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Children and Youth Services Review
journal homepage: www.elsevier.com/locate/childyouth
The effectiveness of Nurture Groups in improving outcomes for young
children with social, emotional and behavioural difficulties in primary
schools: An evaluation of Nurture Group provision in Northern Ireland
Seaneen Sloan
a,b
, Karen Winter
a,⁎
, Paul Connolly
a
, Aideen Gildea
a
a
Centre for Evidence and Social Innovation, Queen’s University Belfast, United Kingdom
b
School of Education, University College Dublin, Ireland
ARTICLE INFO
Keywords:
Nurture Groups
Young children
Children in care
Social, emotional and behavioural difficulties
Educational intervention
ABSTRACT
Concerns have grown regarding the increased prevalence of social, emotional and behavioural difficulties ob-
served in young children in primary school settings. Contributory factors are multiple and varied but one
consistent emphasis has been on the negative effects of children’s poor attachments with significant others
which, due to contextual factors, may not have developed sufficiently. Some groups of children are more at risk
of not developing strong attachments, particularly children in care whose ‘pre-care’and ‘in care’experiences
make it more likely that their attachments will have been adversely impacted. Reflecting this increasing concern,
there has been a growth of school-based interventions that aim to strengthen attachments in order that children
can develop social and emotional skills; thus enabling them to be better placed to access learning opportunities
and reach levels of educational achievement and attainment similar to their peers. One such intervention is
Nurture Groups, modelled on attachment theory. Nurture Group provision is a short-term, schools-based in-
tervention targeted at individual children beginning school who are already displaying social, emotional and/or
behavioural difficulties. This article reports the findings of one of the first larger-scale evaluations of the ef-
fectiveness of Nurture Group provision in improving outcomes of children, and the first to explore the differ-
ential effects of Nurture Groups in relation to school-, pupil- and programme-level characteristics. The evalua-
tion used a non-random control group design, involving a total sample of 384 children, aged 5–6 years, from 30
Nurture Group schools and a further 14 matched schools with no Nurture Group provision in Northern Ireland.
The trial found effect sizes ranging in magnitude from g = 0.528 to 1.352 for a range of social, emotional and
behavioural outcomes, using the Boxall Profile and the Strengths and Difficulties Questionnaire. However, no
evidence of effects was found for academic outcomes. The article discusses the implications for policy and
practice of the findings.
1. Introduction
Definitions of social, emotional and behavioural difficulties vary. In
a UK context, they are commonly referred to as ‘behaviours or emotions
that deviate so much from the norm that they interfere with the child’s
own growth and development and/or the lives of others’(Cooper, 2017,
p. 13). International definitions emphasize similar themes, namely:
responses from children that are very different from normative age-
appropriate responses and that result in impairments socially, educa-
tionally and developmentally (Linsell et al., 2019; Poulou, 2015;
Wichstrøm et al., 2011). Broadly speaking, emotional difficulties (also
referred to as ‘internalising problems’) include phobias, anxiety,
emotional regulation and depression, whilst behavioural difficulties
(also referred to as ‘externalising problems’) refer to aggression, agi-
tation, defiant, oppositional and confrontational behaviour (Poulou,
2015). Reflecting changes in the dominant policy discourse, the con-
stellation of issues is now more likely to be subsumed under the broader
category of ‘social, emotional and mental health’(SEMH) rather than
social, emotional and behavioural difficulties (SEBD) (Bayer, Hiscock,
Ukoumunne, Price, & Wake, 2008). Notwithstanding challenges in op-
erationalising concepts, existing evidence suggests that: social, emo-
tional, behavioural and/or mental health difficulties experienced by
young children are on the increase; difficulties are noticeable in pre-
school settings; they continue into primary school settings; and they can
https://doi.org/10.1016/j.childyouth.2019.104619
Received 4 September 2019; Received in revised form 14 November 2019; Accepted 15 November 2019
⁎
Corresponding author at: School of Social Sciences, Education and Social Work, Queen’s University Belfast, 6 College Park, Belfast BT7 1PS, Northern Ireland,
United Kingdom.
E-mail address: k.winter@qub.ac.uk (K. Winter).
Children and Youth Services Review 108 (2020) 104619
Available online 28 November 2019
0190-7409/ Crown Copyright © 2019 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/BY-NC-ND/4.0/).
T
have adverse impacts into adulthood (Doyle, Hegarty, & Owens, 2018;
Linsell et al., 2019; Poulou, 2015).
In terms of contributory factors, there is some evidence to indicate a
connection between social, emotional and behavioural difficulties and
the intrapersonal characteristics of children; including their genetics,
disposition and temperament (Wichstrøm et al., 2011). However, there
is also research illustrating that children’s social, emotional and beha-
vioural difficulties may well be an understandable response by young
children to poor emotional bonds with their main carers formed in a
context of familial and social structural adversities including exposure
to: familial neglect, abuse and violence; inconsistent parenting; familial
separation/deaths; racism; poverty; and social exclusion/margin-
alisation (Doyle et al., 2018). It is known that these challenging social
circumstances can impact on attachments between primary carers and
their children and that attachments are not always secure (Linsell et al.,
2019). Furthermore, research has identified that some groups of young
children are more prone to social, emotional and behavioural difficul-
ties than others and these include young children in care (Sempik,
Ward, & Darker, 2008). For this particular group, these difficulties are
exacerbated by experiences of poor attachments in the pre-care home
environment and also by the difficulties forming strong, positive at-
tachments when in care, with the result that attachments are not always
secure.
1.1. Attachment theory
Attachment theory, first proposed by Bowlby (1969, 1988), builds
upon this concern regarding the importance of emotional bonds and
focuses on how individuals respond when in need of comfort and/or
under threat. It is suggested that children, from birth, seek out the
proximity of an adult with the expectation and anticipation that they
will receive the comfort, safety and support they need. In situations
where, over time, the caregiver is attuned –that is alert, responsive,
consistent and sensitive –the developing attachment is more likely to
be secure. Furthermore, Bowlby (1969, 1988) contends that where
children cannot rely on their carers for regular, consistent, sensitive
responses, children have to learn ways of managing in those relation-
ships since they cannot exit them. Ainsworth and Bell (1970), building
on Bowlby’s work, proposed that in such contexts, three types of at-
tachment style could be identified: secure; insecure avoidant; and in-
secure ambivalent. The latter is characterised by a child feeling anxious
when separated from their caregiver but not reassured by their return;
since their presence cannot be relied on as an indication that needs will
be met. By contrast, in relation to avoidant attachment, the child avoids
their carer.
It is suggested that secure attachments provide the ‘secure base’
from which children can develop their social and emotional skills. For
example, from a secure base, Bowlby (2008) contended that a child is
more likely to be able to: confidently explore their environment; ac-
quire skills such as emotional regulation (managing stress, empathy,
controlling impulses such as anger, rage); and to acquire social skills
(establishing rapport, turn taking, listening and sharing). There is evi-
dence to suggest that where a child has not had the opportunity to form
secure attachments, their ability to soothe themselves, regulate their
emotions and form relationships has been adversely impacted (Linsell
et al., 2019). Furthermore, their self-esteem and self-confidence can be
low; not believing themselves to be worthy of attention, love and care
and not believing others to be trustworthy, safe and dependable (NICE,
2015). These difficulties can become amplified within school settings
where certain emotional and social skills within group settings are re-
quired to progress and where access to learning opportunities can be
hindered as the social, emotional and behavioural difficulties act as
barriers to learning (Boxall, 2002; Steinsbekk & Wichstrøm, 2018).
