1. Workstream breakouts

2. Format for Workstreams sessions
Introductions at your table
Improvement Bootcamp overview and other improvement journeys
Components of a learning system – how does our work stack up?
Workstream presentations – 30 mins each including Q&A
Table top reflection on own learning and application of improvement methodology

3. The Bootcamp Experience : from this…..
So, what is bootcamp?
It is an exciting 2 day programme on Improvement Science which allows Bootcampers become immersed in deep learning about improvement science methodology
The programme covers a variety of themed topics including systems thinking, project planning, application of the model for improvement, developing measures for improvement and human factors
It is delivered by out IHI IA colleagues and EYC IAs and follow up coaching is available to ensure these newly developed improvers are able to apply the methods in their improvement work and also support others in its use.

4. The Bootcamp Experience : to this……
Spending 2 days concentrating on the Improvement Science principles and theories is a great experience,
however the real learning begins when Bootcampers return to their CPP and begin to apply the principles in their practice.
It is then that the pieces begin to fit together and the hugely valuable learning through application in practice begins.
You are going to hear from colleagues, like you, who have either been to bootcamp themselves and have been beginning to apply their new knowledge to improvement work in their practice.
We also have a few presenters in these workstream sessions who have not been to bootcamp but who have been working hard to adopt the methodology in their practice and have a learning experience to share with us.

5. Components of a Learning System
System level measures
Explicit theory or rationale for system changes
Segmentation of the population
Learn by testing changes sequentially
Use informative cases: “Act for the individual learn for the population”
Learning during scale-up and spread with a production plan to go to scale
Periodic review
People to manage and oversee the learning system
From Tom Nolan PhD, IHI
The components of learning system were covered in the plenary session – Opportunity for the big team in the room to consider the elements, reflect on the work presented and their own work in terms of components covered or not that will inform the work going forward.
IAs can you also let us know if the team in the room come up with any interventions that will inform our upcoming discussions about key changes for the EYC – ie the big ticket items that would accelerate progression towards the aims if they were done at scale. 5

6. Scottish Borders

7. SOA- Reducing Inequalities (Early Years strategy 12-15, Children and Young Peoples Service Plan 12-15, Healthy Living programme, PASPE strategy 2011)
Our children have the best start in life and are ready to succeed
% of S4 pupils with 5 awards at SCQF at level 5 or above-
52.6% difference between least and most
If we don’t put the work in now on supporting children and families to be successful this will only grow
We need to question if we are giving our children all of the opportunities that they deserve

8. Aim: To establish an assessment that enables the CPP to accurately record and plan for the developmental milestones of children on entrance into P1 by August 2014
Scottish Borders currently have no measure for children on entrance into P1 Varied measures across Scotland so when we do report we need to look at the quality of the data (apples& oranges)
Measuring children on entrance into school is perceived as creating a deficit model (how do we over come this concept, we need cultural changes)
How does this link into our local indicators? What is important for Scottish Borders?

9. Early Years Collaborative
Aim- to establish and implement an appropriate measure for Workstream 3 by December 2014
Workstream : Lead- Amanda Cronin
Primary Drivers
Secondary Drivers
Local Actions
Suitability of assessment
Education Based
Test using SOGS
Health Based
Test Using PIPs
Other Authority
Review tests and combine
Develop own
Various tests to establish the most appropriate age
Establish tests that look who should be assessed at P1
Establish appropriate
assessment for P1 entrants
Establish process
Age of Child
Profession of Assessor
Criteria for P1 assessment
Conduct tests using various professionals to conduct the assessment, HV, NN (Health) NN (Education) Staff Nurse, Nursery Teacher
Local driver to try and map out what was required to establish an appropriate measure
Have we covered all of the points need to complete a robust testing cycle,
Are we sharing this information, and does it meet the needs of children and families
Purpose of assessment
Quality assure planning
Conduct tests to review effectiveness of the 24 month plans
Establish appropriate plan for P1
Conduct tests that allow nursery teachers and partner agencies to support children in transition to school

