1.1GM Early Years New Delivery Model

Version: 1

Review Date: February 2015

Contents

1. Introduction

1.1GM Early Years New Delivery Model

The crucial period for child development is from conception to age three. Our work is focused on promoting all opportunities to ensure that parents have the knowledge and support to enable their children to have the best possible start in life. The consequences of a poor start can be permanent, limiting children’s lifetime potential.

The Greater Manchester Early Years New Delivery Model has been developed to ensure all our children in Greater Manchester have the opportunity to achieve their full potential. This will be achieved through a preventative and early intervention approach that focuses on the ‘whole family’. There are eight key components of the New Delivery Model;-

1. A shared outcomes framework, of population indicators and individual child measures, across all local partners;
2. An eight stagecommon assessment pathway across GM: eight common assessment points for an integrated (‘whole child’ and ‘whole family’) assessment at key points in the crucial developmental window, building on existing assessment points, with the remaining Healthy Child Programme visits to continue as standard;
3. Evidence-based assessment tools have been selected to identify families reaching thresholds for intervention or having multiple risk factors as early as possible; Needs assessment triggers referral into an appropriate evidence-based pathway;
4. A suite of evidence-based interventions has been identified, which alongside other public service interventions forms a package of transformational support to families. Areas are able to ‘top up’ the suite of interventions with additional services according to local circumstances;
5. Ensuring better use of early learning /daycare: new ‘contract’ with parents eligible for targeted twos early learning entitlement to drive engagement in education/ employment/ training/ volunteering, and introducing new common principles to support all early years settings, notably supporting them to work with parents to promote home learning
6. A new workforce approach, to drive a shift in culture: enabling frontline professionals to work in a more integrated way in support of the ‘whole family’ and with other services to collectively reduce dependency and empower parents;
7. Better data systems to ensure the lead professional undertaking each assessment has access to the relevant data to see the whole picture, to reduce duplication and confusion and to track children’s progress;
8. Long-term evaluation to ensure families’ needs are being addressed and add to national evidence for effective early intervention.

1.2The 8 Stage Assessment Pathway

This approach is underpinned by the GM 8 Stage Assessment Pathway(see below), undertaking child development assessments at regular intervals across all Early Years Services. In practice, however, the assessment will cover parental need too, as part of the whole family approach recognising the significant impact that parental behaviours and the family circumstances have on child development. If parents are empowered and enabled to care for their children and help them learn and achieve at school, this will help to reduce dependency on the State.

1.3What is the SARA?

TheStandard Assessment and Reporting Arrangements (SARA) contain details on how assessments are undertaken at each of the 8 Stages within the Greater Manchester model.

This document has been produced by health visiting, midwifery and local authority representatives from across the ten GM local authorities. The document is available from the following website:

The purpose of the document is to promote the consistency of assessment practice across GM and to secure accuracy and reliability of the data collected and submitted both to the LA and to GM.

The SARA applies to Midwives; Health Visitors and any early years practitioners who are required to undertake ASQ assessments as part of their local programme.

All information containedin this guidance document is correct at the time of print but subject to change. Any changes will be communicated to the local early years implementation groups.

This document should be used in conjunction with the Ages and Stages Questionnaire Third Edition (ASQ-3) and Ages and Stages Questionnaire Social and Emotional (ASQ-SE)manuals[1] and local competency and standard operating procedures.

1.4Concerns and complaints

It is the responsibility of service providers to follow up complaints about assessments undertaken by their employees. Employers must ensure guidelines, training, supervision and audit are in place to quality assure the assessments undertaken by their employees.

Feedback about the GM New Delivery Model, the 8 Stage Pathway or the GM Early Adopter Dataset should be raised with the Public Service Reform Team via:

• Ben Tomlinson, Project ManagerEarly Years Theme

Tel: 0161 245 7507 | Email:

• Pat McKelvey, Early Years Theme Lead

Tel: 0161 245 7522 | Email:

1. Responsibilities

All professionals responsible for completing and reporting assessments at any stage should refer to this document.

The SARA provides information on the responsibilities of professionals and organisations involved in completing and reporting in line with the 8 Stage Model.

2.1Midwifery and Health Visiting Services

• Clinical Lead and General Manager are responsible for ensuring that the GM protocols and standards are adhered to and consistently applied within Midwifery and Health Visiting Service and that the Midwives and health visiting teams have the necessary resources and equipment to deliver GM Model.
• Midwifery and Health Visiting Team Leads are responsible for ensuring that all staff have the necessary training, skills and experience to undertake the relevant reviews and will support staff to achieve this; and
• Midwifery and Health Visiting Practitioners are responsible for delivering the relevant reviews according to the GM standards and protocols.