Within this context, and as noted by Boxall (2002), issues regarding
children’s attachments are associated with wider disadvantage and
their prevalence more likely to be associated with particular subgroups,
most notably children and young people in care. Furnivall and Grant
(2014), for example, highlight the challenging circumstances faced by
this group of children in particular, that lead them to come into care,
including abuse, neglect and witnessing domestic violence that are all
then compounded by loss and trauma experienced through being re-
moved from their familial home and placed in care. Ford and Courtois
(2013) and Francis et al., (2017) note that such experiences of abuse
can affect physical health and cause hyperarousal, poor attention span
and attachment problems. To address attachment issues, a range of
interventions has been designed that seek to strengthen attachments
between children in care and their carers (Dickes, Kemmis-Riggs, &
McAloon, 2018; Kerr & Cossar, 2014). While the role played by schools
in developing secure attachments has been the subject of debate (Parker
& Levinson, 2018), it is now widely acknowledged that attachment
theory is of relevance to schools; reflecting an acceptance that children
tend to have multiple attachments at any one time (Parker & Levinson,
2018) and that these may change over time. Moreover, the opportunity
to develop a secure attachment can help mitigate against attachments
that are not secure and that schools can play a pivotal role given the
amount of time children spend in school each day (Cameron & Maginn,
2011; Geddes, 2006). With this in mind, the development of schools-
based interventions that focus on children’s attachments as a means of
enabling them to better access learning opportunities are an important
development, especially for young children in care whose attachment
relationships –because of abuse, neglect and challenging social cir-
cumstances –are more likely to have been impaired. Nurture group
provision is among these programmes.
1.2. Nurture Group provision
Established by Marjorie Boxall, who worked as an educational
psychologist in Hackney (London) in the 1960′s, Nurture Groups were
originally established in certain primary schools in socially and eco-
nomically deprived areas in London, in response to high levels of early
childhood psychosocial disorders and the attendant emotional and be-
havioural problems that was evident in some children on entry to pri-
mary school (Boxall, 2002). In identifying the source of these difficul-
ties Boxall (2002) argued that the main parent/carer-child attachment
relationship had been compromised because of the impact of challen-
ging social circumstances in the family home; the source of which could
be traced back to a range of structural factors including poverty, racism
and social marginalisation. She suggested that the resulting emotional,
behavioural and social difficulties experienced by children impacted on
their ability to adjust to the demands of the classroom setting and to
access learning opportunities.
In response, Boxall designed Nurture Groups to take a small group
of children (10–12 maximum) out of the mainstream classroom for a
certain period each day and for a limited length of time over the course
of one school year and, within a small group setting, to model out
positive attachment relationships and provide opportunities for social
learning and the development of emotional literacy, whilst simulta-
neously enabling children to access educational learning opportunities.
Underpinned by Bowlby’s attachment theory, the role of the key adult
in the school setting was regarded as critical in terms of establishing
routines and relationships in a safe, predictable and nurturing en-
vironment. Accompanying this, the Nurture Group model placed a
strong emphasis on the physical environment, as Colley (2009: 291-2)
outlines:
The nurture room sets out to provide a safe, welcoming and caring
environment for learning and will replicate the home environment
with a comfortable seating area, a kitchen facility for preparing food
and a working area to address formal curriculum demands. A range
of activities are undertaken which aim to help the young people to
develop trust, communication skills and the growth of confidence
and self-esteem. This might involve the sharing of news, emotional
S. Sloan, et al. Children and Youth Services Review 108 (2020) 104619
2
literacy sessions, turn-taking games, group activities, formal curri-
culum tasks or the nurture ‘breakfast’.
The proposed theory of change underpinning Nurture Groups is that
if children’s attachment relationships can be enhanced then their
emotional and social wellbeing will improve and this, in turn, will lead
to improved behaviour that will better place children to access learning
opportunities with the end result that their academic scores should
increase. Whilst there is some variation in Nurture Group provision
between the ‘classic model’(outlined above) and ‘variants’(Cooper,
Arnold, & Boyd, 2001), they are all underpinned by the same long-term
aim to improve children’s educational outcomes. To plot these im-
provements, Boxall developed a bespoke measure, known as the Boxall
Measure (Bennathan, 1998) which has a diagnostic and developmental
strand, to plot children’s baseline scores and progress over time. This,
combined with the use of the Strengths and Difficulties Questionnaire,
have tended to be the key measures used to plot change in children
participating in Nurture Group provision to date.
Across the UK as a whole, there are currently over 2,000 Nurture
Groups UK (Nurtureuk Policy Briefing, 2019) and, in Northern Ireland,
there were, in 2016, 32 groups (https://www.theyworkforyou.com/
ni/?id=2016-11-15.1.70 –accessed 28/10/19). As indicated above,
different variants of Nurture Group have been identified. ‘Variant 1′
Nurture Groups (the ‘classic’model) are classes of about 10–12 children
looked after by a teacher and teaching/classroom assistant (Boxall,
2002; Cooper & Whitebread, 2007). Children spend most of the school
week in this Group, receiving highly structured and supported learning
experiences and, where possible, re-joining their mainstream class for
registration, assembly, break, lunch and home time. Typically, children
attend the Group for between two and four terms, after which the ul-
timate aim is that they can reintegrate into their mainstream class on a
full-time basis. ‘Variant 2′Nurture Groups adhere to the principles of
the classic model but differ in terms of structure and organisation
(Cooper & Whitebread, 2007). They may run on a part-time basis,
possibly involving a group of children aged 5–6 in the Nurture Group in
the morning sessions and involving an older group (aged 7–11 years) in
Nurture Group in the afternoons. Such models are often seen as a more
feasible option for schools as more pupils can be supported while, at the
same time, children spend more time accessing the mainstream curri-
culum with their peers. Both Variant 1 and 2 Nurture Groups are re-
cognised by the Nurture Group Network (NGN) as meeting the quality
standard of nurture provision. ‘Variant 3′Groups have been described
as groups radically departing from the principles and practice of Nur-
ture Provision based on, for example, lunch-time or after-school groups
that tend to focus on social and emotional issues but have no focus on
teaching the curriculum in the way that Variant 1 and 2 Groups would
do. Cooper and Whitebread (2007) define ‘Variant 4′groups as those
that bear the name but that do not adhere to the nurture group prin-
ciples in practice and therefore essentially should not be labelled as
Nurture Groups. The Nurture Groups in Northern Ireland are based on
Variants 1 and 2.
