National Early Years Conference Edinburgh Conference Centre Heriot Watt Campus October 2010

Key findings from evaluation

REFERRALS 217 first time mums referred 52% postnatal and 48% antenatal 31 clients have successfully completed the programme 64% of the mums referred have and continue to fully engage

Key Findings- Impact Programme is performing well and has potential to meet outcomes First Steps is having a positive impact for ante-natal and post-natal clients. Specifically: Ante-natal –Healthy eating –Physical activity Post natal –Parenting skills –Confidence in interacting and supporting development –Confidence to care for the baby –Positive feelings towards the baby

Key Findings - The referral process Majority of referrals to the programme are young women (aged 21 and under) The majority of referrals are appropriate to programme criteria Concern that some women who could benefit are excluded by eligibility criteria Ante natal referrals are low –Mothers value support at ante-natal stage

Key Findings - Assessment & Action Planning Clients report that assessment process straight forward and not intrusive When should first assessment take place? –Takes time to establish a trusting relationship –Initial scores can be false But –Essential that activities tailored to client needs Clients often do not perceive benefits of the assessment/ action planning process

Key Findings- Assessment & Action Planning Continue to refine approach to setting and measuring goals. Action plans should be SMART (Specific, Measurable, Achievable, Realistic and Timely) Evidence that assessments and action plans are not always shared with partner agencies Some benefits are not captured by assessment tools e.g. confidence and self esteem / advocacy

Key Findings- Activities Most clients receive a weekly/ fortnightly visit – between an hour and a few hours depending on activity. Possibility of more intensive support in early stages? Activities tailored to needs of the client High satisfaction among clients with intensity/ nature of support Advocacy and emotional support highly valued by mothers

Key Findings- Activities FSWs role in promoting activities to mothers is valued – mothers report that they would not be aware of activities without First Steps. Concern that some become dependant. Workers should monitor and encourage mothers to try things on their own between visits.

Key Findings- Partnership working Public Health Teams –Relationship developing well –Regular informal dialogue about shared clients –FSW often attend PHN team meetings –PHNs value support of FSWs – they are able to work intensively with clients and provide support on issues outside of PHN remit –Relationship could be enhanced by more formal joint reviews of client progress

Key Findings- Partnership working Social work teams –Initial concern of duplication and too many agencies involved –But FSWs seen as valuable contribution to the team –Regular informal communication - primary communication through PHNs –FSWs have encouraged vulnerable mothers to access Family Centres

Key Findings- Partnership working Midwifery teams –Integration with midwifery teams less advanced than with PHNs. Perhaps most significant challenge in first year –Lack of referrals –Evidence that scope of First Steps support is not always well explained to eligible mothers –Priority area going forward

Key Findings- Areas for development Little evidence of impact in relation to smoking cessation Lack of ante-natal referrals therefore little opportunity to impact on breastfeeding

AREAS FOR IMPROVEMENT

1.Increase numbers of ante-natal referrals and engagement 2.Review and fine tune data collection 3.Build evidence base on vulnerable clients excluded 4.Assessment process 5.Client action planning 6.Engagement with other locally available services 7.Continuing professional development 8.Monitoring outcomes data 9.Sustainability 10.Caseload management 11.Cost benefit analysis

Recommendations 1.Increase numbers of ante-natal referrals and engagement Key findings –46% of referrals were ante-natal –39% referred at ante-natal stage are engaging Actions –Programme manager and implementation group to progress relationships –FSW work with midwives to identify reasons for non-engagement –Programme manager to seek agreement for FSWs to attend midwifery team meetings on regular basis

Recommendations 2.Review and fine tune data collection Key findings –There are currently gaps in the database –Unclear whether data is not collected or is collected but not in the format required Actions –GEN to identify current gaps and meet with Programme Manager and database developer to fine tune database

Recommendations 3.Build evidence base on vulnerable clients excluded by datazone or number of children Key findings –PHNs, Midwives, and FSWs report that current criteria is excluding clients who could benefit –Eligibility criteria cannot be changed in current funding period –By gathering evidence during 2010 Implementation Group in stronger position to consider different criteria going forward Actions –Midwives/ PHNs basic information for all clients they would refer regardless of eligibility. –This will be captured in database

Recommendations 4.Carry out initial review within 2 weeks of joining the programme Key findings –Some challenges completing initial review because FSWs need time to establish relationship –BUT It is important that ensure that activities are guided by formal assessment of need rather then assumptions Actions –Complete assessment within 2weeks –Where possible and appropriate increase number of visits during this period to establish relationship –At second review (6weeks after initial assessment) include questions about position prior to joining –This should be captured on the data base

Recommendations 5.Greater emphasis on action plans as a means of focussing clients on their objectives Key findings –When prompted clients were aware of action plans but they are not currently a tool that clients and FSWs use to guide activities and set goals for clients between visits Actions –FSWs should ensure that clients keeps a copy of action plan –Action plan should be referred to on each visit to discuss progress –Action plan should be presented to client as a working document

Recommendations 6.Greater emphasis on encouraging and supporting clients to engage in locally available services Key findings –FSWs are identifying local activities for clients and often attend with them at first –Clients often do not continue with the activities after their first visit –For sustainable outcomes is it important to develop and maintain networks of support Actions –Where clients do not enjoy the activity FSWs should continue to explore alternatives until something suitable is found –Where issue is confidence, workers should continue to attend until the client has developed the confidence to go alone and also undertake other activities

Recommendations 7.Review and maintain ongoing continuing professional development of FSWs Key findings –Ongoing training and development is a strength of the programme –Areas to consider for ongoing training include (Child Protection, Baby Massage, Drugs and Alcohol, Counselling and delivery of challenging health promotion messages Actions –Programme Manager and Implementation Group to continue to review training needs and invest in workers

Recommendations 8.Monitor outcomes data every two months Key findings –Programme impacting positively on clients health and parenting behaviours –More success against some outcomes than others but absence of data at present Actions –Data should be reviewed at team meetings every two months, challenging outcomes can be discussed and actions agreed to improve achievement on these

Recommendations 9.Explore options for future sustainability Key findings –Emphasis on early intervention at the national level – First Steps can clearly contribute to this agenda Actions –Scope for First Steps to contribute to research evidence base –Dialogue around potential mainstreaming and the search for additional funding should begin now –This will be taken forward by the Implementation Group

Recommendations 10. Alter database to record number of actively engaging clients, and ensure that FSWs have sufficient referrals to be working with 15 actively engaged clients at all times Key findings –While almost all workers operating at of slightly about the agreed maximum (15 clients) a number of these are not actively engaging Actions –Programme should aim for caseload of 15 actively engaging clients –Database to be updated to allow programme manager to review number of actively engaging clients –Definition of ‘actively engaging’ clients to be agreed between programme manager and FSWs –Work with PHNs/ Midwifery teams to maintain sufficient referrals

Recommendations 11. Consider revising the current outcome measures to capture the impact of advocacy work carried out by FSWs Key findings –Practical advocacy support is valued by clients –Support with these issues reduces stress and other barriers to engagement in healthy lifestyles –These benefits are not captured at the moment Actions –Implementation Group to review outcomes