Workstream breakouts

Format for Workstreams sessions• Introductions at your table• Improvement Bootcamp overview and other

improvement journeys• Components of a learning system – how does our

work stack up?• Workstream presentations – 30 mins each including

Q&A• Table top reflection on own learning and application

of improvement methodology

The Bootcamp Experience : from this…..

The Bootcamp Experience : to this……

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

Scottish Borders

SOA- Reducing Inequalities(Early Years strategy 12-15, Children and Young Peoples Service Plan 12-15, Healthy Living

programme, PASPE strategy 2011)

65.4

12.8

40.5National average

36.6

Least deprived areas Scottish Borders Most deprived areas

Our children have the best start in life and are ready to succeed

% of S4 pupils with 5 awards at SCQF at level 5 or above-

Aim: To establish an assessment that enables the CPP to accurately record and plan for the developmental milestones of children on entrance into P1by August 2014

Early Years CollaborativeAim- to establish and implement an appropriate measure for Workstream 3 by December 2014

Secondary DriversPrimary Drivers Local Actions

Suitability of assessment

Establish process

Purpose of assessment

Education Based

Establish appropriate assessment for P1 entrants

Health Based

Other Authority

Develop own

Age of Child

Profession of Assessor

Criteria for P1 assessment

Test using SOGS

Test Using PIPs

Review tests and combine

Various tests to establish the most appropriate age

Establish tests that look who should be assessed at P1

Conduct tests using various professionals to conduct the assessment, HV, NN (Health) NN (Education) Staff Nurse, Nursery Teacher

Conduct tests to review effectiveness of the 24 month plans

Quality assure 27-30 planning

Establish appropriate plan for P1

Conduct tests that allow nursery teachers and partner agencies to support children in transition to school

Workstream : Lead- Amanda Cronin

Aim: To establish an assessment that enables the CPP to accurately record and plan for the developmental milestones of children on entrance

into P1by August 2014

A P

S D

APS

D

A PS D

D SP A

DATA

FEEDBACK TO

FRONTLINE

STAFF:

Complia

nce w

PVC check

D SP A

Cycle 1a: Ask one HV to test one child aged 50 months using the SOGS tool who had a 24 month assessment

Cycle 1c:????????????????

Cycle 1e:????????????

Cycle 1d:????????????

Cycle 1b: Ask the same HV to test a different child at the same age using SOGS who had a 24 month assessment

Process Change: Implement a measure for children upon entrance into P1

Measures

We have built relationships

Start together

Plans for next 3-6 months

• Review data from 24 & 27-30 month assessment

• Review driver diagram with all testers to ensure we have all elements covered

• Continue cycle of testing

- Identify test and appropriate testers- Establish a robust system to measure- Secure support for implementation - Involve everyone in the design collection and

understanding of the data

What needs to be done?

East Dunbartonshire

East Dunbartonshire CPP and community

Life Expectancy:Males 79.4 Females 82.7Highest in Scotland

Residents in Owner Occupied Housing: 85%Scotland: 65%

Average gross weekly earnings:£549.603rd highest in Scotland

Hillhead:Amongst the 5% mostdeprived areas in Scotland

Our aim

Working together to achieve the best with the people of East Dunbartonshire.

We will strive for the best possible outcomes for children, young people and their families and support the Scottish Government’s aim

to make Scotland the best place in the world to grow up.

Culture changeSystems changePractice change

Getting It Right for Every Child

Key wins for Workstream 3: driver diagram

Children have all the developmental skills and abilities expected at the start of primary school

Societal Issues

Child’s physical & mental health and emotional developmentDetailed 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

Early Learning & Play

Aim

Access To Services

Carer’s physical & mental health and skills Parenting skills

& knowledge

Additional Support

• Agree a protocol for sharing the 27/30 month assessment with education and consent issues with parents.

• Review and develop early years provision within EDC to meet aim of 600 hours for every pre-school child.

• Ensure clear referral pathways.• Improve the quality of provision in local authority and

partner providers• Implement GIRFEC policy and procedures in all early

years establishments.

• Provide Stay and Play (for parents with their children) within a local authority nursery.

• Improve the knowledge and skills of early years workforce on child development.

