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What is the impact of out-of-home integrated care and education settings on children aged 0-6 and their parents? Summary


This report looks at research that assesses the impact of out-of-home integrated care and education settings on children aged from birth to six.

Integration is currently a topical issue in the field of early childhood provision, but there is considerable confusion about how and why integration should be pursued, and what works in what contexts. Arguments for integration include:

  • the benefits to children of receiving consistent care and education in the same place and at the same time, rather than the disruption of moving between different provisions;
  • the benefits to parents of the comparative simplicity of these arrangements;
  • the cost-effectiveness of single provision.

In many European countries, it is conceptually problematic to present the care and education of young children as separate because they are simply not distinguished from each other. It might be more appropriate to represent integration of care and education as a continuum, with the UK, where childcare and education have been treated as distinct in policy and in practice, representing one extreme. Childcare in the UK, where it exists, has been 'wrapped around' a standard two-and-a-half hour education offer for 3-4 year- olds. Attempts are now being made to change this situation, and to offer 'integrated' provision in 'children's centres'. However, 'integration' is an umbrella term that encompasses many different meanings. It may refer only to different types of services working alongside one another, in adjacent spaces, loosely co-ordinated, but without any fundamental change of approach; or it may mean a coherent service equally accessible to all potential users, with a common costing, staffing, health, pedagogic and curricular framework for all provision. It may also mean combining care and health provision, rather than care and education provision. These are the issues that this review set out to clarify.

We therefore adopted a minimalistic, pragmatic approach for the review. We defined 'care' as offering six hours a day or more of care for children - in other words, longer than a full school day and long enough to offer employed mothers an opportunity to have their childcare needs met or partly met. We defined 'education' as a system that followed an agreed publicly-stated curriculum. Unless it was clear from the context (i.e. the country in which the research took place), we required that the care and education contents were stated according to these definitions, in all research studies to be included in our review.


The core group of researchers included academics and practitioners in care and education. This was supplemented by another group which included a wider range of academics and practitioners, who were consulted at various stages in the procedure: formulating the research question; writing the protocol; and writing the draft report.

Initial work concentrated on development of definitional statements, inclusion/ exclusion criteria and extensions to the EPPI Centre keywords. Integrated education was defined as institutional; open for at least six hours a day, five days a week; and with a formally agreed curricular framework and delivery of activities. A table was developed of types of provision in different countries to assist in determining whether provision was integrated, where this was not explicitly stated.

Other inclusion criteria were as follows: the study must be aimed at children aged six or under; the study must be evaluative; the study must be published after 1974; the study must be written in Bengali, Dutch, English, French, German or Spanish; and the study must not be a thesis. A search strategy was developed, based around the combination of a range of words related to education, with a range related to care. Major databases, websites and library catalogues were searched using this strategy.

The abstracts were scanned to make an initial decision about whether they met the inclusion criteria. Those where determination was positive or unclear were obtained, and where they still met the criteria on examination of the documents, they were keyworded using the EPPI and review-specific keywords.

Following this exercise, a map of relevant literature was produced. Literature at this point had not been restricted by study type and the map included reviews and primary studies. These studies measured effects on outcomes and/or processes for a range of stakeholders. It was decided that the in-depth review question should be, 'What is the impact of out-of-home integrated care and education settings on children aged 0-6 and their parents?'. Further criteria were developed for the in-depth review in addition to the ones mentioned above. These were that the study should evaluate effects on outcomes for children or parents; be a primary study and not a review, and report on provision starting before age five. Most importantly, the criteria referred to quality of reporting. Studies were required to state the aims of the research unambiguously, give details about data-collection, sampling and recruitment methods and describe the study's sample. Data-extraction was undertaken using EPPI Reviewer and EPPI Centre Guidelines for assessing the weight of evidence attached to each study were followed.

The decision to make the review international and wide-ranging caused significant problems. Firstly, keywording criteria were difficult to apply consistently because of the considerable difference in provision across the countries. It was often difficult to predict from the name of the setting what sort of service was being provided. More detailed work in this area resulted in some articles being excluded from the map. Secondly, comparisons across countries caused problems at the data-extraction stage. Sampling frames, measures and tests were very different. This also highlighted the insularity of much of the research. Researchers often assumed that the circumstances of the setting in their country would automatically be known and did not need to be specified.


