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Dawn Moss NHS Borders Early Years Collaborative Improvement Adviser Child Protection Health Needs Assessment. Background. Why does it matter - long-term effects for child ’ s health, growth, intellectual development and mental wellbeing (NSPCC, 2010) - PowerPoint PPT Presentation
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Dawn MossNHS Borders
Early Years Collaborative Improvement Adviser
Child Protection Health Needs Assessment
Background• Why does it matter - long-term effects for child’s
health, growth, intellectual development and mental wellbeing (NSPCC, 2010)
• Primary drivers in EYC Workstreams 2 and 3: child’s physical, mental and emotional development
• Child Protection Health Needs Assessment process established in 2013 – improvement needed to ensure that every child who needs it will have a health needs assessment
Cycle 1: Child Protection Team collects data at weekly Child Protection Unit Business meeting
Cycle 2: Senior Nurse Child Protection has responsibility for collecting data, additional information identified, Nurse Consultant inputs data onto excel spreadsheet
Cycle 3: Senior Nurse Child Protection has responsibility for collecting and inputting data onto excel spreadsheet
Cycle 4: Repeat cycle 3 now that problems accessing excel spreadsheet are resolved.
Cycle 5: All members of Child Protection Team to take a turn in collecting and inputting data to ensure consistency.
PDSA RAMP 1: Test data collection tool
8
PDSA RAMP 2: Test new Health Needs Assessment documentation
Cycle 1:Test new HNA form with health visitor, changes made
Cycle 2: Test new HNA form with school nurse, no changes
Cycle 3:Test introduction of new form as part of HNA process with one health visitor (currently underway)
9
PDSA RAMP 3: Communication with staff
Cycle 1: Communication via email to paediatricians re having discussion at end of weekly Child Protection Unit Meeting for all children discussed to be considered for HNA
Cycle 2: Test feedback form to health visitors/school nurse when HNA request (currently underway)
Cycle 3: Test briefing/workshop format (currently underway)
Cycle 4: Test written guidance for staff (currently underway)
Reflections• Worrying about measures – I’m doing it wrong
• Lots of activity but no run charts!
• Not knowing what is wrong, not knowing what questions I need to ask!
• Knight in shining armour.... ta-da... Brandon Bennett
• Knowing your process – steps – decision points
• “Moving from objective reality to belief”
Background• Telephone advice line (TAL) for pregnant
women, funded from SL Tackling Poverty Programme
• Lower than expected referrals from universal NHS midwifery services
• Focus initially to increase referrals from community midwives to service
• Initial tests post LS1 – one midwife in Hamilton; tested a number of change ideas
Phase 1 testing
AP D
S
AP
D S
APD
SA P
DS
Result: initial rise; but slows. Think again
Learning from data
Cycle 2: information about service given to women as part of visit as well as discussion with midwife:
Cycle 3: case studies used to promote the service with women.
Cycle 1 : Helen in Hamilton is recruited to test new ways of promoting service. She starts speaking to women as part of routine visits.
Aim: to increase referrals from community midwifery services to the TAL
Measure(s): NO. of referrals from midwifery staff to TAL:
Change Ideas: midwife speaks to women routinely as part of visit; use of case studies; Are we ready to scale up?
Cycle 4: stop using case studies but feel change is embedded.
Cycle 5: start test with another midwife in EK.
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ay
03-Jun
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01-Jul
08-Jul
15-Jul
22-Jul
29-Jul
05-Aug
12-Aug
19-Aug
26-Aug
02-Sep
Money Advice Line - Pregnant Mums
no of women given info/no contacting service
blue line - no of women given info on servicered line- no of these women taking up service
Run chart data
Use of case studies – stopped following data protection concerns
Add a new site...Run Chart
Data suggests no increase in Hamilton overall and EK little or no change.
Financial advice services and information are available and accessible
Aim Primary drivers Secondary drivers
What changes will make a difference?
Staff working with ante-natal women refer clients to service
Opportunities for other forms of income support are available and accessible
Opportunities for training and education are available and accessible
All pregnant women on low incomes have the opportunity to maximise their incomes during pregnancy and in the first year of their child’s life
Financial advice services have specialist knowledge to support pregnant women
Women get the information they need when they need it
Women take up Healthy start vouchers and vitamins
Women and their partners have access to information on training and employment schemes
Parents have access to affordable childcare
Redesigned leaflets with input from potential and past service users increase women’s knowledge
Women allow midwifery staff to pass details to TAL for phone back
Midwifery staff routinely talk to women about the TAL
Staff member with good generic knowledge of financial issues linked to midwifery team
FNP/First Steps staff routinely refer women to TAL or other service
Pregnant women need support to be able to budget and manage their money
Focus of current tests
South Lanarkshire CPP: phase 2
AP D
S
AP
D S
APD
SA P
DS
Result: initial rise; volume becomes an issue
Learning from data
Cycle 2: Continue to monitor Helen’s progress and a second midwife starts using the new approach :
Cycle 3: (planned):more midwives in the team use this method with women in their clinics.
