Saving the human race – delivering health and care beyond the walls

Introductions and aims of the session – Chair, Elaine Meade• Understand key success factors from early years improvement work

• Understand how Asset Based Community Development can help focus improvement work

• Explore techniques for engaging communities and families in the improvement work

Judith Ainsley

To make Scotland the best place in the world

to grow up in by improving outcomes, and

reducing inequalities, for all babies, children,

mothers, fathers and families across Scotland

to ensure that all children have the best start in

life and are ready to succeed

Ambition

Our contextCommunity Planning Partnerships - Partners work together to achieve positive outcomes for citizens (5m)

Multi agency approach

Children from 0-8

Health inequalities

Social inequality

170,000 children live in poverty

Early Years experience has a substantial impact on outcomes

The Early Years Collaborativebeen building will & generating ideas for a while!

Brain develo-pment

Perry

Pre-School

Ed

(2004)

GIRFEC

(2004)

CMO report

(2007)

Early Years

Frame-work

(2008)

Early Interv-ention

(Allen 2010)

Joining the Dots

(2011)

Collabo-rative

(2012)

Knowing is not enough; we must applyGoethe

Early Years Collaborative

-9 months to 1 year

1 year to 30

months

30 months

to Primary school

Leadership5 – 8 years

Scotland – the best

place in the world to grow up

Stretch Aims1. Positive pregnancies which result in the birth of more healthy

babies by end 2015, through a reduction of 15% in the rates of stillbirths and infant mortality.

2. 85% of all children reached all of the expected developmental milestones at the time of the child’s 27‐30 month child health review, by end‐2016

3. 90% of all children reached all of the expected developmental milestones at the time the child starts primary school, by end‐2017

4. 90% of all children in each Community Planning Partnership area will have reached all of the expected developmental milestones and learning outcomes by the end of Primary 4, by end-2021

The story so far

• Year 1 practitioners chose tests of change and became familiar with the method

• Year 2 we identified key changes• Now have 40 Pioneer Sites • Faster learning for scale and spread• 4 Learning Sessions• Learning Session 5 on 9 and 10 June

Importance of using our Assets

• Massive change across the public sector

• Scarcity of economic resources • Health and Social Care Integration• Children and Young People’s Act• Lots of improvement activity• All working to improve things for the same children and families

Adapted from Albert Hirschman, Against Parsimony& @helenbevan

diminish grow

Economic resourcesdiminish with use• money• materials• technology

Natural resourcesgrow with use• relationships• commitment• community

Video

• ABCD in the Early Years Collaborative

• 1140 -1145• 1410 -1415

Angela Glassford – Head Teacher• ABCD – Assets Based Community development• Shared understanding of asset based work - what this looks like in

your context (values and approach)• What did we set out to achieve and why? What was the plan and how

things happened?• Sharing some of the specific ways in which we engaged with children and

their families to develop both individual and community assets (our change ideas)

• How this enabled us to deliver better health and wellbeing outcomes and experiences for the children in our locality

• How this fitted with our local priorities? The infrastructure to support it.

• How we plan to spread and sustain this approach as we move forward

• 1145-1200• 1415-1430

Early Years Strategy

• Recognised need to focus on early years

• Multiagency responses• Workshops to develop

model• Culture Change• Family Focussed Approach• £6.8 Million investment

Delivering!

Salutogenesis

Growing health and wellbeing

Locality Model• Ferguslie and Linwood (Pathfinder Areas)• Core Teams in each locality• Mapping of existing community assets• Strengthening of links between existing services, including

third sector• Integrated practice across the disciplines• Building universal services and increasing community

capacity• Targeting support in partnership with families

What do families tell us?

Someone to look at my whole family and not just judge me

Someone to look at my whole family and not just judge me

Someone to listen to me…not numerous people I have to tell the same thing to again and again

Someone to listen to me…not numerous people I have to tell the same thing to again and again

Someone to help me see what my problems are and with support, how I can solve them

Someone to help me see what my problems are and with support, how I can solve them

Someone to tell me when I’m doing well…this really worked!