2. Current evidence regarding the effectiveness of Nurture Group
provision
There now exists a wide-ranging literature related to Nurture
Groups. Using a thematic framework, the current literature that spans
from the mid-1970s onwards can be organised into three main cate-
gories. First are the descriptive accounts of Nurture Groups that explore
issues such as the background, theoretical underpinnings, component
parts, composition, processes, practices and intended outcomes of
Nurture Group provision (Bennathan, 1997; Bennathan & Boxall, 2000;
Bishop, 2008;Boxall, 1976;Boxall & Lucas, 2010; Cooper & Tiknaz,
2007). Second, there are studies that detail the perspectives, experi-
ences and views of parents and children (Cefai & Pizzuto, 2017; Kirk,
2018; Kirkbride, 2014; Morris, 2019). Third are the studies that
consider the effectiveness, impact and outcomes of Nurture Group
provision. It is this latter category of research study that provides the
main focus for this present article and is appraised in further detail
below. As noted in the reviews conducted by Hughes and Schlösser
(2014) and Bennett (2015), these studies typically (although not ex-
clusively) focus on children in primary schools and involve pre- and
post-tests using a range of measures including the Boxall profile
(Bennathan, 1998), the Strengths and Difficulties Questionnaire
(Goodman, 1997) and the Behavioural Indicators of Self-esteem (BIOS).
With regards to the measures that have tended to be used, the Boxall
profile (Bennathan, 1998) comprises a developmental and a diagnostic
strand. The diagnostic strand contains 34 items describing behaviours
that act as barriers to the child’s full and satisfactory participation in
school. Items are organised under three clusters: self-limiting features;
undeveloped behaviour; and unsupported development. The develop-
mental strand consists of 34 items describing aspects of the develop-
mental process in the early years that lays the foundation for being able
to function socially, emotionally, behaviourally and academically in
school. Items are organised under two clusters: organisation of ex-
perience; and intermalisation of controls. The measure aids in the
identification of priority areas for intervention for each child, such as
areas of social skills development, which can then be targeted de-
pending on the needs of each pupil. The Strengths and Difficulties
Questionnaire (Goodman, 1997) consists of 20 statements describing
negative behaviours, which can be summed to give a ‘total difficulties’
score and also broken down into the following subscales (which each
contain 5 items): conduct problems (e.g. ‘often has temper tantrums’);
emotional symptoms (e.g. ‘often unhappy’); hyperactivity (e.g. ‘con-
stantly fidgeting’); and peer problems (e.g. ‘rather solitary, tends to play
alone’). The Behavioural Indicators of Self-esteem (BIOS) is used by
teachers to measure the frequency of behaviours that are associated
with positive self-esteem. It comprises 13 items which are rated from
‘never’to ‘always’. Scores are associated to these ratings and the
average of these scores provides the measure of self-esteem.
Regarding the studies currently available, some consider impact on
outcomes by tracking the progress of various cohorts of children but
where there is no control group (Binnie & Allen, 2008; O’Connor &
Colwell, 2002). Binnie and Allen (2008), for example, reported the
findings from a study involving 36 children (28 male and 8 female,
mean age 7 years and 2 months) attending Nurture Group provision in
six schools in one Local Authority between 2006 and 2007. The design
involved repeated measures (Boxall profile, SDQ and BIOS) with eight
months between pre and post-tests and questionnaires with staffand
parents. In the findings, the children showed statistically significant
improvements, regarding scores obtained in the developmental strand
of the Boxall profile, with a pre-intervention mean of 79 increasing to a
post intervention mean of 114 (standard deviations were not reported
by the authors). Improvements were also noted in the diagnostic strand
of the Boxall profile, with a reported pre-intervention mean 63 com-
pared with a post-intervention mean of 35. On the BIOS, children in all
schools demonstrated a positive change in children’s self-esteem, with a
pre-intervention mean 33 and a post-intervention mean of 42. Although
there was some attrition, the teacher and parent completed SDQ
showed that parents and staffreported similar positive impacts of
Nurture Group attendance on the children concerned.
Other studies track the progress of cohorts using various types of
control groups (Cooper et al., 2001; Cooper & Whitebread, 2007; Iszatt
& Wasilewska, 1997; Reynolds, MacKay, & Kearney, 2009; Saunders,
2007). An early study, often referred to, is that by Iszatt and
Wasilewska (1997). The study concerned 308 children who had been
placed in Nurture Groups between 1984 and 1988. They noted that the
vast majority (87%) were returned to their mainstream class within one
academic year. This compared very favourably with a small group of 20
non-matched pupils who were deemed suitable for Nurture Group
provision but no place was available and where higher levels of chronic
difficulties were found with 35% placed in special schools and only
S. Sloan, et al. Children and Youth Services Review 108 (2020) 104619
3
55% coping well in mainstream schools. Nurture Groups appeared to
impact positively on children’s social and emotional skills and their
levels of self-confidence.
A later study by Cooper et al. (2001) reported preliminary findings
of a then ongoing longitudinal study involving 342 children (aged be-
tween 4 and 10 years) in 25 schools (23 primary and 2 secondary
schools), in eight local education authorities (LEAs). Of the 342 chil-
dren, 216 children were in Nurture Groups and their outcomes were
compared with two control groups. Control Group 1 comprised 64
‘matched’children with social, emotional and behavioural difficulties’
but who remained in their mainstream class within the school that was
delivering Nurture Group provision. Control Group 2 comprised 62
children without social, emotional and behavioural difficulties in
mainstream classes. Teachers completed the Strengths and Difficulties
Questionnaire and the Boxall profile. In the snapshot findings, Cooper
et al. (2001) reported that children in Nurture Groups made gains
compared with children with difficulties in mainstream classes and the
non-social, emotional and behavioural controls. On the SDQ, and at
entry to Nurture Group, 92% children were scored as abnormal/bor-
derline, compared with 84% of the children in Control Group 1. By the
third term (i.e. within the year), this had changed to 63% for Nurture
Group pupils compared with 75% in Control Group 1 and was noted as
statistically significant. On the Boxall Profile, the mean improvements
from the first test (term one) to the second test (term three) were noted
as statistically significant. Furthermore, on the qualitative data gath-
ered from parents and teachers regarding their perceptions of the
children’s progress, Nurture Groups were positively received and be-
lieved to be making a positive impact (Cooper et al., 2001, p. 164).
More recently, research by Reynolds et al. (2009), using a quasi-
experimental research design, notwithstanding its design limitations,
has been cited as the most robust study available (EIF, 2019). A total of
221 children (142 males and 79 females, ages 5–7 years) were involved
in the study. They attended one of 32 schools, 16 of these had Nurture
Group provision (117 children in the study attending these) and 16
were matched schools without Nurture Group provision (104 children
attended these). The children’s outcomes were assessed via a pre-test
and post-test (with tests being 6 months apart) and using the Boxall
profile, the Strengths and Difficulties Questionnaire and the Beha-
vioural Indicators of Self Esteem (BIOS). Findings indicated that: ‘on the
Boxall Profile, significant benefits were found for the nurture groups in
comparison with the controls on all five strands, with significance levels
ranging from p = 0.003 to p < 0.001′(Reynolds et al., 2009, p. 208).
