Greater Manchester Public Service Reform

Early YearsNew Delivery Model Update

June 2014

Pat McKelveyEarly Years Lead

What are we doing in Greater Manchester?

10 Local Authorities

175 Children’s Centres

12 CCG’s

855 primary schools

7 Maternity Providers

1214 Daycare providers

6 HV Provider Trusts

777.5 Health Visitors (in 2015) 37500 babies per annum

3

GM Consistent principles of reform

1. Interventions chosen on strength of evidence base2. Integrated, co-ordinated and sequenced – bespoke packages of support at

the right time, in the right order3. Family based approach to changing behaviour, not just focus on individual4. Methodology:- Define the cohort, and how they are identified- Co-design new delivery models with partners based on these three principles- Cost-benefit analysis based on modelled assumptions vs business as usual- Test examples of reform, obtain evidence- Replace modelled assumptions with actuals- Use as basis for securing investment from partners into scaling up- Decommission reactive services no longer required as we reduce demand,

reinvest some of the savings

To increase the number of children who are ready for school by making the best use of resources to improve

outcomes for all children in their early years and close the gap in performance for the Early Years

Foundation Stage Profile (EYFSP) between all children and the bottom 20%.

Early Years New Delivery Model Business Case Oct 2012

Early Years Overall Objective

• No silver bullet, most families will need a sequenced package of support, some over two years and others even longer

• Holistic approach taking the whole child within the whole family

• Integrated across sectors - health, local govt, daycare providers, voluntary providers

• Early identification of need and risk factors through timely assessments points

• Evidence-based approach to assessment and intervention

• Ensuring maximum VFM for the taxpayer

• Emphasis throughout on work and skills for both children and parents (linking with Universal Credit)

• Evaluation to inform planning and policy making

New Delivery Model Principles

New Delivery Model Components

1. A shared outcomes framework,

2. A common assessment pathway across GM

3. Evidence-based assessment tools

4. A suite of evidence-based interventions

5. Ensuring better use of daycare

6. A new workforce approach, to drive a shift in culture

7. Better data systems

8. Long-term evaluation

Outcomes - Population

Children ready to learn

Improved familyHealth & well-being

Improved economicand well being

Improved parentingskills

Children achieving a good level of development- at age 2 to 2 ½ (ASQ3/SE)

- Early Years Foundation Stage Profile

Breastfeeding rate6 to 8 weeks

Hospital emergency admissions caused by unintentional and deliberate

injuries to children

Referrals to Children’s Social Care

Secure attachment/Social and

Emotional Development KPI

Children accessing high quality

ChildcareHome Learning

Environment Index

Children living in poverty KPI

Disclosures of Domestic Abuse

Outcomes - impact

School Readiness

(incl. cognitive dev)

Behavioural/emotional

dev.

Population earnings

Population unemployment

Truancy

Exclusion

ASB

Crime

Maternal supportiveness

Early cognitive stimulation

Early development

Short term direct parental

impacts: e.g. employment,

smoking

Short term direct child

impacts: e.g. use of health services

Intervention

Mental health

Outcomes - Child

The 8 Stage Assessment

Stage 2 New Birth Visit10 – 14 days

Health VisitorNewborn Behavioural Observation

Stage 3 2 monthsHealth Visitor

(EPDS, ASQ3)

Stage 4 9 monthsHealth Visitor

(ASQ3 & ASQSE if in use)

Stage 4b Targeted 18 monthsChildren’s Centre or HV team

To identify need and promote uptake of 2 year old Early Learning Offer

(ASQ3 & ASQ SE if in use)

Stage 5 24 monthsHV & EY provider

Integrated Review/Information to be shared(ASQ3 and EYFS, ASQSE if in use)

Stage 6 On entry to Nursery (universal 3/4 year old provision)

EY Provider/School(ASQ3 and EYFS, ASQSE if in use)

Stage 7 On entry to Reception in schoolEY Provider and receiving school (ASQ3 and EYFS, ASQSE if in use)

Stage 8Early Years Foundation Stage Profile

Optional ASQ3 &/ SE (up to 5 ½ yrs of age)Undertaken by school within the last term

before the child's 5th birthday (by30/6)

Stage 1 Pre Birth

Under Review

•All points are already part of Healthy Child Programme or Early Years Foundation Stage apart from Stage 4b, which is a targeted assessment for children identified with needs at stages 2 to 4

•Assessments at Stages 2, 3 and 4 to be undertaken within the family home wherever possible

•The engagement points will be expected to be undertaken in line with the appropriate ASQ3 tool

•ASQ3 is parent led, standardised, retest reliable, and has been selected as the National measure of childhood development at 2/2 ½. EYSF is used throughout within early learning settings to measure progress.

Assessment and Outcomes tools

The Child

The Child

InContextThe Family

The Community

The Child in the Family

Assessments to cover:-

Learning and development

Evidence based tools

incl. ASQ3

Core Pathways

EIF evidence standard: criteria and ratings

Suite of Evidence Based Interventions

1. Project Team and worksgroups continue to develop details to support implementation, notably re sustainable effective workforce

2. Localities are establishing Early Adopters aiming to test the model in a ward/s

3. Exploring funding options for staged implementation of the full model , including conversations with Public Health, Schools and CCG’s re joint investment

4. High Needs Family Pathway; Pre-conception to Reception integrated pathway for families in the social care system

5. ESRC funded Baby Express Randomised Control Trial

Current Priorities

High Needs Family Pathway – Integrated Early Years, Complex Dependency, Children’s Social Care from pregnancy to school – amalgamation of best current practice140827

Lead worker in place – responsible for ensuring coordinated provision, child and family meetings and plan or Child In Need or Child protection plan

Named Health Visitor at Universal Plus level – using Solihull or Family Partnership Model

Family Nurse Partnership – assertive engagement to promote uptake for all first time young mothers with high needs

Social Care at 20wks – Pre-

Birth Assessment

Midwifery Health and Social Care/ Booking Assessment identifiedhighly Complex Social

Factors e.g. ACE- Early referral to

Children’s Social Care and Health Visiting

As Required – working together as multi-agency team around the familySpecialist Mental Health Primary Care MH & IAPT Parent Infant MH Service VIG CAMHS GP Domestic Abuse intervention

Drug & Alcohol Services Debt advice Voluntary sector services Probation Housing Police

Pregnancy Pregnancy Birth 1 year old 2 years 3 years School12 weeks to 20 weeks old old old 19 weeks onwards

School Nursing

Intensive midwifery – specialist or named midwife1:1 antenatal education as Preparing for Pregnancy, Birth and Beyond

2,3 and 4 years early learning

School transition

plan

M/A referral

hub

Work and skills within whole family

Sequence of evidence based parenting programmes promotingattunement, attachment, social,emotional, behavioural development

Perinatal parent education eg PEEP 1:1/Group

Incredible Years Baby

Incredible Years Preschool Basic

NBAS

Evidence based intensive family support model (TF)

Statutory Child in Need/Child Protection Plan

Children’s Centre targeted groups and community connections

Attachment focussed parent education eg Perinatal PEEP

or Solihull baby 1:1/Group