Fife Early Years Collaborative Learning System & Operating Model

To make Scotland the best place in the world to grow up in by improving outcomes, and reducing inequalities, for all babies, children, mothers, fathers and families across Scotland to ensure that all children have the best start in life and are ready to succeed. Reduce Stillbirths and Infant Mortality. A reduction of 15% in the rates of stillbirths and infant mortality by % of all children have all the developmental skills and abilities expected of a month old by the end of % of all children have all the developmental skills and abilities expected at the start of primary school by the end of % of all children in each Community Planning Partnership area will have reached all of the expected developmental milestones and learning outcomes by the end of Primary 4, by end-2021

Improving early years development of children in Fife Raising educational attainment and reducing educational inequality Improving the health of Fifers and narrowing the health inequality gap Making Fife’s communities safer EYC Priorities for Fife CPP 4 Outcomes from Fife’s Community Plan

Fife EYC Execution Strategy Driver Diagram Develop high impact interventions Develop infrastructure and culture to create learning system Build capacity and capability in QI Children & families in Fife have the best start Aim Primary Drivers Secondary Drivers I Develop and share data and measurement platform Further develop leadership at all levels Integrate EYC structures with existing governance structures in children’s services Develop programme to support workforce development Leadership at all levels Develop systems to provide improvement support for key interventions Develop communication systems to share progress and priorities across all services

By 2017, 90% reach all expected primary school milestones By % of Looked After Children will have a plan for permanence within 12 months of being accommodated. By 2017, increase to 86% proportion of children categorised as healthy weight at P1 health check By 2021, 90% reach all expected P4 milestones and learning outcomes Priorities for Fife CPPKey DriversImprovement Projects Transitions Attachment & Child Development Reducing Inequalities 100% of children attending Sunflower Nursery participate in 30 minutes physical activity 3 or more times a week by June % of children in Levenmouth have the option to start on day 1 at nursery (3hours 10mins) by August % of Fife nurseries delivering one universal parenting intervention by June % Protected Places awards will be planned in conjunction with the children using the What Matters To Me engagement tool by December 2015 By August 2016, 95% of Pr. 1 children at Capshard Primary School will achieve ES in reading 90% of children at Methilhill primary school achieve their expected learning outcomes by % of children at Kirkcaldy West achieve their expected learning outcomes Early Learning 100% of children attending Sunflower Nursery participate in 30 minutes physical activity 3 or more times a week by June 2015

By 2015, reduce the rate of stillbirths to 5.9 /1000 By 2015, reduce the rate of infant mortality to 4.6 /1000 live births By 2016, 85% of children reach all expected milestones at months By 2017, 90% reach all expected primary school milestones By 2017, 41% of Looked After Children will be looked after at home or in kinship care arrangements By % of Looked After Children will have a plan for permanence within 12 months of being accommodated. By 2017, minimise the percentage of babies requiring treatment for illicit substance misuse withdrawal to 6.5% By 2017, increase to 27% children exclusively breastfeeding at 6-8 weeks By 2017, increase to 700 number of children benefiting from a risk management plan through MARAC. Early Support for Pregnancy & Beyond Parenting & Family Learning Workforce Development Priorities for Fife CPP Key DriversImprovement Projects Transitions Attachment & Child Development Reducing Inequalities Increase no of women <25 living in the Lochgelly area who have a form of contraception recorded by 10% by March Fife EYC practitioners are trained and are confident in using the MFI and other quality improvement tools to deliver change projects by December By January 2016, 90% of parents who have knowledge of the Before Words 4 key messages, will report they have adapted their interaction with their baby. 80 vulnerable families in Dunfermline with children under 3 are engaging and sustaining attendance at community groups by June % of Fife nurseries delivering one universal parenting intervention by June Increase to 50% by end of 2018 children in Fife taking Healthy Start Vitamins 100% Protected Places awards will be planned in conjunction with the children using the What Matters To Me engagement tool by December 2015 Increase breastfeeding initiation rate in D & WF CHP by 5% by December To improve avoidable repeat rates by 80% in newborn blood spot screening tests by June 2017 Leadership at all levels

Fife EYC Stretch Aims - Progress Ensure all children reach their developmental milestones at start of primary school Stretch Aim WS % End of P1 Learning Outcomes (Above or beyond expected CFE level) 93.3% End of P1 Learning Outcomes (Above or beyond expected CFE level) 90% in 2017 Ensure all children reach their developmental milestones and learning outcomes by end P4 WORKSTREAM % Learning Outcomes (Above or beyond expected CFE level) 86.9% Learning Outcomes (Above or beyond expected CFE level) 90% in 2021 Stretch Aim WS1 WS2

Building capacity & capability (2014 & 2015) Introductory training to MfI: 240 participants Bootcamp 2014/15: 7 participants Bootcamp+: 1 participants Fife QI programme: 32 participants Improvement Advisors: 2 in training