Regarding the SDQ, the findings indicated that there was improvement
but that this was not statistically significant. With regards to the Be-
havioural Indicators of Self Esteem (BIOS), significant effects were
noted for children attending the nurture group compared with those in
the control groups (p = 0.001). This study also used a Baseline As-
sessment for Early Literacy which was completed by teachers and as-
sessed basic literacy skills and ‘early reading readiness’(Reynolds et al.,
2009, p. 207). The measure has four sub sections and includes concepts
of print, phonological awareness, early reading skills and develop-
mental tasks. The findings indicated that children attending the Nurture
Groups had made statistically significant gains as measured by their
final scores following their baseline assessment. Further analysis using
multiple regression to detect which variable was the best predictor of
educational attainment indicated that ‘unsupported development (on
the Boxall measure) was the best predictor accounting for ‘almost a
quarter of the variance’(Reynolds et al., 2009, p. 208) and that together
with organisation of experience and internalisation of controls these
accounted for half of the variance in baseline improvements in this
area.
As noted by Hughes and Schlösser (2014) and Bennett (2015) in
their reviews of research regarding Nurture Group provision, the
overall message emerging from quasi experimental studies (see Table 1)
and other studies, appears to suggest that: Nurture Group provision has
positive impacts on children’s social, emotional and behavioural
difficulties; that improvements made are generally quite well-sustained
over time; and that because children are better able to access the cur-
riculum, they make related gains in achievement and attainment.
However, there are notable limitations to the current evidence base,
including the fact that there are currently no randomised controlled
trials of the effectiveness of Nurture Group provision. Furthermore, of
the evidence that does exist, studies that include control groups are still
limited in number. Even then, of those with control groups, most are
small scale studies with only a handful of studies having a sample size
of over 200 children. Moreover, and for these studies, there is little
reported evidence of sub group analyses. The study reported in this
article seeks to address some of these limitations by reporting the
findings of a larger-scale non-randomised control group trial involving
384 children from 44 primary schools in Northern Ireland where the
control group comprised matched schools and where sub analyses was
undertaken. Although not reported here (due to word restrictions), the
study also included a secondary data analysis, a process evaluation and
a cost effectiveness analysis (Anon, 2016), therefore making this one of
the most detailed studies available on the implementation, experience
and impact of Nurture Group provision.
3. The present study
In Northern Ireland there are a number of established Nurture
Groups that have been operating for many years, with some schools
self-funding or accessing funds through the former Department for
Social Development (now known as the Department for Communities
(Northern Ireland)) and the Neighbourhood Renewal Investment Fund.
In 2012, the Office of the First Minister and Deputy First Minister an-
nounced funding for 20 new Nurture Groups, through the government’s
Delivering Social Change (DSC) Signature Projects. Furthermore, the
Department of Education Northern Ireland (DENI) also invested funds
for the continued provision of 10 established Nurture Groups in schools
where funding was coming to an end. To ensure a consistent approach
to the set up and delivery of nurture provision, Nurture Guidelines
developed collaboratively were published and, as part of the Signature
Project, each region of the Education Authority received funding
through DENI for a Nurture Support Officer/Nurture Advisor and
Educational Psychologist hours to provide support and advice to the
Signature Project schools.
3.1. The research design and ethical approval
This present article reports the findings of a non-randomised con-
trolled group trial evaluation of Nurture Group provision in Northern
Ireland, funded by DENI. The trial formed part of a larger study that
also included: secondary analysis of existing data on the progress of
children that had previously participated in Nurture Groups; a cost-ef-
fectiveness analysis; and a qualitative process evaluation involving in-
terviews with key professionals, parents and children as well as ob-
servations of the Nurture Groups in practice. The aims and objectives of
the research were to: assess the effectiveness of nurture provision in
improving child social, emotional and behavioural development, and
ability to learn, both within the Nurture Group and following re-
integration with the mainstream class; and to assess the cost-effec-
tiveness of nurture provision in achieving its objectives. The research,
which took place in 2015–2016 and was approved by the research
team’s institutional research ethics committee.
The trial component of the study, that provides the focus for this
present article, tracked 384 pupils attending nurture groups in 30
schools during one school year (2014/2015) and compared those with a
control group of pupils who had a similar level of need from 14 mat-
ched schools without nurture provision. These schools were identified
from the list of schools that satisfied the original criteria for allocation
of Signature Project funding (i.e. schools with above average proportion
of pupils eligible for free school meals, below average attendance,
S. Sloan, et al. Children and Youth Services Review 108 (2020) 104619
4
below average attainment at ages 5–6 and 10–11 years, when tests are
undertaken, and above average numbers of children with a statement of
special educational needs). The recruitment of participants and their
flow through the trial is illustrated by Fig. 1.
Table 2 compares the intervention and control groups in relation to
key demographic characteristics. As can be seen, there were some
(statistically significant) differences between the two groups, with the
intervention group tending to have a higher proportion of children that
were: eligible for free school meals; looked after; known to social ser-
vices; and/or on the child protection register. In contrast, a higher
proportion of pupils in the control group were from minority ethnic
backgrounds and had English as an additional language. As described
further below, these differences were controlled for in the analysis by
including dummy variables for each of these characteristics listed in
Table 1 as covariates in the multilevel regression models fitted.
3.2. Outcome measures
For comparability, the outcome measures selected were: the Boxall
measure (using both its developmental and diagnostic components); the
Strengths and Difficulties Questionnaire (SDQ); data held by the schools
regarding tracking assessment scores; and a bespoke measure for chil-
dren to indicate school enjoyment. Whilst widely use for previous stu-
dies of Nurture Groups, there is currently no reliable psychometric data
reported on the Boxall measure (EEF, 2019). However, there is some
evidence to suggest that it has strong concurrent validity when com-
pared to the SDQ (Couture, Cooper, & Royer, 2019). Using the baseline
data collected for this present study, the five sub-scales were found to
reliable (alpha ranging from 0.632 to 0.906) and the two main com-
ponents were highly reliable (alpha = 0.931 and 0.919 respectively).
In contrast, the SDQ is a widely-used outcome measure with strong
and consistent psychometric properties (EEF, 2019; Husky et al., 2018).
The SDQ has five sub-scales and four of these focus on negative beha-
viour (conduct problems, emotional symptoms, peer problems and
hyperactivity) and combine to create a ‘total difficulties score’. The fifth
sub-scale, provides a stand-alone measure of ‘prosocial behaviour’.
Analysis of the baseline data for this present study indicated that the
main total difficulties score and prosocial behaviour scores were reli-
able (alpha = 0.798 and 0.818 respectively) as were the four sub-do-
mains (alpha ranging from 0.654 to 0.843). For the target age range of
this present study, the SDQ has versions for teachers and parents to
complete. The teacher version was used to minimise missing data.
Enjoyment of School was measured by children completing a be-
spoke self-report on the following 11 aspects of school: reading; writing;
spelling; numeracy; using the computer/iPad; working by yourself;
outdoor play with your class; break/lunchtime in the playground; lunch
time in the dinner hall; golden time; and coming to school. Children
were invited to rate each aspect on a 5-point scale by point to or putting
a circle around one of a set of five ‘smiley faces’and labelled from ‘don’t
like it at all’(scored ‘1′)t
o‘like it very much’(scored ‘5′), meaning that
total scores could range from 11 to 55. Inspection of the baseline data
indicates that the scale as a whole has good reliability (alpha = 0.799).
