Donna MurrayQuality Improvement Officer The City of Edinburgh Councildonna.murray@edinburgh.gov.uk

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

1. 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.

3. 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.

• 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

Key Theme and Lead GreenActive 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 adoptedPhysical Activity in P1(4)

Childhood Assessments (including 27-30 month child health review)Graham MacKenzie

Timing of review. (2)Completeness of review.(2)Referral patterns.(2)Now sharing data by post code.

Information sharing/transitionsHeather Gorton

Temporary Accommodation(1-4)Process refinedManaging OT waiting list(2-4)Moving to P1 (3)

Developing parenting skills and Family Engagement to support Early LearningMaura Daly

Increasing referrals and attendance to Incredible Years (3)GIRFEC HMP Edinburgh (1-4)

Addressing Child PovertyJohn Heywood

Access for 2’s with entitlement (2)Tackling Money Worries (1-4)Improving the Home learning environment (4)

PlayMargaret WestwoodHealth and WellbeingLuisa Walker

Total 17

Projects developingKey ThemeInfrequent 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 ExpectationsParent Knowledge of developmental milestones

Information sharing/transitions

Involving school nurse , LAC - Permanency , Sharing good practice in Transitions from nursery to P1Transient populations, Identifying HV at time of registration for nursery., Parents in PrisonAON 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

What we did… testing and

spread

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)

4) We shared the recommendations and data with team leads, for cascade, and started visiting the other teams (May to Nov 2014).

3) We put the lessons into a simple recommendation sheet and flow chart for pregnant women and their midwife (May 2014).

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

Our Pioneer Site Project has been a key success Healthy Start Registration at Pregnancy

Number of pregnant women receiving vouchers by month

Source: Department of Health data

Key: Blue arrow = survey Red arrow = team visitD = improvement in documentationS = increase in sign up

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).

D

Outcome

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 DescriptionWe 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

Edinburgh Early Years Collaborative

PDSA Cycle Number 1 (of Phase 4 of the project)

Date_9th January 2015

Key Change Theme ____Temporary Accommodation

Project Aim_By June 2015 an Assessment of Need is completed for all children under 5 registered for temporary accommodation

Relevant EYC Stretch Aims 1 2 3 4

CHANGE IDEA: Share information on the number and details of children not matched between H-SCD & SCD-H within 3 weeks.

? Will sharing this info highlight any issues with the new process?

PREDICTION: The agreed contacts will be able to identify why the children have not matched in the returns within 3 weeks.

Ask NP contact to include the Health Visitor name in the return and also include if a child’s details have been passed to FNP

Emailed H& SCD with details of the 3 children not matched within 3 weeks.

Emailed SCD&NP contact with details of the 3 children (different children) not matched within 3 weeks. Requested they find out why this might be.

Total 6 children

Return form SCD identified 2/3 children had different initials due to middle initial being included or wrong initial being returned. Return from NP contact identified 2/3 children had been sent to FNP so not included in the return. Both SCD and NP were unable to locate their respective 3rd child. Therefore the reason why 2/6 children were not match was not found. It is possible the D.O.B for these children was incorrect.

Edinburgh Early Years Collaborative

PDSA Cycle Number 2 (of Phase 4 of the project)

Date_9th January 2015

Key Change Theme ____Temporary Accommodation

Project Aim_By June 2015 an Assessment of Need is completed for all children under 5 registered for temporary accommodation

Relevant EYC Stretch Aims 1 2 3 4

CHANGE IDEA: Ask NP contact to include the Health Visitor name in the return and also include if a child’s details have been passed to FNP

? Will inclusion of the HV name make it easier to trace any children not matched between SCD-NP.

PREDICTION: The return from NP will include HV names.

Email the Health contact separately and attach the form. Request that she uses this in the weekly returns from now on.

Sent out the usual email request for weekly updates and included a reminder in the email that the returns form had a request for the HV name.

The health return did not use the updated form. Therefore the HV name was not included. 2/4 children on the return were not matched with Housing or SCD, so it will be difficult but not impossible to trace them. Perhaps prompting the health contact within a generic email did not highlight the need to include the HV name enough.

Edinburgh Early Years Collaborative

PDSA Cycle Number 3 (of Phase 4 of the project)

Date_19th January 2015

Key Change Theme ____Temporary Accommodation

Project Aim_By June 2015 an Assessment of Need is completed for all children under 5 registered for temporary accommodation

Relevant EYC Stretch Aims 1 2 3 4

CHANGE IDEA: Email the Health contact separately and attach the form. Request that she uses this in the weekly returns from now on.

? Will the individual prompt lead the Health contact to include the HV name in following requests?

PREDICTION: Yes

Create an additional record sheet for the health contact to return. This will include the Record of Assessment of Need completed by a Health Visitor as a result of receiving information that the child is registered for temporary accommodation. Aim to match these with the health returns within 3 weeks.

Email request sent to health contact with request that HV name be included in returns from w/b 26th Jan onwards.

HV name included on the return received on 26th. This will help as we follow up cases. Time between health receiving and being able to complete the AON can vary due to several factors e.g. HV is unable to contact the parent to arrange a visit. Suspect more AONs are being completed than records show, but we are not receiving the information on these due to timing.

Edinburgh Early Years Collaborative

PDSA Cycle Number 4 (of Phase 4 of the project)

Date_26th January 2015

Key Change Theme ____Temporary Accommodation

Project Aim_By June 2015 an Assessment of Need is completed for all children under 5 registered for temporary accommodation

Relevant EYC Stretch Aims 1 2 3 4

CHANGE IDEA: Provide health contact with a sheet to record information on AONs as a result of receiving information that a child is registered for temporary accommodation

? Will this information match the health returns within 3 weeks to provide confirmation of the AON’s

PREDICTION: 50% of the children on the health return will have an AON confirmed within 3 weeks

Send the sheet again along with a telephone call to the HV contact to explain verbally the purpose of the AON return.

Sent the sheet via email.

The sheet was returned along with the usual health return. It contained the same AON information as the usual return, so learned nothing new. Should probably have made it clearer that the AON sheet was for AON’s completed for children HV had been notified as in temporary accommodation, but the HV had not completed the AON yet for various reasons.

•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 aims1. 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

2. 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!

3. 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%!

4. 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.

Wednesday 27th May The Faith Mission,

Gilmerton. (50 places available)

donna.murray@edinburgh.gov.uk