfed their babies at least once increased by only 3% between 2004 and 2011, those who did breastfeed are feeding for longer.
• Mothers who gave birth in 2011 and who managed to breastfeed beyond the first month had a 25% higher chance of breastfeeding for longer compared with mothers in 2004. 
• This was far more pronounced among mothers from disadvantaged backgrounds. Mothers with few or no educational qualifications had a 150% higher chance of continuing to breastfeed for between 6 and 10 months in 2011 than their peers did in 2004.
• The study also found that mothers in households where a language other than English was spoken had a four times higher chance to breastfeed their child compared with mothers where only English was spoken.
• There remains a significant proportion of women who stop breastfeeding within the first month. Not having enough milk was the most commonly given reason for stopping so early.

In the past decade, the Scottish Government has been at the forefront of public health policies among developed nations in terms of breastfeeding promotion. Changes have occurred at policy level, in national legislation, in hospitals and in health care staff training. One of the key shifts since 2005, in health services aimed at children has been the recognition that families assessed as being more vulnerable would benefit from being offered more intensive support. These findings, by comparing the lives and habits of families before and after the policies were introduced, have the potential to demonstrate the value of policies to tackle health-related issues among disadvantaged populations.

For more information:
CRFR briefing 71: Changes in Scottish infant feeding policy and breastfeeding habits between 2004 and 2011.

Skafida, V. (2014) Change in breastfeeding patterns in Scotland between 2004 and 2011 and the role of health policy. European Journal of Public Health.

They study has already attracted keen interest from the Scottish Government and public health analysts. Acting Chief Medical Officer, Dr Aileen Keel, welcomed the research, particularly noting the encouraging trend among mums from disadvantaged backgrounds. Similarly Minister for Public Health Micheal Matheson was  pleased to see a rise in the number of mothers from disadvantaged backgrounds who have breastfed for longer, especially in light of the longlasting health benefits this brings and evidence to suggest that breastfed babies are less likely to use NHS services in later life.

'I felt so guilty': emotion and mothers’ experiences of caring for their young children

Guilty, frazzled, tired and upset. How does it feel to be a mother caring for her baby in the first days and weeks, and then months and years, of her baby’s life?

In the last decade, the policy context of health visiting practice has shifted the focus of health work with new parents from working with all families to working with those who it is felt are the most vulnerable.  This, however, poses a tricky dilemma as we try to understand what vulnerability is, and, how it is experienced by different parents.  

Caroline King, in a seminar on 15 May, as part of CRFR’s emotions series, will consider what the study of emotion can tell us about mothers’ experiences of caring for their children. She will explore the accounts of 20 mothers who took part in her PhD study.  She will also draw on her own experience as a mother and consider whether at times she was vulnerable after the birth of her children.  In doing so, she will consider the role of emotion and emotion work in both uncovering and covering the tracks of vulnerability.  Can vulnerability, she will ask, be experienced by any mother?   If so, what role do personal resources play, for example, a mother’s education or income, in how we frame, manage and categorise vulnerability?

In her analysis Caroline will consider the particular role of class in opening up and closing down what is recognised as vulnerability and the implications of this for mothers and their children.

An introduction to the topic of vulnerability in the contexts of mothering and health visiting practices can be found by viewing a short film made in collaboration with artist Rosie Gibson (previously CRFR artist in residence), and based on Caroline’s PhD findings,  https://vimeo.com/62327287.

This experimental piece considers issues around framing and managing vulnerability.  It draws on the narratives of mothers and health visitors to consider the most dominant ways in which vulnerability is couched through professional practice. In doing so, it aims to open up discussion about what it means to be vulnerable and the ways in which meaningful support can be provided.

To book a place at the seminar at CRFR in Edinburgh email Brenda Saetta. Places are funded and free to delegate but numbers are limited.