Finally, the data derived from schools comprised results of assess-
ment tests carried out with children at Key Stages 1 and 2 on com-
munication, using mathematics and using ICT.
With regards to the analysis, baseline differences between pupils in
the intervention and control group (in terms of both core characteristics
and baseline scores on measures of social, emotional and behavioural
functioning, enjoyment of school, attendance and academic attainment
in literacy and numeracy) were explored. Raw changes in these out-
come measures from pre-test to post-test in both the intervention group
and control group were then examined and compared. For the main
analysis, data were analysed in a series of multi-level statistical models
for each outcome to account for the clustered nature of the data
(children clustered within schools). These models compared post-test
mean scores for those in Nurture Groups with those in the control
group, accounting for any differences at baseline in terms of pre-test
scores and other key pupil characteristics (i.e. gender, year group, free
Table 1
A summary of the findings of evaluations of Nurture Groups employing quasi experimental designs.
a
Study (year) Location Design Sample Developmental
Pre-post scores
Effect size Diagnostic
Pre-post scores
Effect size
The Present Study Northern
Ireland
Single-group pre-post-test; average
time between assessments = 3 terms
N = 507 pupils in 27
schools
Pre: 77.28
Post: 108.96
+1.49 Pre: 53.17
Post: 26.13
−0.97
Shaver and McClatchey
(2013)
Northern
Scotland
Single-group pre-post-test; 8 weeks to
1 year between assessments
N = 32 pupils in 2
schools
Age not reported
Pre: 89.21
Post: 112.10
+0.88 Pre: 33.18
Post: 22.77
−0.31
Reynolds et al. (2009) Glasgow Pre-post-test with matched control
group; 6 months between assessments
N = 97 pupils in 16
schools
b
Age 5–7 years
Pre: 81.25
Post: 102.10
*Pre: 41.11
Post: 28.20
*
Binnie and Allen (2008) West Lothian Single-group pre-post-test; 8 months
between assessments
N = 36 pupils in 6
schools
Age 5–10 years
Pre: 79
Post: 114
*Pre: 63
Post: 35
*
Cooper and Whitebread
(2007)
Various sites,
England
Pre-post-test with matched control
group; time between assessments
ranges from 2 to 4 terms
N = 359 pupils in 23
schools
b
Age 4–14 years
After 2 terms
(n = 253):
Pre: 77.92
Post: 96.19
After 4 terms
(n = 86):
Pre: 73.37
Post: 105.53
+0.75
+1.07
After 2 terms
(n = 253):
Pre: 51.58
Post: 41.34
After 4 terms
(n = 86):
Pre: 51.24
Post: 33.72
−0.34
−0.68
O’Connor and Colwell
(2002)
London Single-group pre-post-test; average of 3
terms between assessments
N = 68 pupils in 5
schools
Mean age = 5.25 years
Pre: 71.22
Post: 110.16
+1.66 Pre: 49.15
Post: 23.43
−0.63
Cooper et al. (2001) Various sites,
England/
Wales
Pre-post-test with matched control
group; average time between
assessments = 2 terms
N = 216 pupils in 25
schools
Age 4–10 years
Pre: 77.14
Post: 95.21
+0.73 Pre: 50.83
Post: 39.98
−0.38
a
Published UK research by Sanders (2007); Seth-Smith et al. (2010) and Scott and Lee (2009) are not included as raw mean scores were not reported.
b
Only intervention group data reported.
* Standard deviations not reported in original publication therefore effect size could not be calculated.
S. Sloan, et al. Children and Youth Services Review 108 (2020) 104619
5
school meal eligibility, neighbourhood deprivation, looked-after status,
if pupil’s family was known to social services). Effect sizes (Hedges’g)
were calculated as the standardised mean difference in outcomes be-
tween the intervention and control groups. Hedges’g was used in
preference to Cohen’s d as it is a more reliable measure of standardised
mean effects for smaller sample sizes. These post-test mean scores were
estimated from the regression models and thus were adjusted for any
differences at pre-test. In addition, each model was extended by
including additional interaction terms to assess whether there was
evidence of differential effects of Nurture Groups in relation to a set of
school-level and child-level characteristics. These are explained further
in the next section.
For the purposes of the main analysis, the two interventions group
(Fig. 1) were combined to ensure improved statistical power for com-
parisons between those receiving Nurture Group provision (whether via
the existing Nurture Groups or the new Groups funded through the
Signature Project) and the control group. However, potential differ-
ences between the two intervention groups were explored as part of the
further sub-group analysis and no evidence was found that the effects
associated with both intervention groups differed (see Table 7 reported
later).
4. Results
Table 3 provides a summary of simple descriptive statistics from the
trial of the mean scores (with standard deviations) for the intervention
and control groups for each of the outcome variables at pre-test and
post-test. In comparing the pre-test mean scores of both groups, it can
be seen than the core developmental, social and educational outcomes
for those in the intervention group tended to be slightly lower than
those in the control group. Again, these differences were effectively
controlled for in the main analysis as described above by including the
children’s pre-test scores as covariates in each model.
In considering the gains made by children during the period of the
trial, a visual inspection of the progress made by both groups from pre-
Intervenon Group 2:
•Pupils (n=66) from 10 funded
‘established’ Nurture Groups
Control Group:
•Pupils (n=88) from 14 schools
meeng the Signature Project
criteria but with no nurture
provision
All primary schools in NI
assessed against Nurture
Unit Signature Project
eligibility criteria
Schools meeng criteria
(N=44) ranked according to
%FSM
20 schools with highest
%FSM offered funding for
nurture unit
Intervenon Group 1:
•Pupils (n=232) from 20
Signature Project Nurture
Groups
•Boxall Profile at pre-test
(n=232) and post-test
(n=197)
•SDQ at pre-test (n=219) and
post-test (n=163)
•Enjoyment of School at pre-
test (n=106) and post-test
(n=137)
•Boxall Profile at pre-test (n=63)
and post-test (n=56)
•SDQ at pre-test (n=45) and
post-test (n=46)
•Enjoyment of School at pre-
test (n=57) and post-test
(n=61)
•Boxall Profile at pre-test (n=86)
and post-test (n=84)
•SDQ at pre-test (n=86) and
post-test (n=84)
•Enjoyment of School at pre-
test (n=84) and post-test
(n=82)
10 primary schools already
funded under the exisng
Nurture Group provision in
Northern Ireland
14 primary schools
purposively selected from
the remaining sample of
schools that met the Nurture
Unit Signature Project criteria
but were not selected and
had no nurture provision
Fig. 1. Flow diagram of recruitment and data collection.
Table 2
Comparison of the characteristics of the intervention group and control group
(%).