10. Aim: To establish an assessment that enables the CPP to accurately record and plan for the developmental milestones of children on entrance into P1 by August 2014 A P S D
DATA FEEDBACK TO FRONTLINE STAFF: Compliance w PVC check
Measures
Cycle 1e:????????????
Cycle 1d:????????????
Cycle 1c:????????????????
Quick wins, cherry picked the test to get it up and running
Where do we go from here
How do we ensure we can plan for children going into school?
Cycle 1b: Ask the same HV to test a different child at the same age using SOGS who had a 24 month assessment
Cycle 1a: Ask one HV to test one child aged 50 months using the SOGS tool who had a 24 month assessment
Process Change: Implement a measure for children upon entrance into P1

11. We have built relationships
Key Wins in Presented Area of Work,
Relationships
Shared vision
Willingness to engage

12. Start together Key Lessons Learnt
We didn’t all start together people have engaged at different stages
Make sure everyone is engaged
Agree what you want to achieve
Have a shared understanding

13. Key Wins in the Area of Measurement
We have agreed to use the data 24 month assessment and extrapolate some useful data from that.
Schools are now looking at sending base line information from children who require support on entrance into school.
This is a great step forward as our schools felt the idea of a measure was not inline the principles of CFE

14. Plans for next 3-6 months Review data from 24 & 27-30 month assessment
Review driver diagram with all testers to ensure we have all elements covered
Continue cycle of testing

15. What needs to be done? Identify test and appropriate testers
Establish a robust system to measure
Secure support for implementation
Involve everyone in the design collection and understanding of the data

16. East Dunbartonshire

17. East Dunbartonshire CPP and community
Life Expectancy:
Males Females 82.7
Highest in Scotland
Average gross weekly earnings:
£549.60
3rd highest in Scotland
EDC: THE CONTEXT
If you mention ‘East Dunbartonshire’ to most people, they will think of the leafy suburb areas such as Milngavie, Bearsden and Lenzie.
Compared with other areas in Scotland, EDC has:
- the highest life expectancy for both males and females
- the third highest average gross weekly earnings
85% of residents in are owner occupiers, compared with 65% across Scotland
However, there are some areas within EDC which are quite different and don’t fit the above profile. One of these is the Hillhead area of Kirkintilloch which, according to the Scottish Index of Multiple Deprivation, is amongst the 5% most deprived areas in Scotland. Hillhead has therefore become the focus for some of the initial work of EDC’s Early Years Collaborative and we would like to tell you about two of the Hillhead projects in this short presentation.
Hillhead:
Amongst the 5% most
deprived areas in Scotland
Residents in Owner Occupied Housing: 85%
Scotland: 65%

18. Getting It Right for Every Child
Our aim
Working together to achieve the best with the people of East Dunbartonshire.
We will strive for the best possible outcomes for children, young people and their families and support the Scottish Government’s aim to make Scotland the best place in the world to grow up.
Culture change
Systems change
Practice change
Getting It Right for Every Child
The aims of the early years collaborative have been central in developing our new Early Years structure. An inter-agency approach is a the centre of our programme and we are currently enabling the change by training staff in the range of services and changes to those services which may impact children in their care.
GIRFEC provides the ‘how’ for positive change in our services. We hope that the EYC collaborative approach will help us get positive results at the frontline more quickly.
GIRFEC requires a fundamental shift in the way we work. To support this we have implemented the continuous change process of PDSA tests.
Culture change – putting children and families’ needs at the centre of planning. Increasing the links between services so that a network of support is built around the child’s needs rather than traditional departments
Systems Change – will not have direct impact on children but will enable the front line in developing more effective services
Practice change – This is the focus of today’s presentation – we want to build the capacity of our staff so that they are fully equipped to meet the stretch Aim of WS3. By up-skilling our nursery staff in the first instance we anticipate an improvement in response to concerns, communicating skilfully and working consistently across establishments

