Several Midlands community schemes to help poor families are potential models for the government's pre-school Sure Start scheme. Pat Healy examines their impact

A community worker is diverting children in one of Birmingham's poorer neighbourhoods by putting them through a quiz. There are lots of questions about sport, television and pop stars.

Preparing them for pub quizzes in later life? 'University Challenge,' the community worker retorts. That response reflects the increasing confidence in the potential of children and parents in an area which until recently was notorious for drugs and prostitution.

The quiz is taking place in a council flat, previously the home of a local drugs dealer and now a community resource for a wide range of activities.

Its roots lie in an initiative by local mothers who wanted to clean up their streets on the Benmore estate, which has a high proportion of isolated single mothers, widespread poverty, depressive illness and high infant mortality and morbidity rates.

'Every day, I was going out and the streets were littered with condoms and needles,' says Gloria Dillion. 'I have three daughters and it was not good for them to grow up in that kind of atmosphere.'

Gloria started as a volunteer worker at the flat but is now on the staff, her salary funded by Birmingham health authority. She says: 'Each day things are getting better, but I won't rest until we have got rid of all the drugs and prostitutes.'

The project, in which health visitors are employed by Southern Birmingham Community trust, is one of several pioneering ways of improving the lives of poor families which could prove to be models for the government's Sure Start programme.

Public health minister Tessa Jowell, who ran a carers' programme in Birmingham before becoming an MP, visited many of the projects before the launch of the scheme. Nationally, it is intended to cover 125,000 socially disadvantaged pre-school children and their families through a network of 250 centres which may be based on existing health centres, clinics or schools.

Sylvia Fry, the trust's nursing director and community manager, is convinced that the various family support groups piloted in Birmingham fit in neatly with the government's intentions.

'We are looking for long-term benefits, not a short-term fix,' she says.

Already there are indications of health gain from the Benmore project. Depressive illness is down, more parents have found work, children sleep better - and the improved confidence of previously isolated mothers has led many to demand - and get - better housing away from the estate.

The community flat, a simple, two-bedroom unit, hosts a range of activities from mother and toddler groups, a credit union, welfare advice, and drop- in facilities to night patrols of the area by local people donning fluorescent jackets.

A giant cheque from the West Midlands police authority is prominently displayed on the wall of the room that serves as an office.

Mrs Fry has her eye on a disused local pub, closed because of its reputation as a centre of illegal drugs activity, as a new and more spacious venue for the expanding range of community flat activities.

It would be a fitting denouement for a project which, as health visitor Jacqueline Charlton puts it, has succeeded to the extent that 'people don't feel frightened any more'.

The Benmore project is very much a 'bottom-up' scheme, where local residents have determined what happens.

In Sparkbrook, a more assertive outreach approach has been used to target Asian first-time mothers, who often come to Britain for arranged marriages with little knowledge of English or the culture of their new country.

They have little awareness, either, of the health service and how it can be used. They may also be inhibited for cultural reasons from seeking help.

The aim is to provide a culturally sensitive health-visiting service to give women the information they need to care appropriately for their children and themselves. The initial pilot proved so successful that the HA has now given it mainstream funding.

Women are visited at home before giving birth to be told about the project and taken through a questionnaire. Once the baby is born, they are visited each week to establish feeding patterns, and then have monthly visits until the baby's first birthday. Meanwhile, they are invited to a monthly antenatal support group at a local health clinic to discuss any topic they want. Popular issues include diet, breastfeeding, housing and benefits.

Asian link workers work with the women by offering information about a range of issues, including nutrition, health, language and the development of children as well as the health and well-being of mothers.

They encourage the women to use the information to decide for themselves how to bring up their babies.

The programme encourages mothers to breastfeed and then wean their babies on to 'family food' rather than commercial foods. This helps them to establish healthier eating habits for their own children than is likely to happen otherwise.

One woman says she can make direct comparisons with her own relatives. She gives her son 'meals' rather than snacks or bottle-feeds and has experienced no problems with establishing feeding and sleeping routines.