Pupils Intervention
Group
Control
Group
Sig.
a
Male 64 70 0.359
Eligible for FSM 87 66 < 0.001
EAL 3 15 < 0.001
Non-white 5 22 < 0.001
Looked after 8 3 0.185
Known to social services 36 16 < 0.001
On Child Protection Register 9 2 0.043
Special Educational
Needs
Not on SEN
register
3 29 < 0.001
Stage 1 12 19
Stage 2 54 17
Stage 3 26 24
Stage 4–54 5
a
Based on chi-squared tests.
S. Sloan, et al. Children and Youth Services Review 108 (2020) 104619
6
test to post-test would appear to indicate notable (and statistically
significant) positive improvements for the children in the intervention
group across all of the social, emotional and behavioural outcomes;
with reductions in negative behaviours and increases in prosocial be-
haviour. This compared to limited evidence of change for those in the
control group. Interestingly, there only appeared to be smaller (and
non-significant) changes in academic outcomes; namely their enjoy-
ment of school (measured using the total score) and their literacy and
numeracy outcomes (using school-assessed key stage results).
As noted above, the data were more formally analysed using mul-
tilevel regression models and the findings from these are summarised in
Table 4 that presents the adjusted mean post-test scores for the inter-
vention and control groups, estimated using the multilevel models.
As can be seen from Table 4, there is clear and consistent evidence
of improvements in social, emotional and behavioural outcomes for
children attending Nurture Groups compared to those in the control
group, using both the Boxall Profile and the Strengths and Difficulties
Questionnaire (SDQ). Typically, effect sizes of around 0.2 are con-
sidered to be ‘small’, those around 0.5 to be ‘medium’and those above
0.8 to be ‘large’(Cohen, 1977). It can be seen from Table 4 that the
effects associated with attending Nurture Groups were found to be large
for the developmental strand (g = 1.352) and the diagnostic profile
(g = -0.904) of Boxall and the total difficulties score (g = -1.303) and
prosocial scores (g = 0.926) of the SDQ. Interestingly, there is no
evidence of an effect for Nurture Groups on the children’s academic
outcomes in literacy or numeracy.
In addition, exploratory analyses were undertaken to explore whe-
ther Nurture Groups had differential impacts for: boys and girls; chil-
dren with English as an additional language; from areas with differing
levels of deprivation; children known to socials services, ‘looked after’
by social services; and at different stages of the Codes of Practice. The
exploratory analysis also examined whether the Nurture Group provi-
sion had differential effects in relation to schools with differing pro-
portions of children eligible for free school meals; children with special
education needs; differing levels of deprivation; and differing sizes.
Analyses also took account of differential effects regarding full/part
time Nurture Group provision; size of Nurture Group and how long it
had been established; and type.
In relation to school level variables, the evidence of possible sub-
group differences are summarised in Table 5, by simply reporting the
statistical significance of the interaction term from each of the multi-
level regression models in turn. Given the multiple statistical tests un-
dertaken, and thus the increased risk of Type I errors, these findings are
presented simply to provide an overall sense of the potential existence
of sub-group differences. It would be potentially misleading to use the
current analysis to generate more specific summary statistics for any of
the potential interaction effects found, especially given that many of
these rely on smaller sub-samples.
It can be seen that there was some potential evidence that the size of
the school may be a mediating variable. Further analysis of the fitted
models suggested that there was an inverse relationship between school
size and amount of progress, in that pupils in larger schools made less
Table 3
Comparison of mean pre-test and post-test scores for the intervention and control groups for each outcome.
Outcome Intervention
Mean (sd)
Effect size (d)
[sig]
Control
Mean (sd)
Effect size (d)
[Sig]
Pre Post Pre Post
Boxall Profile
Developmental Strand 74.11 (19.78) 110.05 (18.41) +1.817
[p < .001]
84.29 (24.35) 85.04 (23.35) -0.031
[p = .686]
Diagnostic Profile 54.13 (25.36) 25.53 (21.91) −1.128
[p < .001]
47.43 (29.44) 46.76 (27.44) -0.023
[p = .746]
Organisation of experience 37.65 (12.10) 58.10 (11.02) +1.690
[p < .001]
45.27 (13.26) 44.72 (12.73) -0.041
[p = 625]
Internalisation of controls 36.50 (10.41) 52.00 (10.16) +1.489
[p < .001]
39.01 (13.14) 40.31 (12.05) +0.099
[p = .157]
Self-limiting features 12.31 (5.15) 5.87
(4.60)
−1.250
[p < .001]
9.20
(5.07)
9.68 (5.66) +0.094
[p = .292]
Undeveloped behaviours 13.30 (8.15) 6.18
(6.43)
-0.873
[p < .001]
11.06 (8.31) 10.95
(7.58)
-0.013
[p = .874]
Unsupported development 28.17 (17.01) 13.48 (13.42) -0.884
[p < .001]
27.17 (16.60) 26.13 (17.70) -0.054
[p = .418]
Strengths and Difficulties Questionnaire
Total Difficulties 19.64 (5.75) 10.30 (6.08) −1.622
[p < .001]
17.54 (6.79) 17.65 (5.64) +0.018
[p = .815]
Conduct problems 3.42
(2.59)
1.67 (2.14) -0.681
[p < .001]
3.26 (2.63) 3.33 (2.65) +0.027
[p = .627]
Emotional symptoms 4.64
(3.00)
2.20 (2.16) -0.813
[p < .001]
3.92 (3.53) 4.25 (2.97) +0.094
[p = .236]
Peer problems 3.95
(2.26)
2.20 (2.10) -0.852
[p < .001]
2.90 (2.11) 3.24 (2.12) 0.158
[p = .126]
Hyperactivity 7.62
(2.56)
4.41 (2.88) −1.256
[p < .001]
7.45 (2.69) 6.83 (2.25) -0.230
[p = .003]
Prosocial behaviour 4.28
(2.74)
7.03 (2.53) +1.008
[p < .001]
5.01 (2.69) 5.11 (2.78) +0.035
[p = .675]
Academic outcomes
Enjoyment of school 42.26 (9.41) 45.45 (7.83) +0.338
[p < .001]
44.61 (7.51) 43.29 (7.89) −0.211
[p = .103]
Attendance 90.39 (8.91) 93.08 (5.69) +0.303
[p < .001]
89.06 (13.43) 90.85 (8.79) +0.134
[p = .122]
Literacy 80.19 (9.96) 82.85 (9.34) +0.267
[p = .054]
82.00 (7.78) 78.50 (9.15) −0.450
[p = .001]
Numeracy 82.74 (12.34) 87.00 (11.05) +0.345
(p = .077)
78.57 (9.89) 79.00 (10.80) 0.043
[p = .890]
S. Sloan, et al. Children and Youth Services Review 108 (2020) 104619
7
progress compared to those in smaller schools. In terms of the Peer
problems subscale of the SDQ, Nurture Group pupils in larger schools
tended to have more peer problems at post-test compared to the control
group, whereas Nurture Group pupils in smaller or medium schools
tended to have fewer peer problems compared to the control group. In
contrast, and as can also be seen, there was no evidence found of any
mediating effects for: the proportion of children at school eligible for
free school meals: the proportion of pupils with special educational
needs; or the average level of deprivation for pupils at the school.