19. Key wins for Workstream 3: driver diagram
Agree a protocol for sharing the 27/30 month assessment with education and consent issues with parents.
Review and develop early years provision within EDC to meet aim of 600 hours for every pre-school child.
Ensure clear referral pathways.
Improve the quality of provision in local authority and partner providers
Implement GIRFEC policy and procedures in all early years establishments.
Societal Issues
Aim
Access To Services
Children have all the developmental skills and abilities expected at the start of primary school
Provide Stay and Play (for parents with their children) within a local authority nursery.
Improve the knowledge and skills of early years workforce on child development.
Develop a transition programme with parents, health and education for children starting nursery.
Early Learning & Play
Child’s physical & mental health and emotional development
Develop and implement common assessment of developmental milestones at the end of early years
Develop and implement support for children with ASN in all EDC early years providers.
Improve identification and support for children who require support.
Detailed Aim:
90% of all children within each CPP have reached all of the expected developmental milestones at the time the child starts primary school, by end-2017
Additional Support
Local focus from driver diagram - our first ‘win’ in terms of local progress was knowing our strategy and focus for workstream 3. Defining the key local drivers to achieve the aim made the scope of the workstream more manageable.
These aren’t the only areas we will or are working on. Instead what the driver diagram allows us to do is illustrate how and where we will focus our tests of change in the coming months. We see the driver diagram as a live document which will be reviewed and refreshed as we progress towards the stretch aim.
Carer’s physical & mental health and skills
Provide additional family information via the Play Talk Read Bus.
Provide BookBug sessions within a local authority nursery.
Families in need of parenting support within one of the local authority nurseries.
Provide parenting Provide drop in, surgery and taster sessions (based on Triple P)
Parenting skills & knowledge

20. Key wins in Child Development training programme
Wellbeing
Consistent analysis structures
Staged interventions
Emotional health & wellbeing
Experiential play
Self management skills
Thinking and involvement
Creating memories
Communication
Language rich environments
Unless each child can progress across all 8 areas of wellbeing they are unlikely to be capable of meeting their key milestones. Unless we can identify the challenges preventing achievement in the wellbeing wheel children will not be successful learners, confident individuals, effective contributors, responsible citizens.
Professional training to assess child development will result in early and more astute referrals. For those children who do not need referrals but would benefit from additional support. Structures such as the My World Triangle help guide staff in having challenging but successful conversations with families.
Raising awareness so that first contact with specialist services becomes increasingly early

21. Key wins in the area of measurement
Made strategy personal
Embedded methodology
Increased sharing of ideas & knowledge
Diverse tests of change
Child focused: Ferre Laevers
Development focused: writing, reading, nutrition
Population wide: improving attendance
EYC methodology was built into this year’s professional training programme for nursery teachers and the methodology was further integrated into daily practice by asking all nursery staff to contribute in their in-service days at the beginning of term.
GIRFEC, EY Framework and EYC have been discussed in unison –building upon the strategies that are already out there. The EYC and the work going on to ensure we meet our stretch aim has been framed in terms of ‘small changes making a difference’
Tests of change have been central to our progress but we have emphasised how powerful they can be as a way of monitoring ‘normal’ changes and recording things so that staff can refer back to them over time. Measuring and recording being a way of confirming the hunches they may already have.
Exciting and consistent training. Training session and follow up session with Alice Sharp from Experiential Play. She is very motivating and liked by front line staff – her enthusiasm helped gove the methodology the energy it needed.
We offered ideas of things which might work for guidance but the idea was to let nurseries focus on the process or child most requiring their help at the time.
Open request for tests of change (required for October holiday) encouraged creativity and resulted in far more idea and concepts to pursue
MOST IMPORTANTLY – it resulted in positive change and improvement for children identified as needing additional support

22. Lessons learned in the area of measurement
Assistance, reassurance and updates for all staff
Framing tests of change in familiar language
Examples with identified measurements
Practical and relevant ideas
Positive focus not just ‘threat
of homework’
- though sometimes a deadline provides
the impetus required
Up-skilling staff in child development using EYC methodology
Suggesting ideas but not limiting creativity