Someone to tell me when I’m doing well…this really worked!

More support with mental health

More support with mental health

More time with someone helping me

More time with someone helping meContact with

others so I don’t feel alone

Contact with others so I don’t feel alone

Core Team StructureLocality Manager

Family Core Team Co-ordinator

Family Wellbeing Worker

(across both areas)

3 Family Keyworkers

Admin Worker

Evaluation criteria• Family centred• Responsive early intervention• Integrated working• Flexible delivery of services• Adding value• Minimising barriers• Scalable• Measured against shared goal setting

Giving Our Children the Best Start in Life –

A Strategy for the Early Years in Renfrewshire

John TrainerAngela Glassford

Sustain and Spread

• “It’s not what you do it’s the way that you do it.....”• Link back to families as the driver of change and

development• Outreach• Organisational change• Convert and enable• Security of funding commitment• Political will

Driver Diagrams

• 1200-1215• 1430-1445

Values

Knowledge for Improvement

Psychology

Appreciation of a system

Theory of Knowledge

Understanding Variation Knowledge for

Improvement

Subject matter Knowledge

Where in the System of Profound Knowledge are we learning?

Appreciation of a System

Understanding Variation

Theory of Knowledge Psychology

V

alues

What is a theory?

• A description of our best understanding about why things are the way they are

• Theories/beliefs in other contexts?• Economics – game theory• Biology - theory of evolution• Physics – string theory• Metereology – chaos theory• Assets Based Community Development…?

How is a theory different from a belief?

• A theory can be tested scientifically

• Theories are predictions of the outcome of future events

• Theory is the starting place for generating new knowledge

Project Driver Diagram

do

studyact

plan

What do we believe about why things are the way they are?• Evidence – what objective evidence have we collected

locally or is available to us through the relevant literature?

• Local subject matter experts – people who work at the frontline who experience the system day to day and have strong experiential beliefs about where change is needed

Some guidance on creating a driver diagram

• Start with the outcome in mind – develop an aim statement that reflects the desired future state

• Primary drivers should be nouns that reflect the key leverage points in the system of interest from three areas:

1. Structures – physical, financial, administrative, management and improvement, delegation and accountability

2. Processes – workflow of the system, how things are accomplished

3. Operating norms – written and unwritten rules that govern behaviour

Some guidance on creating a driver diagram

• Secondary drivers must be tangible things where action can be taken on the system

• Change ideas should link directly to secondary drivers and should exhibit these characteristics:

1. Specific - each change idea needs to be clear and concise and it must be obvious how its introduction is different from the status quo

2. How to - each change idea must include a statement about how and where it will be put into practice within the system

So can we use this approach today?

Table time to develop your own aim – 5 minutes

• 1215-1220• 1445-1450

TRIZChange ideas - using Triz as a mechanism to get the elephant in the room and the change ideas on the table!

• 1225-1240• 1455-1510

How could we STOP Assets Based Community Development?5 minutes table work to get ideas – be as radical as you can be!Make a list of all you can do to make sure that you achieve the worst result imaginable with respect to ABCD

From your list – cross out everything ABSOLUTELY not possible

5 minutesGo down this list item by item and ask yourselves,:• Is there anything that we are currently doing that in any way, shape, or form

resembles this item?• Be brutally honest to make a second list of all your counterproductive

activities/programmes/procedures

So what are you left with?

5 minutes – feedbackGo through the items on your second list and decide what first steps will help you stop what you know creates undesirable results• Are these your secondary drivers or change theories to

work on?

Group your change ideas at your table

feedback

Now populate the Driver Diagram

What will be different at the level of:1525125625????

SUMMARY

• Next steps• What are you going to do by next Tuesday?

• 1240-1245• 1510-1515