24 Month Report


Further Information:

24  Month Report – Main Report

24 Month Report – Summary Version

24 Month Report – References



Introduction 24 month report

24 (1)The intergenerational transmission of socioeconomic inequalities in children’s health and cognitive, behavioural, and emotional development emerge early and can persist through life (Najman et al., 2004; Shonkoff & Phillips, 2000).

Evidence suggests that targeted, early intervention programmes aimed at disadvantaged children and their families are an effective means of reducing these inequalities.

Preparing for Life (PFL) is a prevention and early intervention programme which aims to improve the life outcomes of children and families living in North Dublin, Ireland. The programme is being evaluated by the UCD Geary Institute and this evaluation aims to provide evidence on the effectiveness of such early interventions. This chapter describes the objectives and theoretical rationale of the PFL Programme and Evaluation, as well as the aims and structure of the report.



The PFL Evaluation
The PFL Programme is being evaluated using a mixed methods approach, incorporating a longitudinal randomised control trial design and an implementation analysis. The experimental component involves the random allocation of participants from the PFL communities to either a high support treatment group or a low support treatment group. Both groups receive developmental toys, facilitated access to preschool, public health workshops, and have access to a support worker. Participants in the high treatment group also receive home visits from a trained mentor and group parent training using the Triple P Positive Parenting Programme. The PFL treatment groups are also being compared to a ‘services as usual’ comparison group (LFP), who do not receive the PFL Programme.


Recruitment & Baseline Analysis

24 (2) In total, 233 pregnant women were recruited into the PFL Programme between January 2008 and August 2010. Randomisation resulted in 115 participants assigned to the high treatment group and 118 participants assigned to the low treatment group. In addition, 99 pregnant women were recruited into the comparison group. The population based recruitment rate was 52%. Baseline data, collected before the programme began, was available for 104 and 101 high and low PFL treatment group participants respectively, and 99 comparison group participants. Tests of baseline differences between the high and low PFL treatment groups found that the two groups did not statistically differ on 97% of the measures analysed, indicating that the randomisation process was successful. The aggregate PFL group and the LFP comparison group did not statistically differ on 75% of the measures; however, the comparison group was of a relatively higher socioeconomic status.



Summary of Previous Results

24 (3)

The six, twelve and eighteen month evaluations of PFL indicated that the programme was progressing well. 257 interviews (nLow =90; nHigh = 83; nLFP = 84) were completed at 6 months, 247 (nLow = 83; nHigh = 82; nLFP = 82) were completed at 12 months and 225 (nLow = 80; nHigh = 74; nLFP = 71) were completed at 18 months. As found in studies of other home visiting programmes, there were limited significant differences between the high and low treatment groups at six months (14%), twelve months (8%) and 18 months (14%). Many of the relationships were in the hypothesised direction with the high treatment group reporting somewhat better outcomes than the low treatment group. At six months there were significant findings in the domains of parenting, quality of the home environment and social support. However the programme had no significant impact on pregnancy behaviour, infant birth weight, breastfeeding or child development at six months. At twelve months there were significant findings in the domains of child development, child health, maternal health and social support. There were no significant effects in the domain of parenting. At eighteen months there were significant findings in the domains of home environment, parenting, child health and child development, and limited effects in the domains of social support and maternal health. There were no significant effects found in the childcare domain.

While attrition from the programme was low and participant satisfaction was high at six, twelve and eighteen months, the level of engagement was less than anticipated. Although the risk of contamination was high, there was little evidence of contamination between the high and low treatment groups at six, twelve and eighteen months.


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Impact of PFL at 24 Months: Main Results

24 (7)239 (nLow = 84; nHigh = 82; nLFP = 73) twenty-four month interviews were completed. The outcomes of the high treatment group were compared to the outcomes of the low treatment group across eight domains: Child Development, Child Health, Parenting, Home Environment, Maternal Health & Wellbeing, Social Support, Childcare, and Household Factors & Socio-economic Status.

Based on the literature, we hypothesised that there would be moderate positive effects on child development and child health at twenty-four months. We anticipated that PFL parents would be more likely to engage in positive parenting practices. We expected limited programme effects in the areas of the home environment, maternal health and wellbeing, social support, childcare and household factors and SES.

The results supported our hypotheses. 34/166 (21%) of the outcomes analysed showed significant differences between the high and low treatment groups. Significant treatment effects were found across all domains except childcare. The significant findings in the domains of child development and child health supported, yet exceeded, our hypotheses, such that the number of significant positive outcomes in these domains doubled compared to the eighteen month results. The boxes below document the main treatment effects.



24 (6)15% of the sample officially dropped out of the programme between the baseline and twenty-four month assessments (High = 11%, Low = 21%, LFP = 19%). There was no attrition in the high or low treatment groups between eighteen and twenty-four months, and only 1% attrition in the comparison group. 13% of the sample were classified as disengaged at twenty-four months (High = 10%, Low = 13%, LFP = 16%). More twenty-four month interviews were conducted than eighteen month interviews, indicating a level of re-engagement among previously disengaged participants. Very few individual participant characteristics were associated with attrition and disengagement. There is some evidence that more disadvantaged participants were more difficult to contact or more likely to have dropped out of the programme by twenty-four months.



Families in the high treatment group received an average of 33 home visits from the PFL mentors between programme intake and twenty-four months, with each visit lasting approximately 1 hour. The number and duration of visits were similar across time. However a smaller proportion of prescribed home visits were delivered at twenty-four months than in the previous period. On average, participants met their mentor just under once a month between eighteen and twenty-four months. Few individual participant characteristics were associated with the frequency or duration of home visits. Mothers who entered the programme earlier in pregnancy had more home visits and subsequently spent more time in the programme. In addition, mothers with higher cognitive resources participated in more home visits and had visits of a longer duration. This suggests that engagement may be related to the mother’s ability to understand the programme materials and recognise the potential need for the programme in their lives.



Overall participant satisfaction with the programme at twenty-four months was high. As anticipated, the high treatment group reported greater satisfaction with the programme compared to the low treatment group. However, the low treatment group still reported relatively high levels of satisfaction despite the minimal supports received.



A contamination analysis was conducted to determine whether the low treatment group received part of the additional services designed for the high treatment group. The findings indicated that, although the potential for contamination was high, the level of contamination in the PFL programme up to 24 months was quite low and did not bias the 24 months results.


Report Summary & Conclusions

24 (4)The twenty-four month evaluation of Preparing For Life suggests that the programme is progressing very well. While the literature reports moderate findings on certain domains at twenty-four months, the evaluation of PFL identified significant findings in the hypothesised direction for all eight domains. There were a number of positive, significant findings in the areas of child development and health. Additionally there were some limited findings in five of the other six domains; parenting, home environment, maternal health and wellbeing, social support, and household factors and SES. There were no significant positive findings in the childcare domain. The qualitative process evaluation indicated that the mentors and participants had clear, thought-out perceptions about PFL. Mentors spoke about the factors which influenced effective programme delivery and the challenge of engagement, while mothers described the meaning of PFL in their lives, outlining a personal journey from initial reticence to sadness as their time in the programme came to an end. The programme was also successful regarding the retention of participants, with several participants re-engaging with the evaluation at twenty-four months. Importantly, there was no attrition from the high or low treatment groups, and only 1% attrition from the comparison group between eighteen and twenty-four months.