All practitioners should record any actions, concerns, follow-up appointments. Reviews and referrals agreed with the parent/care giver must be documented in the child’s record (in accordance with the relevant organisational guidelines) including Safeguarding.

2.2Early Years Foundation Stage Settings

• Head teachers/Early Years Managers are responsible for ensuring that all Early Years Practitioners have the necessary training, skills and experience to undertake the relevant review in line with the model and will support staff to achieve this; and
• Early Years Practitioners are responsible for delivering the relevant review according to the GM standards and protocols.

All practitioners should record any actions, concerns, follow-up appointments. Reviews and referrals agreed with the parent/care giver must be documented in the child’s record (in accordance with the relevant organisational guidelines) including Safeguarding.

2.3GM Steering Group and Local Implementation Groups

GM City Region and Local Implementation Groups managing the implementation of the GM Early Years New Delivery Model are responsible for supporting the training and briefing of all partners in the Assessment Pathway, monitoring the effectiveness of these guidelines, reviewing the data submitted against agreed Key Performance Indicators (KPIs).

1. Completing Assessments and Accessing Pathways

At all stages a family, strengths based approach to assessment should be taken. The use of the standardised tools, such as ASQ, designed to illustrate a child's strengths as well as needs, are used in the context of the whole family as illustrated by the diagram below. Professional judgement needs to be applied in the use of tools, the interpretation of results and in communication with the family about the findings and next steps.

3.1Ages and Stages Questionnaires

ASQ Third Edition (ASQ-3) and ASQ Social and Emotional (ASQ-SE) published by Brookes Publishing Co. are two of the evidence based-assessment/screening tools selected as part of the GM Model. ASQ is designed to illustrate a child's strengths as well as needs.

The ASQ 3 and ASQ SE should be used to fidelity, adhering to the handbooks at all times.To ensure a broad view of child development and the early identification of emerging difficulties the use of both tools is recommended in GM, however it is recognised that localities will need to take an incremental approach due to cost.

To obtain accurate outcomes, children must be screened using the correct age interval questionnaires (e.g. a 6-month old child should be reviewed using the 6 month questionnaire). When a child has been born prematurely the ASQ prematurity adjustment guidance will ensure that the appropriate tool is used – this is relevant up to the age of two. Note – the ASQ tools are not designed to be used for children with known delay or disability.

Any child who scores within the black area of the ASQ score summary or are significantly below age related expectations within the EYFS will require further assessment, targeted intervention and,if necessary,a referral to a specialist service in line with the local pathway.

Parental Involvement

ASQ-3 and ASQ-SE are parent-report screening tools, meaning that parents are asked to complete the questionnaires prior to an appointment and then discuss the findings with a trained practitioner, who will then collate the scores. Parent-report tools are the most accurate, time- and cost-efficient method of developmental screening. Therefore ASQ Forms should be given to the parents prior to the visit/review and given time to complete them at home wherever possible. Parents should be given a copy of the questionnaire to share with their childcare providerand to keep in their child’s Red Book. The ASQ score sheet must be filed in the child’s development records.

3.2Home Learning Environment

The important role played by parents in taking an interest in their child’s early learning, providing early learning materials and activities at home and spending time on helping their child to learn about letters and numbers is recognised in the New Delivery Model.

A series of Home Learning Environment questions feature as part of the GM dataset, with the Home Learning Environment Index at Stage 6 or 7. This is based on the EPPE Project developed Early Home Learning Index[2], further developed through the Millennium Cohort Study.

3.3Pathways for Targeted Assessments and Interventions

A suite of evidence-based and timely interventions have been developed which are sequenced as a package of transformational support to families, with appropriate step-down support rather than ‘free fall’, with a strong focus on parenting programmes because of the clear link between parenting and children’s behaviour and mental health.

Inter-agency pathways need to be in place to promote seamless, flexible and high quality responsive care and support for parents to gain the best outcomes for their children.

GM outline pathways are under development and localities are recommended to develop these further as integrated pathways. Pathways to consider:

• Social, Emotional and Behavioural;
• Communication and Language;
• Parent-Infant Attachment and Parent Mental Health;
• Young Parents;
• Special Educational Need and Disability (SEND);
• Complex Dependences;
• Troubled Families;
• Work and Skills;
• Domestic Abuse; and
• Substance Misuse.

