Edinburgh Early Years Collaborative EVOC 7th May 2015 Donna Murray Quality Improvement Officer The City of Edinburgh Council donna.murray@edinburgh.gov.uk

The Early Years Collaborative To make Scotland the best place in the world to grow up by improving outcomes and reducing inequalities to ensure all children have the best start in life. Donna Murray, EYC Programme Manager

EYC Stretch Aims Reduce rates of stillbirth and infant mortality by 2015 2. 85% of children reach their developmental milestones at the time of their 27-30 month review by 2016. 90% of children reach their developmental milestones at the start of Primary 1 by 2017. 4. 90% of children reach their developmental milestones and learning outcomes by the end of Primary 4 by 2021. Developmental milestones Vision Hearing Attention Behaviour Fine Skills Gross Skills Speech, Language and Communication Social skills Emotional Skills

Key Themes Early Support for pregnancy and beyond. Attachment and child development The 27-30 month child health review Transitions Developing parenting skills Family engagement Addressing Child Poverty Play Health and Wellbeing

Healthy Start Voucher registration at pregnancy.(1) Key Theme and Lead Green Active projects Early Support for pregnancy and beyond. Angela Dunn Healthy Start Voucher registration at pregnancy.(1) Now sharing data by post code. Tackling Money Worries (1-4) Fathers participating in a child’s plan.(1) Late Bookers (1) Attachment, child development and learning. Graham MacKenzie Bedtime stories. (3) 32 settings adopted Physical Activity in P1(4) Childhood Assessments (including 27-30 month child health review) Timing of review. (2) Completeness of review.(2) Referral patterns.(2) Information sharing/transitions Heather Gorton Temporary Accommodation(1-4) Process refined Managing OT waiting list(2-4) Moving to P1 (3) Developing parenting skills and Family Engagement to support Early Learning Maura Daly Increasing referrals and attendance to Incredible Years (3) GIRFEC HMP Edinburgh (1-4) Addressing Child Poverty John Heywood Access for 2’s with entitlement (2) Improving the Home learning environment (4) Play Margaret Westwood Health and Wellbeing Luisa Walker Total 17

Projects developing Project ideas are in Italics Key Theme Infrequent activity with irregular updates and data. Project ideas are in Italics Early Support for pregnancy and beyond. Folic Acid uptake., Alcohol in pregnancy., Midwife role in child’s plan., Late bookers, Welfare Rights. Whooping cough Attachment, child development and learning. P1 on time (4) Promoting Healthy Start Vitamins in Early Years Settings Childhood Assessments (including 27-30 month child health review) Sharing review findings with Early Years Settings , ASQ-3 completion., Exploration of process for vulnerable groups., Children where both families work., Early Years setting role in the process, Cultural Expectations Parent Knowledge of developmental milestones Information sharing/transitions Involving school nurse , LAC - Permanency , Sharing good practice in Transitions from nursery to P1 Transient populations, Identifying HV at time of registration for nursery., Parents in Prison AON in cases of DV Developing parenting skills and Family Engagement to support Early Learning Involving parents in learning (3) Attendance at Programmes , Engaging Fathers , Adult literacy , improving post programme support Working with teenage parents Addressing Child Poverty Welfare rights information.(1-4), Affordable Childcare., Promoting Healthy Start with Health visitors, Support for ‘Hardly Reached’ and living in poverty Projects developing

What we did… testing and spread Our Pioneer Site Project has been a key success Healthy Start Registration at Pregnancy 5) We kept testing – e.g. reaching new populations, support for women to complete the form, other services and beyond pregnancy…. work that continues… 5 What we did… testing and spread 4) We shared the recommendations and data with team leads, for cascade, and started visiting the other teams (May to Nov 2014). 1) We worked with one midwife to understand the process of signing a woman up for Healthy Start by week 10 of pregnancy (Mar 2014) 2) Once we had identified a simpler and faster process to sign up we surveyed other midwives in the same team, neighbouring team then the whole of Lothian (Apr – May 2014) 3) We put the lessons into a simple recommendation sheet and flow chart for pregnant women and their midwife (May 2014).

Number of pregnant women receiving vouchers by month Outcome Number of pregnant women receiving vouchers by month D Interpretation: We have now seen marked increases in sign up in East Lothian, Stewart and Tollcross, coinciding with specific focus on Healthy Start. Without data on the actual number of women eligible we cannot, however, comment on other teams. Teams with a decrease in absolute numbers have not seen a reduction in % eligible women and children in receipt of vouchers. At a Lothian level we have seen an upward trend from Mar – Sep 2014, and Dec 14 figures were higher than any point since Dec 13. This is not identified at Scotland level (downward overall). Source: Department of Health data Key: Blue arrow = survey Red arrow = team visit D = improvement in documentation S = increase in sign up

27-30 month review findings by EH postcode

Findings have helped target postcodes for improvement work

Improving Outcomes for Children in Temporary Accommodation The original aim was set in January 2014 “By December 2014, an Assessment of Need is completed by the Named Person (or delegated person acting on their behalf) for 90% of children aged 8 and under from families registering for temporary accommodation.” General Description We needed to improve our process for sharing information between housing and the named person to ensure the named person for children from families registering for temporary accommodation is formally informed of this situation in order that they can carry out an Assessment of Need. A pilot week in July 2013 led by Dr Joy Rafferty found that 7/14 children under 5 registered for temporary accommodation in one week had unmet needs. In all cases the named person was unaware of the circumstances which led the family to register for temporary accommodation and the impact this may have on the child.

Change is not easy! Data from the Early Years Collaborative Temporary Accommodation project. Children aged 0-5 years. Phase 1, 3rd Feb – 21st April, Phase 2, 28th April –14th July 2014 (additional data collected to 18th August) Phase 3, 6th Oct – Our process for sharing information between housing and Social Care Direct was not working for approximately 80% of cases

Using data for improvement moved things on! Average number of children under 5 registered for temporary accommodation Phase 1 & 2 = 20 per week Phase 3 & 4 = 11 per week

Improving Information Sharing

Improving weekly information sharing between Housing and SCD Phase 1 & 2 - 20% matched within 2 weeks Phase 4 – matched within 2 Weeks = 86%

The numbers of children being registered for temporary accommodation on more than one occasion during the project. Repeat registrations i.e. number of children who have been registered more than once. Phase 1 & 2 = 30% per week Phase 3 & 4 = 10% per week

Next steps Continue to follow to up children not matched between services. Improve the process for gathering information from Health on children received from SCD Improve the process for gathering information on date and outcome of the Child Health Assessment. Record information on the involvement of Housing when a Child Health Assessment review is required. Review the data from housing to ensure accuracy.

Revised aims By the end of June 2015 a Child Health Assessment review is carried out within 3 weeks for all children under 5 who are a new cause for concern as a result of temporary accommodation information from Social Care Direct. (Outcome) This replaces an AON for all children within 3 weeks By the end of April 2015 100% of children under 5 registered for temporary accommodation are shared with Social Care Direct.(process) We’ve achieved this for the last 4 weeks! By the end of June 2015 the number of children returned by health and matching with the Social Care Direct return within 3 weeks, increases from 48% (at the end of March 2015) to 90% (process) We’ve increased to 60%! The number of children registering for temporary accommodation does not increase as a result of this project (Balancing) Numbers have dropped from and average or 30 to 9 per week registering with housing.

Improvement Model Training day Wednesday 27th May The Faith Mission, Gilmerton. (50 places available) donna.murray@edinburgh.gov.uk