People Group

Integrated Health and Education Reviews (2-21/2 years)

March 2014Theresa Bishop

Professional Lead for Health Visiting

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What are the likely benefits of integrating reviews at age 2 – 2

½?• Integrating health and education reviews could give a more

complete picture of the child. Drawing together the detailed knowledge of how

the child is learning and developing day to day at

their Early Years setting, with the expertise of the

child’s health visiting team at the health review, along

with parents’ views about their child’s progress.

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Aim of the Warwickshire Pilot

To examine:

The appropriateness and effectiveness of combining the integrated 2 to 2½ year health and education reviews

Effective ways of sharing information and findings between professionals

The inter-test reliability of the ASQ and ASQ S:E used by the health visiting team, the Wellcomm Language Screen and the EYFS 2 year Progress Summary

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Who is involved in the Pilot?

The Professional Lead for Health Visiting, the Lead Early Years Speech and Language Therapist and the Senior Officer for Quality, Workforce Development, Training and Safeguarding developed the outline of the pilot;

A Steering Group was established and consisted of key partners health and the Local Authority including Health Visitors, Community Nursery Nurses (CNN) and Early Years Practitioners (EYP) and Childminders;

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Methodology Four geographical areas were identified – two in

Leamington, one in Bedworth and one in Nuneaton all based around children’s centre reach areas;

Four CNNs already familiar with using Ages and Stages were given further training in screening speech and language development and in particular using the Wellcomm Language Screen

All children eligible for the 2 to 2½ year review during 1st September 2012 to 1st December 2012 were included in the pilot (This was 174 children)

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Methodology cont All the Early Years Settings in the pilot areas received a letter

explaining the pilot and asking them to give parents a copy of the Progress Summary if they were asked for it;

A letter was sent to all the parents/carers outlining the pilot and its purpose;

Appointments for reviews were arranged by the Health Visiting team on an individual basis with the child and their parents/carers, in the most appropriate setting. This included the child’s home, Children’s Centres or a Health Centre;

Parents were asked to complete the Ages & Stages Questionnaire (ASQ) Ages & Stage Questionnaire Social and Emotional (ASQ:SE) prior to the review and bring it to the appointment;

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The Warwickshire Approach

In Warwickshire we are using evidence from the CNN teams, Early Years Practitioners in settings and the Wellcomm Screening tool.

The Wellcomm Screening tool is an assessment tool used to monitor development of a child’s speech, language and communication. Early Years Practitioners and CNN’s have been trained to use the monitoring tool.

Data from the Ages & Stages questionnaires, Progress Summary and the Wellcomm Screening tool.

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Integrated Review – ResultsNumber of Reviews Number of Children –

Wellcomm screenNumber of Children eligible for EYFS Progress Checks

Number of children who attend with EYFS Progress Summary

28 – Whitnash 22 complete6 incomplete due to complex SL difficulties

20 14

52 – Bulkington 52 12 6

62 – Sydenham 60 complete2 incomplete due to language barriers

19 5

32 – Stockingford

Total - 174

31

Total - 165

9

Total - 60

7

Total - 32

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What went well? Not so well?Lessons learnt?

What went really well?The Wellcomm Screening Tool as an additional assessment of the child's speech and language development;The EYFS summary to give a comparison of what the parents record on the ASQ's and observations during the assessmentWhat didn’t go so well?Parents not bringing the EYFS progress check – setting not completed or child not in Early Years setting. Language barriers for some families when using the Wellcomm;DNAs (did not attend) Lessons learnt? Early years settings often assess children 3 months after entering at 2 years of age, the progress check completed after 2 year check;To consider training for CNN’s and early years settings across all areas of the process

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DiscussionInter-test Operability: Able to integrate the Wellcomm Screen with the ASQs when

children were seen individually rather than groups; High correlation between the EY Progress Summary and the

ASQ; Significant number of ASQs that identified child’s language

skills as age appropriate but the Wellcomm Screen and the CNN’s observation identified as being delayed;

Both the Progress Summary and the ASQ were at risk of overestimating children’s language skills;

The pilot concluded that the Wellcomm Screen was an effective way of identifying children who may need additional specialist support for speech, language and communication

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Discussion contPhysical, Social, Emotional Development (PSED):

The Pilot suggested less accurate information was being given by the Early Years;

Progress Summary and that assessment of PSED by the EYPs required further development;

Other areas:

No identified means of sharing results of the review with the childcare provider;

The Early Years Progress Summary correlated well to what parents recorded on the ASQs and observations by the CNNs suggesting that these two tools provide the information needed for measuring children’s progress and the need for addition support

The joined up approach provides an holistic picture of the child’s skills.

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Recommendations The CNNs will see children on an individual basis rather

than in groups; Identifying a clear pathway for two way information sharing

between the CNN and early years settings; Further training and support for EYPs in completing the

Progress Summary accurately; The health element of the review will be carried out nearer

to 2¼ to 2½ so that more children will be accessing childcare;

The use of the Wellcomm Screen to enhance the review; Clarify which tools should be used by which practitioners

and the necessary training required in order to expand the integrated review;

Increase the involvement of parents

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NEXT STEPS Phase 2 to begin in the next few weeks; Roll out the Wellcomm Screen to all CNNs; Use the Wellcomm Screen as per professional judgement and/or

parents or concerns; Develop a leaflet for parents explaining the first stage of the

2.2.1/2year review which asks them to bring a copy of the Progress summary when meeting the CNNs (leaflet)

Improving communication back to the settings (post card) Original letter to parents reworded; (new letter) (parents choice) Awareness training for all HV teams and EYPs; Training in the early years settings regarding the completion of the

Progress Summary; Full roll out county wide from January 2014

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Acknowledgement and thanks to Community

Nursery NursesHayley McKeough

Lisa TouigClaire GaffoorLynne Reed