With regards to pupil level variables, the findings are presented in a
similar format in Table 6. In this case, evidence was explored as to
whether there was any evidence to suggest that the effects of Nurture
Groups varied in relation to: a child’s gender; their age; their first
language; their levels of familial deprivation; whether they were
‘looked after’or known to social services; their special educational
needs stage; and their behaviour when entering the Nurture Group
(measured by their baseline score). Findings revealed that Nurture
Groups had similar positive effects for pupils, on average, regardless of
their individual characteristics. One exception to this was while pupils
were likely to make positive progress regardless of their baseline score,
the evidence would appear to suggest that, for most outcomes, pupils
with lower scores at baseline made more progress compared to those
with higher scores. In addition, there is perhaps some evidence to
suggest that Nurture Groups were having some differential effects for
boys and girls with a larger effect in terms of the reduction of total
difficulties for girls compared to boys. Within this, the difference ap-
pears to be explained largely in terms of gender differences in emo-
tional symptoms and peer problems.
Lastly, Nurture Group effects were explored (see Table 7). Findings
indicate that pupils made similar progress across outcomes independent
Table 4
The adjusted post-test mean scores (and standard deviations) for the intervention and control groups and their associated effect sizes for each outcome.
Outcome Adjusted post-test means
(standard deviation)
Sig. Effect size (Hedges’g)
[95% CI]
Intervention Control
Boxall Profile
Developmental Strand 110.70
(18.46)
84.04
(23.35)
< 0.001 +1.352
[+0.098, +1.728]
Diagnostic Profile 25.94
(21.97)
47.13
(27.67)
< 0.001 −0.904
[−1.251, −0.557]
Organisation of experience 58.70
(11.03)
43.74
(12.73)
< 0.001 +1.306
[+0.913, +1.708]
Internalisation of controls 52.03
(9.19)
40.40
(12.05)
< 0.001 +1.170
[+0.843, +1.497]
Self-limiting features 5.79
(4.61)
10.09
(5.66)
< 0.001 −0.882
[−1.312, −0.452]
Undeveloped behaviours 6.24
(6.46)
10.86
(7.58)
< 0.001 −0.685
[−1.002, −0.369]
Unsupported development 13.88
(13.44)
25.84
(17.70)
< 0.001 −0.821
[−1.133, −0.511]
Strength and Difficulties Questionnaire
Total difficulties 10.07
(6.05)
17.80
(5.64)
< 0.001 −1.303
[−1.696, −0.909]
Conduct Problems 1.68
(2.00)
3.09
(2.65)
< 0.001 −0.638
[−0.926, −0.350]
Emotional Symptoms 2.24
(2.15)
4.33
(2.97)
< 0.001 −0.865
[−1.242, −0.489]
Peer Problems 1.95
(2.10)
3.35
(2.12)
< 0.001 −0.663
[−1.045, −0.281]
Hyperactivity 4.15
(2.88)
7.12
(2.25)
< 0.001 −1.093
[−1.445, −0.740]
Prosocial Behaviour 7.33
(2.53)
4.92
(2.78)
< 0.001 +0.926
[+0.571, +0.1.281]
Academic outcomes
Enjoyment of School 46.54
(7.44)
42.62
(7.42)
0.002 +0.528
[+0.199, +0.857]
Attendance rate 93.02
(5.72)
91.18
(6.52)
0.101 +0.308
[−0.060, +0.675]
Literacy 87.54
(11.39)
80.74
(17.41)
0.230 +0.559
[−0.354, 1.472]
Numeracy 85.43
(12,15)
86.94
(13.70)
0.822 −0.119
[−1.154, 0.915]
Table 5
A summary of the evidence of possible differential effects of Nurture Groups in
relation to school-level mediating variables.
Outcome Mediating Variables Explored
a
School %
FSM
School %
SEN
School
deprivation
School size
Boxall Profile
Developmental 0.682 0.141 0.266 0.005
Diagnostic 0.897 0.182 0.775 0.023
Strengths and Difficulties Questionnaire
Total difficulties 0.911 0.048 0.499 0.049
Conduct Problems 0.873 0.202 0.650 0.388
Emotional Symptoms 0.580 0.051 0.495 0.181
Peer Problems 0.298 0.585 0.181 < 0.001
Hyperactivity 0.765 0.057 0.476 0.046
Prosocial Behaviour 0.664 0.864 0.627 0.990
Education-Related
Enjoyment of
School
0.529 0.572 0.878 0.959
Attendance 0.302 0.187 0.208 0.317
a
Statistical significance of interaction terms.
S. Sloan, et al. Children and Youth Services Review 108 (2020) 104619
8
of whether they attended full-time or part-time or in relation to the
length of time the Nurture Group had been running or whether it was
part of the Signature Project or an existing Group.
5. Limitations of the study and discussion
This paper has presented the findings of a non-randomised, control
group trial evaluation of the effects of Nurture Group provision on
outcomes for primary school aged children in Northern Ireland. The
study makes a significant contribution to the national and international
literature in the area, representing one of only a handful of larger-scale
non-randomised control of Nurture Group provision which, combined
with a secondary data analyses, a cost effectiveness analysis and a
process evaluation (reported elsewhere) provides one of the most de-
tailed analyses available adding to existing knowledge.
Notwithstanding the limitations to the methodology employed for this
present study, most notably the fact that the study was not a rando-
mised controlled trial and that measures employed rely on teacher
ratings, the findings would appear to be encouraging and contributing
as they do to a body of related evidence that indicates positive effects.
Moreover, the size of the effects found from this present study are re-
latively large; typically suggesting improvements of around one stan-
dard deviation across a range of developmental outcomes. Furthermore,
and unique to this present study, there is significant potential for NG
provision to benefit looked-after children in particular, given that they
tend to have the lowest developmental outcomes currently and that our
evidence suggested that NGs achieve the highest effects for those with
the lowest baseline scores.
In relation to these positive findings, four points are worthy of
further consideration. First, although our own study reports positive
effects, there remains further work required to help ascertain exactly
why and how these positive effects have occurred. All the literature on
Nurture Group provision stresses the significance of positive attach-
ments for children in a classroom setting. Within this context, the study
serves as an important reminder that attachment theory has evolved
away from an emphasis solely on the main child-carer attachment to a
consideration of children’s attachments in their wider context where it
is possible for children to experience multiple attachments with people
in different positions and relationships around them including teachers
(Bombèr, 2007; Geddes, 2006; Kennedy & Kennedy, 2004). If it is in-
deed positive attachments that make the difference, further theorisation
and exploration of these in a school context is needed. Making a notable
contribution to this is the English-based Attachment Aware Schools
programme that combined a whole-school training programme re-
garding attachment, attunement and trauma informed practice (and
associated strategies, in particular the use of Emotion Coaching) with
the testing of the effectiveness of attachment based interventions to
young children (not just those in care) including Nurture Groups and
Theraplay. Findings from the independent evaluations (Dingwall &
Sebba, 2018; 2018a; Fancourt & Sebba, 2018) and researchers involved
in the programme (Rose, McGuire-Snieckus, Gilbert, & McInnes, 2019)
indicate positive findings worthy of further research.