In addition to the assessments described above the following universal and targeted assessment are included in the New Delivery Model:

And the recommended suite of interventions is as follows:

1. Measuring impact, dataset, data collection and submission

4.1Measuring impact

The impact of the NDM will be monitored at three levels:

1. Population Outcomes – a series of key measures are being proposed to measure need and progress going forward:

1. Intervention outcomes– reliable assessment tools are being specified to measure the impact of targeted interventions. Through providers using these consistently to measure the impact of the interventions we will be able to measure progress for individual children and their families as well as the success of the programme overall. This will provide evidence regarding impact for individual families but also add to the overall evidence of impact of the New Delivery Model.

1. Individual Child progress – a dataset has been drafted for each of the 8 Stage assessments. This will collect information on the child’s developmental progress as well as the wider family context. These stages are existing points of contact within the Healthy Child Programme and/or the Early Years Foundation Stage.

4.2Early Adopter Dataset

The gathering, analysing and sharing of child-level data between officers and agencies is fundamental to ensure that children and family needs are identified and through this that they receive the support they need. This information will have a dual purpose:

A. For use by practitioners working with the child and family to:

–collate information on needs and record changes over time

–recognise risk factors and take these into account when working with the family

–guide the planning of interventions

–measure the impact of interventions

–record the child’s developmental progress over time

B. For planners and commissioners, information to be anonymised and collated

–to understand service usage

–to identify population needs and trends over time

–to monitor the impact of the NDM for groups of children

–to monitor the need for and impact of the NDM interventions

–to evaluate the NDM over time

A GM dataset has been drafted for Stages 2 to 8for testing in the Early Adopter sites are supplied in a zipped folder. These datasets have been designed based on the role and skills of the practitioner who will undertake the assessment. Stages 2,3,4,5 contain three sections:

• Section 1 – details about the child – name, address, NHS Number, GP etc
• Section 2 – some additional information about the child and details about his or her child’s development – including assessment scores.
• Section 3 – Family information – information provided by the parent/s about the family and any services used.

Stages 4b, 6, 7 and 8, undertaken by Children’s Centre, Nursery and school staff just include Sections 1 and 2.

Information Sharing Agreements need to be in place and signed parental agreement must be obtained before any data is shared using the parental agreement form, with associated parental information leaflet/letter.

Most of the information in Stages 2 to 5 is already known by Health Visitors, and collected in their recording.

4.3Data collection and submission

All providers should follow local processes as per local authority requirement for the collection and submission of data for ASQ and Early Years Foundation Stage Profile (EYFSP) for children in reception year of school.

Information gathered on the ASQ scores, the Home Learning Environment Indicators and contextual information needs to be recorded on the Greater Manchester dataset.

1. Contact details

Details of Assessment Lead Officers within each of the boroughs are listed below, along with the contact officer at the Association of Greater Manchester Authorities:

Appendices

Greater Manchester 8 Stage Assessment Model

Assessment and Reporting Arrangements

Appendix 1

Stage one: Pre-birth

Currently Under ReviewJuly 2014

Appendix 2

Stage two: New birth visit

The 10-14 day Health and Development Review (HDR) will take place between the ages of 10 & 14 days.

1. Standard for new birth Health and Development Review

Prior to the review the Health Visitor will:

• Follow local processes for scheduling and arranging visits
• Review any information pertinent to mother and baby through accessing records/discussion with relevant professionals e.g. Social Worker, Midwife, Neo-Natal Unit etc
• Follow local processes for compiling information i.e. Primary pack

At the review the Health Visitor will:

• Introduce self, explain the role and the purpose and process of the review
• Discuss the 8 Stage Assessment programme including the Ages & Stages Questionnaires for Stage 3 onwards
• Discuss consent form and obtain consent from the parent(s) to participate in the programme
• Complete review and give advice about local services
• Summarise visit, complete action plan and red book, arrange next visit and offer to answer any questions

The review will cover

• Newborn Behavioral Observation, flexibly to meet the needs of the family (if HV trained)
• A discussion aboutthe birth of your baby, how you are feeling now as a parent and any concerns you have for you and/or your baby or family
• Advice and support on feeding your baby
• Anew born hearing test if not already performed before you lefthospital
• Advice on safety issues
• Advice and schedules for immunisations.
• Public Health information relevant for this stage e.g. Safe sleep
• Local information on support services available including children’s centres

In addition to the above review, discuss and document: