1. Integrated Health and Education Reviews (2-21/2 years)
March 2014
Theresa Bishop
Professional Lead for Health Visiting

2. What are the likely benefits of integrating reviews at age 2 – 2 ½?
Integrating health and education reviews could give a more complete picture of the child.
Drawing together the detailed knowledge of how the
child is learning and developing day to day at their
Early Years setting, with the expertise of the child’s
health visiting team at the health review, along with parents’ views about their child’s progress. 2

3. Aim of the Warwickshire Pilot
To examine:
The appropriateness and effectiveness of combining the integrated 2 to 2½ year health and education reviews
Effective ways of sharing information and findings between professionals
The inter-test reliability of the ASQ and ASQ S:E used by the health visiting team, the Wellcomm Language Screen and the EYFS 2 year Progress Summary
Health visitors carry out a Health Review for children between 2 – 2 ½ years as part of the Healthy Child Programme (HCP), which is the holistic universal public health programme for all children and families in the UK (DH 2009a) . The review at this stage is key for promoting speech and language; physical, social, and emotional development; as well as providing parental support and guidance (DH 2009b). While health visitors are responsible for leading and co-ordinating the 2 – 2 ½ year reviews, working closely with other services is essential for effective delivery of this programme. 3

4. Who is involved in the Pilot?
The Professional Lead for Health Visiting, the Lead Early Years Speech and Language Therapist and the Senior Officer for Quality, Workforce Development, Training and Safeguarding developed the outline of the pilot;
A Steering Group was established and consisted of key partners health and the Local Authority including Health Visitors, Community Nursery Nurses (CNN) and Early Years Practitioners (EYP) and Childminders;
We all know why age two is important – language and behaviour development is at a critical stage and it’s a time when problems can be identified.
The revised EYFS statutory framework, published in March 2012 (implemented from September 2012), places a new requirement on EYPractitioners to review a child’s progress and provide parents and carers with a written summary of the child’s development in the three prime learning and development areas of the EYFS: Personal, Social and Emotional Development; Physical Development; and Communication and Language. This two year old Progress Check is a holistic approach to reviewing a child’s development within the context of their family as well as the context of their setting. It is designed to support practitioners in identifying at an early stage a child’s development, and plan appropriate interventions to promote learning and development. Parents/ carers are active participants in the process.
As both these checks encompass reviewing the same areas of development, it is believed that joint working between the HVT and EYPractitioner would enable a better reach of children aged ½ years in Warwickshire. This way of working will also enhance integrated working, while providing parents/carers and children with holistic and more consistent, joined-up services. 4

5. Methodology
Four geographical areas were identified – two in Leamington, one in Bedworth and one in Nuneaton all based around children’s centre reach areas;
Four CNNs already familiar with using Ages and Stages were given further training in screening speech and language development and in particular using the Wellcomm Language Screen
All children eligible for the 2 to 2½ year review during 1st September 2012 to 1st December 2012 were included in the pilot (This was 174 children)
Settings are beginning to complete the Progress Checks but it’s in the early stages. Children often don’t have their assessment until they are 2-3months or 2.1/2.
Not all children are in EY settings. 5

6. Methodology cont
All the Early Years Settings in the pilot areas received a letter explaining the pilot and asking them to give parents a copy of the Progress Summary if they were asked for it;
A letter was sent to all the parents/carers outlining the pilot and its purpose;
Appointments for reviews were arranged by the Health Visiting team on an individual basis with the child and their parents/carers, in the most appropriate setting. This included the child’s home, Children’s Centres or a Health Centre;
Parents were asked to complete the Ages & Stages Questionnaire (ASQ) Ages & Stage Questionnaire Social and Emotional (ASQ:SE) prior to the review and bring it to the appointment; 6

7. The Warwickshire Approach
In Warwickshire we are using evidence from the CNN teams, Early Years Practitioners in settings and the Wellcomm Screening tool.
The Wellcomm Screening tool is an assessment tool used to monitor development of a child’s speech, language and communication. Early Years Practitioners and CNN’s have been trained to use the monitoring tool.
Data from the Ages & Stages questionnaires, Progress Summary and the Wellcomm Screening tool.
Following our meeting early this week with the DfE, who are interested in how its working in Warwickshire, we have been invited to be part of a SIG and share our process and learn from others who are operating pilots. This is great recognition of Warwickshire’s work!
Children are having 2-2.1/2 checks by HVNN’s.
Children’s Centres and Early Years settings are assessing children using the Wellcomm Screening tool for SL following a huge investment from the LA on the Time to Talk training.
Early Years setting were completing progress checks.
The pilots are gathering data from ASQ, EY progress check and Wellcomm Screening tool. 7

8. Integrated Review – Results
Number of Reviews
Number of Children – Wellcomm screen
Number of Children eligible for EYFS Progress Checks
Number of children who attend with EYFS Progress Summary
28 – Whitnash
22 complete
6 incomplete due to complex SL difficulties 20 14
52 – Bulkington 52 12 6
62 – Sydenham
60 complete
2 incomplete due to language barriers 19 5
32 – Stockingford
Total - 174 31
Total - 165 9
Total - 60 7
Total - 32

