From standalone services to stacked interventions: describing the uptake of multiple early years interventions in the Born in Bradford’s Better Start (BiBBS) interventional birth cohort

Early childhood experiences significantly impact lifelong health and educational attainment, yet inequalities in early childhood outcomes remain entrenched. There is growing evidence that standalone interventions are unable to act as a ‘silver bullet’ to resolving the complex causes of these inequalities, and that the necessary solution is to deliver combinations (‘stacks’) of interventions that successfully address the multiple causes of inequalities. This study describes the pattern of uptake across nine universal early years interventions delivered through the A Better Start programme in Bradford. Using linkage to routinely collected data from each of the interventions, the Born in Bradford’s Better Start (BiBBS) interventional birth cohort is able to track enrolment into these interventions for 5,697 pregnancies. Nearly one-third (n = 1789, 31%) of the cohort did not enrol in any universal interventions, n = 2293 (40%) engaged with only one, and n = 1609 (29%) enrolled in two or more. Whilst enrolment in more than one intervention was relatively uncommon, there were sufficient sample sizes across a number of intervention patterns, a relatively small proportion (n = 264, 5%) of the cohort received interventions across all three domains. This presents opportunities for future evaluation, potentially providing sufficient sample sizes for target trial emulation of several ‘stacked’ interventions. This study provides a vital first step for evaluating the cumulative impact of early years support in BiBBS, offering a pathway to move beyond ‘scattered’ approaches and effectively address entrenched childhood inequalities. However, these findings also highlight that these universal services operated independently, revealing a lack of systematic integration in service delivery.