2. Workstream 5 Breakout Session Understanding your Workstream and Priority Tests of Change Early Years Collaborative Learning Session Three – Day 2

3. We’ve been building will & generating ideas for a while  Dr Bruce Perry – neuroscience and brain development  EPPE Study –- 2004  GIRFEC - 2004  CMO’s report - 2007  Early Years Framework - 2008  The Foundation Years - Frank Field – 2010  Early Intervention - Graham Allen – 2010  Scottish Government economic modelling (Nov 2010)  Joining the Dots – Report from Professor Susan Deacon (March 2011)

4. Components of a Learning System 1.System level measures 2.Explicit theory or rationale for system changes 3.Segmentation of the population 4.Learn by testing changes sequentially 5.Use informative cases: “Act for the individual learn for the population” 6.Learning during scale-up and spread with a production plan to go to scale 7.Periodic review 8.People to manage and oversee the learning system From Tom Nolan PhD, IHI

5. Breakout Objectives Build a common understanding of the current theory of what drives the overall aim for this Workstream; Identify where on the Driver Diagram your work is having an impact. Identify and prioritize drivers by areas of highest impact at a local level Reflect on the assets within your community that can help you achieve greater impact in prioritised areas Develop a proposal for Tests of Change to be shared with your CPP.

6. How we will spend our time …… Refresh on Driver Diagram theory and presentation of current theory for Workstream 5 Review and Reflect on Workstream 5 Driver Diagram Identification of which Drivers you have the biggest impact on Development of a proposed Test of Change to share with CPP.

7. Conceptual Driver Diagram Outcome 1 ⁰ driver 2 ⁰ driver Specific Change Ideas Aim or Outcome 1 ⁰ driver 1 1 ⁰ driver 2 2 ⁰ driver 3 2 ⁰ driver 2 2 ⁰ driver 1 2 ⁰ driver 4 2 ⁰ driver 5 Ideas: 1 2 3 4 5 6 7 8 9. N Outcome Measure(s) Process Measure(s) Local Process Measure(s)

8. 8 Understanding Our Theory: Early Years Workstream Diagrams

9. Reduce infant mortality Social Issues Post-birth actions Pre-birth maternal health Maternal smoking Improved sharing of information Improved management of care Increase referrals Improved identification Aim 1⁰1⁰ 2⁰2⁰ Theory of what actions will reduce infant mortality Detailed Aim: To reduce by 15% the rates of stillbirth & infant mortality by 2015 Maternal drinking Maternal misuse of drugs Health Increase rate of breastfed babies Quicker diagnoses of Neonatal Abstinence Syndrome Poverty Housing Domestic Abuse & Violence Maternal Obesity Maternal mental health Attachment Improved stability / permanence for LAC Improved uptake of benefits Improved planning Improved family centred response Improved leadership & culture Improved teamwork, communication and collaboration Parenting skills Identification & reasons for current resilience WORKSTREAM 1 (conception to 1 year) Theory of what drivers infant mortality

10. Children have all the developmental skills and abilities expected of a 27- 30 month year old Social Issues Child’s physical and mental activity Maternal health and skills Mother’s level of education Improved sharing of information Improved management of care Increase referrals Improved identification Detailed Aim: 85% of all children within each CPP have reached all of the expected developmental milestones at the time of the child’s 27-30 month child health review by end-2016 Parental misuse of drugs Health Increase child’s dental health Improving child nutrition Poverty Housing Domestic Abuse & Violence Parental obesity Maternal mental health Attachment Improved stability / permanence for LAC Improved uptake of benefits Improved planning Improved family centred response Improved leadership & culture Improved teamwork, communication and collaboration Improving brain stimulation and physical play Parental misuse of drinking Parenting skills WORKSTREAM 2 (1 year to 30 months) Identification & reasons for current resilience Aim 1⁰1⁰ 2⁰2⁰ Theory of what drivers developmental milestones Theory of what actions will ensure developmental milestones are reached

11. Children have all the developmental skills and abilities expected at the start of primary school Social Issues Child’s physical and mental activity Maternal health and skills Mother’s level of education Improved sharing of information Improved management of care Increase referrals Improved identification 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 Parental misuse of drugs Health Increase child’s dental health Improving child nutrition Poverty Housing Domestic Abuse & Violence Parental obesity Maternal mental health Attachment Improved stability / permanence for LAC Improved uptake of benefits Improved planning Improved family centred response Improved leadership & culture Improved teamwork, communication and collaboration Improving brain stimulation and physical play Parental misuse of drinking Early Learning Parenting skills WORKSTREAM 3 (30 months to start of primary school) Identification & reasons for current resilience Aim 1⁰1⁰ 2⁰2⁰ Theory of what drivers developmental milestones Theory of what actions will ensure developmental milestones are reached at the start of primary school

12. WORKSTREAM 5 WORKSTREAM 5

13. Review of DD and Reflection Step One: Take a few minutes to review the driver diagram and discuss with the person next to you. Step Two: Discuss the driver diagram with your table mates using the following prompts: 1. Yes, I’m glad this was included …… 2. I would add…. 3. I don’t understand …..

14. If you have a question while at your table… Raise your GREEN CARD for Improvement Science- related questions Raise your YELLOW CARD for Early Years Content- related questions Raise your BLUE CARD for logistics questions (e.g., Can we have a few more marker pens, please?) All Worksheets will be collected after the session! Don’t Forget!

15. Report Out to the Room “What did you learn that came as a surprise to you?”

16. Prioritization and Inventory of Assets

17. Step One: Using the worksheet and driver diagram identify which of the drivers you are currently working on and identify the top 3 where you feel you can have the most impact. Step Two: For these areas of highest impact, reflect on the community assets that can help you have maximum impact. You can work alone or team up with others on this exercise, however everyone need to complete the worksheet.

18. Creating a Test of Change Using your number 1 area of highest impact, reflect on the tests you could run that could make that work even more impactful and record on the worksheet. You can use this to share your proposed test of change with your CPP.

19. Report out to the Room What intervention are your currently working on, and what is your test of change? Keep all report-outs to a “twitter update” (1-2 sentences!)

20. Thanks for a great session! Transition to CPP Planning Session (Coffee available to take with you!)

21. A NEW HEALTHIER ME!! CALORIES IN CALORIES OUT Limit daily intake Substitute low calorie Limit alcohol Exercise Fidgeting Driver diagram for a new healthier me! Tests of change Secondary drivers Primary drivers Aim Track calories Plan meals Drink water not coke Gym 5 x per week Cycle to work Chi balls