1. High Quality Health and Social Care Close to Home 1 Terrific 2 ’ s Gilda Lewis Health Visitor Practice Teacher

2. High Quality Health and Social Care Close to Home 2 What I ’ m going to cover Brief over view of brain development up to age 2 What that means for behaviour and why How we assess two year old development, and the tools we use What we do if we find something of concern

3. High Quality Health and Social Care Close to Home 3 An embryo’s brain produces many more neurons, or nerve cells, than it needs, then eliminates the excess

4. High Quality Health and Social Care Close to Home 4 Spontaneous bursts of electrical activity strengthen some of these connections, while other (the connections not reinforced by activity) atrophy

5. High Quality Health and Social Care Close to Home 5 The axons spin out to create connection branches between many targets

6. High Quality Health and Social Care Close to Home 6 The connections that are used most are now insulated to further speed up connections

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11. High Quality Health and Social Care Close to Home 11 Needs met Appropriate stimulation /external environmental factors Yes Reinforcing of desirable pathways Secure attachment established Concentration skills improve Learning takes place Abusive or stressful situation continues No Hyperaroused or dissociated infant Yes

12. High Quality Health and Social Care Close to Home 12 The Healthy Child Programme The Healthy Child Programme for the early life stages focuses on a universal preventative service, providing families with a programme of screening, immunisation, health and development reviews, supplemented by advice around health, wellbeing and parenting. DoH 2009

13. High Quality Health and Social Care Close to Home 13 The Healthy Child Programme HV Service delivery contacts Antenatal (targeted) 10-14 days post delivery 6-8 weeks post delivery 2,3,4,12 months and 3yrs 4 months 8-12 months 2 years Additional support as required on assessment

14. High Quality Health and Social Care Close to Home 14 The Health Visitor Implementation plan levels of service delivery Universal partnership plus Universal Universal plus Community

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17. High Quality Health and Social Care Close to Home 17 What are Ages and Stages Questionnaires? ASQs are developmental screening tools to identify infants/children in need of further assessment ASQs development is the result of careful and thorough research and response to the need for a cost-effective, highly accurate tool for screening young children. Tool developed in US

18. High Quality Health and Social Care Close to Home 18 Why use ASQ? Actively involves parents Researched for sensitivity, specificity, reliability and positive predictive values. Parent led questionnaires where parents answer a series of simple questions regarding child’s behaviour Not a pass or fail approach

19. High Quality Health and Social Care Close to Home 19 Enables assessment of child’s progress Can be done by parent or WITH parent Enables discussion regarding child’s development Enables matching of child and parent with resources

20. High Quality Health and Social Care Close to Home 20 Ages and Stages Questionnaire 1.Communication 2.Gross motor 3.Fine motor 4.Problem solving 5.Personal-social Followed by general questions regarding parental/caregiver concerns.

21. High Quality Health and Social Care Close to Home 21 Ages and Stages Questionnaire Social and Emotional 7 behavioural areas not grouped 1.Self regulation 2.Compliance 3.Communication 4.Adaptive behaviours 5.Autonomy 6.Affect 7.Interactions with people

22. High Quality Health and Social Care Close to Home 22 ASQ as a Parent Education Tool Each questionnaire discusses developmental activities tied to the age of the child being screened. In completing and reviewing the questionnaire, parents learn about general developmental milestones as well as their own child’s strengths. Parents find it helpful to receive suggested learning activities they can work on with their child. (Learning activity sheets can be photocopied from ASQ-3 User’s Guide, and more are available in the Ages & Stages Learning Activities.Ages & Stages Learning Activities

23. High Quality Health and Social Care Close to Home 23 Scoring ASQ provides a score in each developmental area ASQ: SE provides a total score LOW scores in ASQ are an indication of concern HIGH scores in ASQ:SE are an indication of concern

24. High Quality Health and Social Care Close to Home 24 High Quality Health and Social Care Close to Home

25. 25 Conclusion We now know how the brain develops from birth to three How vital this period of brain development is as a basis for future development How understanding the services for two year olds can support optimum development through working effectively together