23. Key wins in frontline testing
Staff feedback from initial tests of change
“The fact that it makes you think of the things you do daily to support children in small ways – or how you develop certain areas to accommodate individual needs …take that a step further – involving parents more questioning etc. which we will most definitely do!”
“Continue to make adaptions and changes slowly and gradually, to benefit children’s and staff learning and experiences.”
“It will encourage me to look for missed opportunities in learning in my centres, particularly in interaction with children, ensuring they are challenged appropriately.”
“Picked up lots of good ideas for encouraging home links as test of change.”
“The course has made us think about our practice and how relevant it is.”
Staff show positive response to professional learning programme – great feedback from training sessions which introduced methodology and testing.
Evaluations show that frontline staff are now familiar with the methodology and understand the importance of recording and acting on our changes. Test of change concept is becoming increasingly ‘normalised’ and a high proportion of staff see the benefit of it
The initial brainstorm resulted in some great ideas which we see as having potential to scale up. Adapting and reviewing these opportunities will be our next test of change
Staff had the freedom to test and implement as they wished but there was an ultimate timeframe and bigger picture

24. Everyone assumed they were ‘doing it wrong’
Lessons learned in frontline testing
Everyone assumed they were ‘doing it wrong’
Healthy competition ‘On the spot’ conversations New concepts can worry people Ideas spark change and build momentum
Staff in “competing” nurseries enjoying the opportunity to share and learn
Sending people off with a new idea did worry them. Instead it was about highlighting what they were already doing but writing it down to share and review.
Those who aren’t naturally ‘early adopters’ may have ignored their test of change requirement until the last minute. By regular, random phone calls to 10 nurseries the momentum and urgency was maintained. Staff were reassured they had someone to talk to and bounce ideas off while becoming increasingly aware of the importance and priority placed on their work centrally.
The more we shared the less people found it unnerving. The vast majority of people thought they had ‘done it wrong’ because they tests were different.
– the more ideas were shared the more people were willing to participate. For the next round of training we have a much broader range of activities to illustrate to staff what can constitute a test of change and also what to do next be it adopt, adapt or abandon.

25. Key wins in our place approach
Through a mix of formal and informal services the provision of the ‘family room’ and ‘parent room’ in the school and nursery aims to increase the security, education and welfare of children and parents in the Hillhead community to significantly improve the lives of families
Relocating staff to where they are most needed
Building resilience through fun activities
Changing the way we work for increased efficiency
e.g. A Support for All Group
Our place approach targets the variation of experience that people across East Dunbartonshire experience. We are incorporating this work into the early years collaborative where relevant. The local nursery and school are motivated and enthusiastic which has helped us in developing specific tests of change in the area.
Services which have gone on their in the past year include: Triple P, Family cookery, games and art, Employability sessions, alcohol awareness and smoking cessation.
The mix of activities going on there and the established inter-agency working made it a prime location to focus our development of a common assessment of developmental milestones at the end of early years
Hillhead support for all group
Similar to a pupil support group
A key aim of the group is to identify needs/concerns of nursery children at the earliest opportunity and to agree a plan to meet these needs
Promote of sharing of knowledge and ideas
The group is multi-agency with contributions for all key services:
Nursery management
Nursery staff
Psychological Services
Health
Early Years Centre staff
Social Work (from November 2012)
Since this group began we have tracked and charted its attendance

26. Key wins for Workstream 3: Strengths & Difficulties
Aim: The questionnaire is intended to identify children’s readiness for learning prior to transferring to school.
Measures: Total difficulties score
Changes: Common assessment tool (SDQ) implemented at a standard time across East Dunbartonshire
Plan Do
Study
Act
Our first goal has been Defining developmental milestones. We were aware that a risk of this milestone is that without an ability to assess and measure achievement we would not be able to gauge our own progress. To address this we carried out a pilot of the Strengths and Difficulties Questionnaire in nursery in Hillhead. Ultimately analysis of this data informs interventions prior to transition to school.
Plan:
SDQ will provide an appropriate and effective way of assessing children’s achievement of their milestones
Our hypothesis is that despite the sensitive nature of this questionnaire. Most parents will be willing to share information on their child to a wider service group if it results in the most appropriate care being offered to each child.
Do: 74 children completed the questionnaire with a wide range of staff involved in its implementation and analysis.
Study: We used paper questionnaires which were inputted by HQ staff into a spread sheet for analysis – how can we use technology to speed up the process?
Can we find an alternative for our partnership nurseries (who don’t use SEEMIS)?
We have already arranged training, but what level of uptake should we expect?
Original nursery was engaged and enthusiastic, what can we expect elsewhere?
Act:
Does this data answer the question?
Scaling up from a pilot
Practicalities of systems
Involving partners and sharing our findings
Transforming data into timely information
Using SEEMIS in all out schools for practical collation of information. Creating a template to enable nurseries who are not on SEEMIS
Group set up to establish protocols and training. Next test of change is to carry out a pilot with the nurseries involved in this group only.
Develop an implementation and training programme to enable broader roll-out