The map described 133 reports: 33 were reviews; the rest were evaluative reports describing 63 studies. Much of the research literature in this area reports only on the processes of implementation. Fewer studies report on outcomes for children or parents. Nine studies were selected for the in-depth review. The contexts of these nine studies varied widely: they covered six countries - France, Israel, Korea, Norway, Sweden and the United States - and a range of social groups. Two studies targeted low income multi-problem families, two focused mainly on middle-class families, and others drew on mixed social groups. Research methods also varied: the reports included retrospective, prospective and longitudinal studies. Three studies used comparison groups and two used random allocation to these groups.

Despite the use of quality criteria when screening studies for inclusion in the in-depth review, the nine studies varied significantly in the quality of research and reporting. Using the EPPI weight of evidence system, five were rated medium or medium-high, and none were rated high. Two of the studies were assessed as contributing low weight of evidence because of inadequate reporting of methods.


The review was originally intended to address a topical policy issue in the UK, that is the research evidence on the impact on children and their parents of the integration of care and education in the early years. The Government's focus on integration is relatively new and there are no UK studies that directly consider the issue of the integration of education with childcare for the children of working parents. Although we consider that our findings are relevant to the current UK policy debate, none of the studies we have included for in-depth review were carried out in the UK.

Most of the research literature is framed within one of three particular approaches: the effects of day care on children and their mothers; the effects of various kinds of educational curricula; and the effects of intervention on multi-risk families. We only selected for in-depth review those studies that clearly indicated that children received both care (i.e. for more than six hours a day) and education, whatever the particular research framework.

Although all seven studies rated as reliable found that, broadly speaking, the impact of integrated care and education was beneficial for children, especially children from multi-risk families, and that early age of entry to such provision was advantageous, there are considerable difficulties in generalising across settings. These can be described as follows:

  • The effect of the research framework. The emphasis of the study - on day care, type of curriculum or intervention in multi-risk families - led to a focus on different kinds of results.
  • The effect of type of setting. The Scandinavian and French studies were reporting on well-established systems of early education and care operating under standard conditions, such as training of teachers and childcare workers; in the American and Korean studies, the provision was established for the purposes of the study and might not be easily replicable; the Israeli study investigated a kibbutz, which has unique characteristics. The types of setting were so different that any comparisons across countries can only be very general indeed.
  • The range of study designs, observations and tests. Teacher and parent assessments of children's social competence are likely to rely on local norms and expectations, such as expectations of competency and skills, and variations in school starting age. The studies also used different kinds of measures of impact, some of which, such as IQ, were standard, but others were country-specific. There must, therefore, be concerns about comparability of outcome measures across countries.

Policy recommendations

It is difficult to make unequivocal policy recommendations about the integration of care and education for young children, given the wide variety of settings across countries and the different frameworks within which research in this area has been carried out. There are prior judgements to be made about the types of services offered to young children, about entitlement, cost and quality. It is most likely that integrated childcare and education benefits children and their parents, in particular their mothers; but the evidence does not address the wider issues of setting up such provision - access, staffing, costs and other issues involved in the development of new services.

Research recommendations

This review has highlighted the need for UK research that directly addresses integration issues, given that it is a policy priority. Although our in-depth studies indicated that integrated settings benefited children, this finding is qualified by reference to the country in which the research took place, and in particular by questions of access. Results for countries with universal provision (for example, Nordic countries) cannot be directly compared with results from highly targeted provision for children from multi-problem families (as in the US).

The review highlights the extent to which the issue of integration of childcare and education is under-researched, and the need for policy to be more securely grounded in the research evidence. The review methodology also raises the question of standards of research and research publications in the field. If evidence is to be closely scrutinised, it must be well reported. Details of sampling, test measures, data-collection and analysis need to be clearly set out, for inadequacy in any of these areas might affect outcomes. Much of the research we reviewed, however promising in scope, was very weak in this respect.

Even if the results were not as conclusive as we had hoped, clarifying the issues and highlighting the gaps has been an essential step.

This report should be cited as: Penn H, Barreau S, Butterworth L, Lloyd E, Moyles J, Potter S, Sayeed R (2004) What is the impact of out-of-home integrated care and education settings on children aged 0-6 and their parents? In: Research Evidence in Education Library. London: EPPI Centre, Social Science Research Unit, Institute of Education, University of London. 

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