1.                                    of c
120%                
Early childhood experiences: Improving Transition from Home to Nursery
Toni Barker, Jacqueline Logan, Louise Lee
Rationale: Since the introduction of the new Health Visiting pathway, we found our assessments had become more robust and relationships with parents had improved. This led to a better understanding of the needs of the children on our caseloads. We were also aware that our colleagues in Early Years had very little information to plan a child's entry to nursery. This could sometimes lead to difficulties. To improve this, and address the needs of pre-school children, it was felt that relationships with our partners in Early Years required improvement. We focused on reviewing, updating and formalising the Link Health Visitor role to Early Years settings and share information to improve a child's transition from home to nursery.
Aim: 85% of children, who have enrolled in a Highland nursery and whose parents have agreed to having the child’s information shared, will have had their month wellbeing assessment handed over to Early Year’s staff prior to starting nursery, by Dec 2019.
Method
Results
The idea was shared with senior managers in the Council and a team was put together to test the project using the Model for Improvement. Training was provided through the QI network and UPQIC. We used a force field analysis and process map to plan our project. We created a driver diagram and measurement plan to help us formulate change ideas, PDSAs and measure results.
Our run charts link directly to our aim and outcome measures. This is evidence that most of the time we managed to achieve that aim. The annotations help us to understand our process and informed the next PDSA cycle.
Process Change
New template introduced for Nursery
Introduced Link HV
One HV retired
One HV on Holiday
27-30 month assessment not completed on time
No intake
Conclusions
Colleagues conclusions, transcribed quotes;
HV Merkich Nursery; “we were surprised that parents were not concerned as we were about the information sharing aspect of this - they expected us to be doing this, at this point I have had no parent not allow us to discuss their child’s needs with the nursery”
EYP Merkinch Nursery; “before we had the project it was hard, we did not know how the kids were, it is easier to organise key worker groups to benefit the child, this helped the children, able to put strategies in place before the child starts, we can get toilet training charts SALT in place etc.”
Link HV to Merkinch and Gaelic nursery; “it is reducing the weight of work. It’s spreading the need for child’s plans and things away from just before the summer holidays to throughout the year, I think that’s really beneficial”.
LINK HV to Merkinch and Tenassie nursery: “focusing on the child’s wellbeing and development and sharing this for all children reduces stigma, we are not singling out one child”. “ it’s great, my relationship with the nursery has skyrocketed, we work really well together now”
Childcare manager; “better relationship with the HV team, it is more collaborative, successful partnership give better support and transition to our families and children in Merkinch”.
Achievements
The Health Visitor relationship with nursery staff substantially improved resulting in a stronger partnership. Early Years staff report feeling better prepared to put strategies in place prior to the child starting nursery allowing for improved planning and better key worker groups. This preventative approach allowed for staged interventions to be put in place in a timely way and led to better outcomes for children. Unexpectedly, this project has improved transition from nursery to primary 1, even for children not included on the project.
Scale / Spread
Currently this project is spreading across one team of 10 Health Visitors in the west of Inverness and is being tested on a rural caseload in Tain, north of Inverness. A working group is being formed to devise a plan for scale and spread across Highland. In preparation for this, we are planning to revisit the our measurement plan and continue to test and collect data in other areas. The team are also are in talks with our Data Protection Officer to ensure the project is GDPR compliant before scaling up.
Key Learning Points
Tests show sound partnership working is key to improving outcomes for children. This works best if practitioners meet face to face and build positive working relationships. The Model for improvement and QI tools give a robust framework to facilitate change especially when challenged. It develops leadership skills and job satisfaction for those involved which spreads and motivates others
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