• Develop a transition programme with parents, health and education for children starting nursery.

• Develop and implement common assessment of developmental milestones at the end of early years

• Develop and implement support for children with ASN in all EDC early years providers.

• Improve identification and support for children who require support.

• Provide additional family information via the Play Talk Read Bus.

• Provide BookBug sessions within a local authority nursery.

• Families in need of parenting support within one of the local authority nurseries.

• Provide parenting Provide drop in, surgery and taster sessions (based on Triple P)

Wellbeing Consistent analysis structures Staged interventionsEmotional health & wellbeing

Experiential playSelf management skillsThinking and involvementCreating memories

CommunicationLanguage rich environments

Key wins in Child Development training programme

Made strategy personal

Embedded methodology

Increased sharing of ideas & knowledge

Diverse tests of changeChild focused: Ferre Laevers

Development focused: writing, reading, nutritionPopulation wide: improving attendance

Key wins in the area of measurement

Assistance, reassurance and updates for all staff

Framing tests of change in familiar language

Examples with identified measurements

Practical and relevant ideas

Positive focus not just ‘threat of homework’

- though sometimes a deadline provides

the impetus required

Lessons learned in the area of measurement

Key wins in frontline testing Staff feedback from initial tests of change

“The fact that it makes you think of the things you do daily to support children in small ways – or how you develop certain areas to accommodate individual needs …take that a step further – involving parents more questioning etc. which we will most definitely do!”

“Continue to make adaptions and changes slowly and gradually, to benefit children’s and staff learning and experiences.”

“Picked up lots of good ideas for encouraging home links as test of change.”

“The course has made us think about our practice and how relevant it is.”

“It will encourage me to look for missed opportunities in learning in my centres, particularly in interaction with children, ensuring they are challenged appropriately.”

Healthy competition

‘On the spot’ conversations

New concepts can worry people

Ideas spark change and build momentum

Lessons learned in frontline testing

Everyone assumed they were ‘doing it wrong’

Key wins in our place approach

Through a mix of formal and informal services the provision of the ‘family room’ and ‘parent room’ in the school and nursery aims to

increase the security, education and welfare of children and parents in the Hillhead community to significantly improve the lives of

families

Relocating staff to where they are most neededBuilding resilience through fun activities Changing the way we work for increased efficiency

e.g. A Support for All Group

Key wins for Workstream 3: Strengths & DifficultiesAim: The questionnaire is intended to identify children’s readiness for learning prior to transferring to school.

Measures: Total difficulties score

Changes: Common assessment tool (SDQ) implemented at a standard time across East Dunbartonshire

Plan

Do

Study

Act

Key wins for Workstream 3: Strengths & DifficultiesStrengths and Difficulties Questionnaire (June 2013 pilot)

EDC Sample Female (n=29)

EDC Sample Male (n=43)

All EDC Sample (n=72)

Glasgow (n=4142)84%

86%

88%

90%

92%

94%

96%

98%

Total difficulties: Percentage of pre-school children without likely problems

Key wins for Workstream 3: Strengths & DifficultiesStaff feedback from the pilot

“It has made me stop and think about whether he is ready for school - socially and emotionally I mean”

The universal approach to carrying out the questionnaire “means that children who are ‘invisible’ won’t get missed”

The collaborative approach taken to completing the pilot was noted as being particularly important in providing a richness of data –“different members of staff see children differently so this [completing the SDQ collaboratively] helps to get a picture of the whole child”.

Professional development driving methodology uptakePositive behavioural strategiesProtocols - Looked after childrenEmotional Health & Wellbeing

Acting on initial tests of change Healthy eating: Thumbs up / Thumbs downOutdoor play: Time out numbersCommunication: Leuven Wellbeing scaleSinging Time & Parental InvolvementWriting Register: Identifying one’s name

Implementing the Strengths and Difficulties Questionnaire & transition programme

Plans for next 3-6 months

TABLE DISCUSSION• Who are individuals and/or teams currently

working on in this area? Are they currently using Quality Improvement methods/PDSA cycles to guide their learning?

• Reflecting on the emerging knowledge within this area, and today’s plenary session on scaling up your work, what are some considerations you need to plan for to get to scale for your project?