Second, if positive attachments can be formed in schools, the
question remains as to how specifically do they relate to improvements
in academic performance and achievements? In this present study there
was no evidence that Nurture Groups were having an effect on atten-
dance or academic outcomes compared to those attending control
schools. However, Nurture Group children did report significantly
greater enjoyment of school compared to pupils in the control group. It
is therefore plausible that improvements in academic attainment could
be more medium to longer-term outcomes of Nurture Group provision
that follow once engagement with learning and school in general is
achieved. As such, further research is required to track educational
attainment and achievement outcomes over longer periods of time.
Third, and arising from our study and related studies, is the broader
context regarding the development of secure attachments. Schools do
not operate in isolation and rather than Nurture Groups operating on a
deficit model (e.g. teachers making up for poor attachments at home),
efforts are put into practical approaches so that schools and parents can
Table 6
A summary of evidence of possible differential effects of Nurture Groups in relation to pupil-level mediating variables.
Outcome Mediating Variables Explored
a
Boys vs Girls Year group EAL Deprivation LAC Known to SS SEN Stage Baseline score
Boxall Profile
Developmental Strand 0.528 0.087 0.606 0.294 0.391 0.352 0.948 < 0.001
Diagnostic Profile 0.198 0.977 0.663 0.953 0.449 0.287 0.727 0.006
Strengths and Difficulties Questionnaire
Total Difficulties 0.013 0.528 0.990 0.928 0.360 0.979 0.929 0.118
Conduct problems 0.513 0.673 0.956 0.213 0.499 0.057 0.151 < 0.001
Emotional symptoms < 0.001 0.617 0.605 0.061 0.429 0.603 0.484 < 0.001
Peer problems 0.008 0.184 0.278 0.940 0.129 0.887 0.640 0.049
Hyperactivity 0.346 0.796 0.537 0.702 0.822 0.575 0.988 0.236
Prosocial behaviour 0.149 0.110 0.769 0.174 0.802 0.996 0.656 0.002
Education-Related
Enjoyment of School 0.563 0.834 0.508 0.811 0.354 0.259 0.096 0.146
Attendance 0.936 0.538 0.647 0.114 0.710 0.445 0.825 0.024
a
Statistical significance of interaction terms.
Table 7
A summary of evidence of possible differential effects of Nurture Groups in
relation to programme characteristics variables.
Outcome Nurture group (NG) characteristics explored
a
Full-time Years NG
running
NG size Signature Project
NG
Boxall Profile
Developmental Strand 0.605 0.859 0.275 0.874
Diagnostic Profile 0.770 0.932 0.807 0.604
Strengths and Difficulties Questionnaire
Total Difficulties 0.613 0.166 0.450 0.983
Conduct problems 0.250 0.278 0.100 0.774
Emotional symptoms 0.098 0.436 0.847 0.498
Peer problems 0.682 0.792 0.066 0.329
Hyperactivity 0.914 0.103 0.107 0.753
Prosocial behaviour 0.946 0.354 0.162 0.931
Education-Related
Enjoyment of
School
0.214 0.890 0.331 0.633
Attendance 0.500 0.588 0.644 0.349
a
Statistical significance of interaction terms.
S. Sloan, et al. Children and Youth Services Review 108 (2020) 104619
9
together build positive and strong attachments with children. One of
the relatively unexplored elements of Nurture Group provision, as
noted in the Nurture Group process evaluation that accompanied our
own study, was the importance of the relationship between the Nurture
Group teacher and teaching assistant and the parents/main carers.
Rather than keep parents at arm’s length, the Nurture Groups in our
study, proactively sought to build and nurture their relationships with
parents/main carers, spending time with them, inviting them in to
breakfast sessions and other events, to support them and to equip them
with the strategies and techniques being employed in the classroom
setting that could also be used in the family home.
The role of parent/main carer/significant other is an important and
yet relatively unexplored area. It is all the more important in the con-
text of particular groups of young children, most notably those in care.
The English NICE guidelines Children’s Attachment (NG26, NICE, 2015)
make specific recommendations regarding how best to support children
in care with attachment difficulties in schools. These include making
training on attachment available for all staffwho come into contact
with children in care; and ensuring that all staffwork together re-
garding the management of and interventions regarding the attachment
difficulties. At present, it is not clear that social workers, care givers,
educational and indeed other professionals working with children in
care have had the opportunity to: a) be made fully aware of the im-
portance of attachment theory; b) receive adequate training in the core
principles of attachment theory; c) develop a working knowledge of
school based interventions that might assist the children they are re-
sponsible for; and to d) develop a meaningful relationship with a par-
ticular school to support the delivery of an intervention. This is an area
that requires attention and it seems imperative that interdisciplinary
training (and indeed refresher training) on attachment relationships
should form part of the ‘bread and butter’of carers and/or profes-
sionals’training profiles; that there should be renewed efforts to
strengthen the daily, lived out relationships between educational,
health, social work professionals and carers and that findings from
practice developments should be made available in shared inter-
disciplinary fora. This may help prevent missed opportunities for chil-
dren in care to benefit from developments in educational practice and
will build on the work that highlights the importance of this issue and
the calls for further evidence (Fernandez, 2019).
Fourth and regarding evidence, it is the case that there are no
randomised controlled trials regarding Nurture Groups. It is noted by
Reynolds et al. (2009) that it is challenging to undertake a full trial
given the number of Nurture Groups that have been established and the
difficulties then caused in the random allocation of children to control
and intervention groups. This was certainly the case in Northern Ireland
where decisions had already been taken in relation to the provision of
existing Nurture Groups and a second round of additional Groups under
the Signature Project. The selection of such schools was already made
before the current research team were commissioned, and hence the
impossibility of applying a randomised controlled trial (RCT) design in
this present case. This, combined with the pre-determined teacher rated
measures, are limitations to the study. It is worth stressing that this
inability to use an RCT design is a significant limitation and yet it is
avoidable if commissioners and deliverers of services engage with re-
searchers at an earlier stage. In most cases, including this present one, it
would have been possible to establish a robust RCT design for the
evaluation of Nurture Groups in Northern Ireland whilst still ensuring
that the level of provision made was maintained and was still targeted
at those schools in most need. This is a critical point that has implica-
tions far beyond this present evaluation regarding the urgent need for
much better coordination and joined-up approaches between govern-
ments and service providers and independent research teams if we are
to build a strong and robust evidence-based for social and educational
interventions.
Funding
The research study was funded by Department of Education
Northern Ireland.
CRediT authorship contribution statement
Seaneen Sloan: Conceptualization, Methodology, Funding acqui-
sition, Investigation, Formal analysis, Writing - original draft. Karen
Winter: Conceptualization, Methodology, Investigation, Writing - ori-
ginal draft, Writing - review & editing. Paul Connolly:
Conceptualization, Methodology, Funding acquisition, Formal analysis,
Writing - review & editing. Aideen Gildea: Conceptualization,
Methodology, Investigation, Writing - review & editing.
Declaration of Competing Interest
The authors have no competing interests.
Appendix A. Supplementary data
Supplementary data to this article can be found online at https://
doi.org/10.1016/j.childyouth.2019.104619.
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