27. Key wins for Workstream 3: Strengths & Difficulties
Strengths and Difficulties Questionnaire (June 2013 pilot)
The Strength and Difficulties questionnaire identifies children who are likely to experience problems within each of the domains and on the Total Difficulties scale.
In the chart we have reversed the numbers to calculate the percentage of children who are not likely to have problems. We think this is a more positive approach to take and, in the context of Stretch Aim 3, we believe it gives us an indication of the percentage of children who have reached their developmental milestones.
In terms of Total Difficulties, 96.6% of females and 88.4% of males (overall 91.7% of the EDC sample) were identified as not likely to experience problems.
The Strengths and Difficulties questionnaire has been used in Glasgow, where it identified 93.8% of children likely to experience problems.
The Questionnaire has also been used in a national sample, but were are still endeavoring to track down the percentage of children identified in that sample as likely to experience problems.

28. Key wins for Workstream 3: Strengths & Difficulties
Staff feedback from the pilot
“It has made me stop and think about whether he is ready for school - socially and emotionally I mean”
The universal approach to carrying out the questionnaire “means that children who are ‘invisible’ won’t get missed”
The collaborative approach taken to completing the pilot was noted as being particularly important in providing a richness of data –
“different members of staff see children differently so this [completing the SDQ collaboratively] helps to get a picture of the whole child”.
Key wins so far:
This pilot although small has given us some indicative data to progress workstream 3 and provided an opportunity to study and act before our larger roll out.
The introduction of the questionnaire for all children provides a structure upon which staff can focus conversations with parents and carers.
Staff feedback includes:
The collaborative approach taken to completing the pilot was noted as being particularly important in providing a richness of data, with- “different members of staff see children differently so this [completing the SDQ collaboratively] helps to get a picture of the whole child”.
Carrying out the questionnaire with all children offers universal access to psychological services which had not previously been available.

29. Plans for next 3-6 months
Professional development driving methodology uptake
Positive behavioural strategies
Protocols - Looked after children
Emotional Health & Wellbeing
Acting on initial tests of change
Healthy eating: Thumbs up / Thumbs down
Outdoor play: Time out numbers
Communication: Leuven Wellbeing scale
Singing Time & Parental Involvement
Writing Register: Identifying one’s name
Implementing the Strengths and Difficulties Questionnaire & transition programme
In the coming months we will continue to integrate the methodology of the EYC into our staff development programme. The culture change we are striving towards has small continuous change at its heart. At each point that we engage with our staff we are highlighting the potential impact each small alteration can have on the success of a child.
Professional development driving methodology uptake
Positive behavioural strategies
Protocols - Looked after children
Emotional Health & Wellbeing
Implementing the Strengths and Difficulties Questionnaire
Guidance for nurseries December
Training in January
Implementation in February
Continued up-skill of staff
Formal training
Informal local information sharing – newsletters and pooling ideas
Acting on feedback to provide specific development requirements e.g. Ferre Laevers training
Acting on initial tests of change. Current ideas to pursued include:
Healthy eating: Thumbs up / Thumbs down
Outdoor play: Time out numbers
Communication: Leuven Wellbeing scale
Singing Time & Parental Involvement
Writing Register: Identifying one’s name

30. TABLE DISCUSSION
Who are individuals and/or teams currently working on in this area? Are they currently using Quality Improvement methods/PDSA cycles to guide their learning?
Reflecting on the emerging knowledge within this area, and today’s plenary session on scaling up your work, what are some considerations you need to plan for to get to scale for your project?