Integrated Health Checks — Hampshire Evaluation — Children’s Centre

Integrated Health Checks — Hampshire Evaluation

Michael Newman and Sarah Bridge share how they have developed the integrated two year review process for Hampshire through strengthening partnerships between early years and health visiting services.

BACKGROUND

In 2011, the Government set out their vision for the system of services to support parents, children and families in the foundation years from pregnancy until a child’s fifth birthday. This included a commitment to ‘explore options for a single integrated review from 2015’, bringing together the Healthy Child Programme review at 2 to 2½ years and the Early Years Progress Check at age 2 from 2015.

In anticipation of this, a steering group with early years and health visiting representation was established in November 2013 to explore how integrated working could be developed. In designing the integrated review model for Hampshire, a number of other local authority models were used to develop the approach.

A pilot was established in two Hampshire districts (Fareham and Gosport) over a 12 month period to inform the development of the model, building on work already taking place. The recommendations from the implementation study commissioned by the Department of Health and Department of Education in November 2014 were also used to inform the development of the Hampshire model and inform the next steps of the steering group.

HAMPSHIRE’S APPROACH

Hampshire’s model uses the Personal Child Health Record (PCHR), also known as the red book as the main means of communicating the outcomes from the two separate two year checks. Birth to Three Network meetings are used as the primary engagement method for early years providers and health visitors to develop a joint understanding of:
— the different reviews
— each others’ roles and responsibilities.

As part of the agreed process, early years providers (with parent permission) can book face-to-face appointments with health visitors to discuss individual children. The health visiting contact number is also available to providers to discuss any concerns or clarify issues.

A flow chart for early years practitioners providing an overview on how to request additional support dependent on the level of the child’s needs was also developed as part of the model. The document is designed to be used alongside the Hampshire Safeguarding Children’s Board and Children’s Trust Thresholds Chart which can be accessed at:

http://www3.hants.gov.uk/thresholdchartposter.pdf

To support the implementation of the model across Hampshire a toolkit has been produced. This offers practical guidance for colleagues working in services for young children and health visiting on implementing the integrated two-year-check process agreed by Hampshire County Council and Southern Health. The toolkit includes the following:

- Background to the two-year-old integrated check

- An outline of the Hampshire model

- Support documents including team contact details, parental consent forms for settings, presentations for team and staff briefings and support documents for early years practitioners

- contact details for project leads for Hampshire County Council and Southern Health.

To support the planning and delivery of services, early years providers submit termly two-year-old tracking data of children’s attainment in the Early Years Foundation Stage (EYFS) prime areas of learning (Communication and Language, Physical Development and Personal, Social and Emotional Development). This is shared with the health visiting team and used to inform future discussions and sharing of expertise at the Birth to Three Networks.

The pilot was evaluated across the Fareham and Gosport district in June 2015. The following outputs from the pilot were noted:

More Engagement
More cohesive engagement between settings and health visiting teams as a result of shared understanding of each sectors’ respective 2-year-old review. As a result settings have identified strategies to support children who have not taken up the universal offer of the 2-year-old check with the aim to increase the percentage of children having the health review.

Sharing information with parents
82% of providers stated they were regularly seeing the child’s ASQ with the same proportion reporting no issues with parents sharing the red book when requested.

Increased contact with health visitors
82% of providers are using the ASQ findings to support earlier identification of needs. Anecdotal evidence from provider comments on the survey also reinforced this point, with increased communication and contact with health visiting teams.

Use the ASQ to inform the progress review
Of those, 64% were reviewing the ASQ when the child registered with 18% stating this was seen when undertaking the EYFS progress review. Consequently the advisory team have been reinforcing the message that the ASQ should also be used to inform the review.

More face-to-face appointments
42% of providers had made use of the telephone contact number to speak with health visiting teams with 24% booking face-to-face appointments.

IMPLEMENTING THE MODEL

Key to the pilot’s success has been having named leads from both services for young children and health visiting teams taking responsibility for the coordination and development of the pilot. The Birth to Three Network sessions focused on increasing the understanding between early years providers and health visitors of their roles, responsibilities and processes. Early years providers were also asked to share examples of how they implemented the process in their setting. For example, one provider discussed how they used the health review to inform the individual development plans for 2-year-olds attending their setting.

USING THE DATA

Analysis of the 2-year-old tracking data submitted by early years providers is shared with them to improve practice. For example, at the Birth to Three Network meetings the advisory teacher team model how this data can be used to analyse and identify areas of needs and any training gaps. A discussion then takes place on which interventions can be used to support children. This is then reviewed at the next meeting to see if progress is being made.

The data is also used to inform integrated workforce development sessions. For example, submission of tracking data identified that 30% of funded 2-year-olds were at risk of delay in health and self care. Analysis of the data and discussion with early years practitioners highlighted toileting as a factor. As a result, the health visiting team led a session on toilet training at the Birth to Three Network Meeting and early years practitioners shared expertise on how they have successfully supported toileting with a focus on supporting parents; also practitioners moderated age and stage bands evidence in health and self-care to ensure consistency in judgements across the district.

At the end of the meeting, early years providers agreed to implement a number of tasks which included:

- developing resources to support parents (for example, home learning packs which include guidance, examples of rewards, toy potty and doll (boy/girl versions)

- visual and physical support aids such as, ensuring appropriate foot rest and Makaton sign to support understanding and communication of toileting needs.

THE IMPACT

Whilst it is still relatively early days in terms of collating impact evidence, tracking our funded 2-year-olds in early years provision shows the following outcomes:

- Between the spring and autumn term 2015 the gap between the funded and non-funded children at risk of delay in health and self-care has decreased by 13%

- In the last 12 months, the percentage of children at risk of delay in their communication and language development has reduced from 33% to 21%.

NEXT STEPS

We are currently in the process of rolling out the model across Hampshire and developing our work in the following areas:

Further developing integrated workforce development training packages to target gaps identified within the Healthy Child Programme and the EYFS
Implementing the integrated two year review model with registered childminders.

Sarah Bridge is an Advisory Teacher for Hampshire County Council, supporting early years practice from birth to the end of the Early Years Foundation Stage. Mike Newman is a Children’s Centre Support Officer for Hampshire County Council working directly with commissioned third party providers and leads on the integrated two year review project.