The effects of out-of-home daycare on the health and welfare of disadvantaged children and their families : a randomised controlled trial

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Effectiveness of out-of-home day care for disadvantaged families: randomised controlled trial

OBJECTIVE: To assess the effects of providing daycare facilities for young children on the health and welfare of disadvantaged families. DESIGN: Randomised controlled trial. Eligible children from the application list to a daycare facility were randomly allocated to receive a daycare place or not. SETTING: Early Years daycare centre in Borough of Hackney, London. PARTICIPANTS: 120 mothers and 143 eligible children (aged between 6 months and 3.5 years). INTERVENTION: A place at the centre, which provided high quality day care. Control families used other child care that they secured for themselves. MAIN OUTCOME MEASURES: Maternal paid employment, household income, child health and development. RESULTS: At 18 months' follow up, 67% of intervention group mothers and 60% of control group mothers were in paid employment (adjusted risk ratio 1.23 (95% confidence interval 0.99 to 1.52)), but were no more likely to have a weekly household income of above pound 200 (risk ratio 0.88 (0.70 to 1.09)). Intervention group children had more otitis media with effusion (risk ratio 1.74 (1.02 to 2.96)) and used more health services (1.58 (1.05 to 2.38)), but both estimates were imprecise. CONCLUSION: The provision of child day care may have increased maternal employment, but it did not seem to increase household income. The results suggest that providing day care may be insufficient as a strategy to reduce poverty. The study shows how random allocation can be used to ration and evaluate interventions where demand exceeds supply

Using random allocation to evaluate social interventions: three recent UK examples

Although widely accepted in medicine and health services research, randomized controlled trials (RCTs) are often viewed with hostility by social scientists, who cite a variety of reasons as to why this approach to evaluation cannot be used to research social interventions. This article discusses the three central themes in these debates, which are those of science, ethics, and feasibility. The article uses three recent U.K. trials of social interventions (day care for preschool children, social support for disadvantaged families, and peer-led sex education for young people) to consider issues relating to the use of random allocation for social intervention evaluation and to suggest some practical strategies for the successful implementation of “social” RCTs. The article argues that the criteria of science, ethics, and feasibility can and should apply to social intervention trials in just the same way as they do to clinical trials. </jats:p