But her relatives, who automatically respond to a baby's cry with a bottle, find their children are fussy about food and take longer to be weaned on to normal Asian family food. They also have problems putting their children to bed, she thinks because they are hungry.

This woman comes to the support group at the centre 'just to talk to someone', a rare experience because 'not many people talk about problems in my country'. She is now studying for a BA degree in humanities.

Another young mother, who arrived from Pakistan with no knowledge about pregnancy and childbirth, is now passing the information she receives through the project back to relatives and friends at home.

The health centre itself is encouraging. Only a few years old, it is attractively and sensitively designed for its users. Nobody can tell that an Asian woman is receiving family-planning advice, for example, while the creche enables mothers to discuss personal problems out of their children's hearing.

It is a culturally safe place to go - and husbands are happy to come, too. The centre also offers courses in English as a second language, an example of the inter-agency co-operation that backs the project.

Some women attending may become recruits for a new community parents project aimed at enabling ethnic minority women to work in the health and social care fields through a one-year training course at a local college.

Due to start in September, the course aims at training 20 women a year, who will receive a training allowance, childcare and travel costs through a grant from the European Social Fund.

The course is seen as vital to improve the public health of the target group in particular and the Sparkbrook population in general. Life expectancy here is 12.4 years less than in nearby Sutton Coldfield, and the area shows all the signs of inner-city deprivation, including high accident rates.

Unemployment among black women is high at 14 per cent, and they neither enter the professions nor go to university. The community parents' course is intended to train 20 people a year to become a 'para professional' in the health and social care professions with a recognised NVQ certificate.

Sheila Fry says 20 women a year may seem like a drop in the ocean, but there is an incalculable ripple effect as they become more confident, acquire new skills and take on roles they would not have contemplated before.

The public health implications of empowering women in this way are immense.

Isolated mothers are also being targeted through the 'Lifesteps' programme based in a GP practice in the leafier avenues of Longbridge in outer Birmingham and run by health visitors Jennifer Menzies and Clare Edwards.

They are offered a free 32-week modular course, run in term time and during school hours, with free childcare thrown in. They can learn about the importance of play to child development, food hygiene, first aid and behavioural management.

At the end of the course they get recognised educational certificates which can help their chance of getting a job or lead on to other courses.

Ms Menzies says the programme has brought college teachers into a community clinic to provide mothers with accessible education which would not have been available to them otherwise. And it has achieved health-promotion goals, too.

One young woman says becoming a mother led to a loss of confidence. By coming to the course she realised that she still has the skills to get through a job interview when she is ready.

A mother of four, now 36 and anxious to return to work but not to her old job in a shop, she has completed modules on behaviour, first aid, food hygiene, play and managing illness.

She is now starting an A-level in psychology as the next step towards her new ambition to go into occupational therapy. She is fulfilling one of the key aims of the project - to encourage mothers to work in health or social care.

A new course starts in September and is already oversubscribed, with parents asking for courses on subjects such as car maintenance and DIY. Grandparents want to join the first aid course.

It may seem a long way from mainstream health service activity, but all the family-support projects bring together professionals from different disciplines, in line with health secretary Frank Dobson's mantra about removing 'Berlin walls'.

Sylvia Fry says developing multi-agency projects makes sense, not just for managers and finance directors, but for service users. 'People have needs which have to be met. They don't care if it is health or social services or education or employment that provides it, just so long as their need is met.'

About Sure Start

Sure Start is a 540m initiative over three years to tackle social exclusion affecting young children and their families.

Funded through a Children's Fund, it will aim to reach 5 per cent of newborns to three-year-olds, starting with 100m in 1999-2000, and a further 220m in each of the following two years.

Its aims are to ensure that children are 'healthy, confident and ready to learn when they reach school'.

Building on existing services, the project promises a visit from an outreach worker within three months of a baby's birth to allow an assessment of their needs and to provide advice and support for parents.

The programme will focus on pre-school children and the families who face the greatest problems and live in areas of disadvantage. Services will be free to those on low incomes and 'at a reasonable cost' to better- off families.