9. What went well? Not so well? Lessons learnt?
What went really well?
The Wellcomm Screening Tool as an additional assessment of the
child's speech and language development;
The EYFS summary to give a comparison of what the parents record
on the ASQ's and observations during the assessment
What didn’t go so well?
Parents not bringing the EYFS progress check – setting not
completed or child not in Early Years setting. Language barriers for
some families when using the Wellcomm;
DNAs (did not attend)
Lessons learnt?
Early years settings often assess children 3 months after entering at
2 years of age, the progress check completed after 2 year check;
To consider training for CNN’s and early years settings across all
areas of the process
Children in a setting, parent promised to post the summary - to date none received.
Training - Settings are also unsure of what we are doing in respect of 2yr ages and stages as have had no training!!
Unsure of what is needed with the pilot.
The Wellcomm is invaluable for assessing and supporting Speech and Language development.
Other issues; follow ups for children who need extra help, lack of support for SLTeams and CC capacity for Chattermatters and Family Support 9

10. Discussion Inter-test Operability:
Able to integrate the Wellcomm Screen with the ASQs when children were seen individually rather than groups;
High correlation between the EY Progress Summary and the ASQ;
Significant number of ASQs that identified child’s language skills as age appropriate but the Wellcomm Screen and the CNN’s observation identified as being delayed;
Both the Progress Summary and the ASQ were at risk of overestimating children’s language skills;
The pilot concluded that the Wellcomm Screen was an effective way of identifying children who may need additional specialist support for speech, language and communication
What is the Early Years Foundation Stage?
The Early Years Foundation Stage (EYFS) is how the Government and early years professionals describe the time in your child’s life between birth and age 5. It is a framework setting the standards for learning, development and care for children during this period. Nurseries, Pre-schools, Reception classes and Childminders must follow the legal document called the EYFS Framework which can be accessed at: E
You can ask for information about your child’s development at any time and there are two stages (the “progress check” at age 2, and again at age 5) when the professionals caring for your child must give you written information about how he or she is doing. The written summary of their progress at age 5 is called the EYFS Profile.
As a mum or dad, how can I help with my child’s learning?
All the activities that you do with your child at home are important in supporting their learning and development, and have a really long lasting effect on your child’s learning as they progress towards and through school. For example, talking, reading, singing nursery rhymes with your child or cooking and baking with them. More ideas can be found at: Even when your child is very young and is not yet able to talk, you talking to them helps them to learn and understand new words and ideas.
Parents often underestimate what they can do to support their child’s development. If you feel unsure of what to do at home to support your child’s learning, you can find out what is on offer at your local children’s centre. Many offer „messy play‟ activities which you and your child can join in, and many of the activities they provide are free. Staff can also give you advice about the kinds of books or other activities your child might enjoy at different ages. They can give you ideas on how you can help your child learn.
Where can I go for further information?
You may want to find out what is on offer at your local children’s centre. Also visit for a range of resources and contacts 10

11. Discussion cont Physical, Social, Emotional Development (PSED):
The Pilot suggested less accurate information was being given by the Early Years;
Progress Summary and that assessment of PSED by the EYPs required further development;
Other areas:
No identified means of sharing results of the review with the childcare provider;
The Early Years Progress Summary correlated well to what parents recorded on the ASQs and observations by the CNNs suggesting that these two tools provide the information needed for measuring children’s progress and the need for addition support
The joined up approach provides an holistic picture of the child’s skills. 11

12. Recommendations
The CNNs will see children on an individual basis rather than in groups;
Identifying a clear pathway for two way information sharing between the CNN and early years settings;
Further training and support for EYPs in completing the Progress Summary accurately;
The health element of the review will be carried out nearer to 2¼ to 2½ so that more children will be accessing childcare;
The use of the Wellcomm Screen to enhance the review;
Clarify which tools should be used by which practitioners and the necessary training required in order to expand the integrated review;
Increase the involvement of parents

13. NEXT STEPS Phase 2 to begin in the next few weeks;
Roll out the Wellcomm Screen to all CNNs;
Use the Wellcomm Screen as per professional judgement and/or parents or concerns;
Develop a leaflet for parents explaining the first stage of the 2.2.1/2year review which asks them to bring a copy of the Progress summary when meeting the CNNs (leaflet)
Improving communication back to the settings (post card)
Original letter to parents reworded; (new letter) (parents choice)
Awareness training for all HV teams and EYPs;
Training in the early years settings regarding the completion of the Progress Summary;
Full roll out county wide from January 2014

14. Acknowledgement and thanks to Community Nursery Nurses
Hayley McKeough
Lisa Touig
Claire Gaffoor
Lynne Reed
Without the contribution from these ladies the pilot would not have been possible. 14