Cohort 1 (October 2014 – December 2014) S ervice & (number of participants) Cohort 2 (April 2015 – November 2015) Service & (number of participants) NHS Health Improvement (3)NHS Health Improvement (1) NHS Maternity Services (1)NHS Maternity Services (2) Early Years & Partner Support (1)Early Years & Partner Support (2) NHS Speech & Language Therapy Service (2)NHS Speech & Language Therapy Service (5) NHS Children’s Services (2)NHS Child Development Centre (3) Barnardos (1)Schools (9) Family Nurture Approach (1)Police Scotland (2) Workforce Development - Quality Improvement Mentors Programme

Fife CPP Aim - Improving the health of Fifers and narrowing the health inequality gap EYC Stretch Aim – 13 Early Learning & Childcare providers distributing Health Start Vitamins by June 2015 Health board direct vs community pharmacy distribution of children's Health Start Vitamins April 2012 – Sept 14

Phase 1: Exploring and Preparing Phase 2: Planning and Resourcing Phase 3: Implementing and Operationalising Phase 4: Business as Usual Stakeholder buy-in and champions identified Qualified team, delivery model and key responsibilities identified First time innovation into effect, on-going support, feedback Innovation mechanisms mainstreamed, fully operational, culturally embedded, outcomes evaluated Only 64% of survey respondents agreed that the EYC ‘ identifies a project structure’ (Phase 1 requirement), suggesting that many respondents were not aware of the overall structure and delivery model of the EYC Only 55% of respondents disagreed that ‘Resistance to change such as cultural barriers’ (Phase 3) were impeding development. This suggests that resistance to the EYC ethos or improvement model is still a significant barrier % Agreement with items in Phase 85% 79% 64% 39% Fife EYC carried out a progress evaluation summary between January & March 2015 to assess the planned implementation of Fife EYC against actual delivery using a National EYC implementation model. This executive summary is drawn from a larger report available on request from the authors. Fife Early Years Collaborative Progress Evaluation Executive Summary Max French PhD Researcher, University of Stirling Faye Richardson CLD Intern, University of Dundee Craig Morris Fife EYC Programme Manager Some 82% of respondents believed that there was ‘Positive ethos towards the vision of the Early Years Collaborative’ (Phase 4) suggesting a broadly held alignment in ambition Results suggest Fife EYC is currently located within Phase 3 of the national implementation model, and that significant work still lies ahead before Phase 4 is reached. Drilling down into the data reveals some aspects of Phase1 and Phase 2 which are deficient, while progress is seen in some aspects of Phase 4 (see right)

Ensure that EYC workforce understand the MFI as a tool of empowerment, not as an additional process on top of existing workload or just as a form of quality improvement. Further integration of the EYC within existing governance structures to help its spread ensure its long-term sustainability Outcomes Respondents to the survey believe the EYC is working: 78% agreed there is evidence that Fife EYC is improving outcomes for children & families Structure Structure and management in are place – those who are in the EYC know who’s who. The role of the programme manager has been seen as invaluable to many research participants Commitment There has been broad commitment from all participants to EYC goals and priorities. There is a strong will to be involved Development Workforce development opportunities have been successful in upskilling practitioners and increasing confidence in carrying out improvement work Using Tools There has been demonstrable success at both practitioner and senior levels in using ‘model for improvement’ with the right support (they must have the knowledge and not perceive it as extra paperwork) Resistance to Change Project Methodology Many survey respondents were not clear of the EYC’s project structure (they know who’s in place, but not how it’s supposed to work). Practitioners have sometimes noted that they were not aware of the ‘bigger picture’ of the EYC Co-production The role of service users as a resource and source of innovation has been important in improvement work analysed, but has not been explicit in EYC guidance or the Model for Improvement What’s working?What needs work? Recommendations Further engagement should be made with middle-management within Fife EYC to enhance and increase their knowledge of the EYC and commitment to its vision. Packages of workforce development should be continued to engage early years practitioners, including middle-managers, in the vision and methodology of the EYC For all enquiries regarding this research, please contact: Max French PhD Researcher University of Stirling Craig Morris Fife EYC Programme Manager Fife Council Resistance to change and a lack of support is still often inhibiting improvement work, particularly among practitioners. Many have complained of ‘isolation’, which can kill commitment to improvement work

Key inputs & outputs Fife EYC carried out a progress evaluation summary between January & March 2015 to assess the planned implementation of Fife EYC against actual delivery using a National EYC implementation model. Part of the recommendations & conclusions highlighted that “further integration of the EYC within existing governance structures is need to help its spread and ensure its long-term sustainability Fife EYC Key elements for integration 2015/16 1.Strategic Governance EYC Project Management Champion & Programme Mgr Project Manager Workstream Leads Data Management Away Team Home Team Improvement Support Workforce Development Strategic & Operational Workstreams & Key Change Areas Reporting & Communications Key Areas for integration 2. Improvement Support Support Appointments Project Manager Scottish Government IAs 3. Workforce Development Introduction to MFI Overview of Collaborative Specialist QI Mentors Training QI Masterclasses National IA/SCIL programmes 4. Workstreams & Key Changes WS meetings Leads Stretch Aims Key Change workshops 5. Reporting & Communications EYC Communication Plan Reporting to Scottish Govt & Local Elected Members Ongoing profile of EYC developments Strategy Groups