Cycle 1 : Helen starts asking women if details can be passed to TAL. Initial results seem favourable :
Aim: to increase referrals from community midwifery services to the TAL
Measure(s): number of referrals from midwifery staff to TAL:
Change Ideas: pass contact details to TAL who phone back the women for initial discussion.
Reflections• Complexity of testing across services and
organisations
Tackling poverty (Com & Ent)
Money Matters Advice Service (SW)
Midwifery services
FNP
Local Authority NHS
EYC
Reflections (2)• You don’t know what you don’t know!
• Scale - one eye on full scale when starting small.
• Don’t make assumptions about new practice and scale too early
• Don’t forget basic project management
• Volume
• Much work across EYC is to improve low volume activity – implications for scaling up
Sacha WillAberdeen City CPP
Early Years Collaborative Improvement Adviser
Improving Attachment-led Practice
Background
• Series of multi agency training sessions held on Attachment during 2013
• 2014 – Early Adopters identified
• Preschool settings incl. private childcare sector
AIM: Identify, by December 2014, an evidence based change package which can improve attachment-led practice within pre-school settings in Aberdeen.
Linking Roots of Empathy
Evaluation of Attachment Training (WS4)
Consistent/ clear assessment of attachment/emotional wellbeing
Engage with Private Sector
Enhancing Secondary Education PSHE
Access to Bumps programme
Attachment Training
Promoting skin on skin/ eye contact (WS1)
Evaluate support for
parents (incl. Foster Carers) Pre-birth and Beyond
Developing Dad’s Work
Provision of Antenatal Education-universal as well as targeted
Content of Ante-natal classes
Attachment
Developing Co-production methods
Aim
1⁰ 2⁰ Tests of Change
Parent/Caregiver is attuned and responsive to children’s needs.
Wider Communication Strategy
Develop Assets to support positive
and secure attachment (Co-
production)
Early Identification of parents that need support (Inc. pre-birth)
Parental engagement with projects.
Developing Community Assets
Workforce Development and Training
Version 2: 120913
To ensure that 90% of children
experience positive and secure
relationships with their caregiver by June 2015, when
assessed
Optimise Family Relationships
Optimise Workforce Capacity to implement
attachment-led practice
Engagement with PEEP
Improve Maternal Health and Wellbeing
Optimise development of children’s emotional well being and resilience.
Early identification of Health Plan Indicators (WS1)
Access to support when needed.
Development of Peer networks to reduce isolation and share knowledge & understanding
Improving attendance at Ante Pre-School provision (WS3)
Engage parents in planning for transitions
Supporting children’semotional wellbeing
Aim
1⁰ 2⁰ Tests of Change
Provide information to parents about importance of emotional wellbeing and early brain development
Reliable Assessment & intervention
Share assessment information with parents
Version 1: 2 May 2014
Improve children’s emotional wellbeing in 4 pre-school settings
in Aberdeen by October 2014 through the use of an evidence based assessment tool and individual support
plans.
Informed & Engaged Parents
Individual support plans are developed and implemented for children with low levels of emotional wellbeing and for all children during transitions
All children are assessed during times of transition
Use of evidence-based, standardisedassessment tool
Provide learning opportunities for practitioners about importance of emotional wellbeing and early brain development
Informed & Engaged
Workforce Provide learning opportunities for practitioners about strategies to support emotional wellbeing
Include information on brain development and emotional wellbeing into parent’s information pack
Introduce use of home visits to engage parents in development of transition planning
Introduce evidence-based, standardised assessment tool(Leuven Scale for Emotional Wellbeing and Involvement)
Develop ‘transitions bundle’ to support assessment and interventions for children during transitions
Provide Learning Sessions on Attachment-led practice
Develop on-line resource on early brain development and importance of emotional wellbeing
All children are regularly assessed
Engage parents in development and implementation of support plans
Provide training to all practitioners on use of assessment tool
Pre-school Setting 1Aim: Introduce use of assessment tool and individual support plans to improve support
provided for children’s emotional wellbeing by September 2014.
AP D
S
AP
D S
APD
SA P
DS
Learning from data
Cycle 2: Test use of Leuven Scale with two practitioners and small group of children
Cycle 3: Test use of Leuven Scale with three practitioners and all children.
Cycle 1: Test use of Leuven Scale of Wellbeing & Involvement with one practitioner and small group of children
Cycle 4: Develop individual support plans for specific children
Cycle 5: Test use of run chart to display progress for individual children
Data for Setting 1
Percentage of children assessed for emotional wellbeing in Setting One
Tool introduced Next Practitioner trained
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jan
ua
ry
Fe
bru
ary
Ma
rch
Ap
ril
Ma
y
Jun
e
July
Au
gu
st
Se
pte
mb
er
Oct
ob
er
No
vem
be
r
De
cem
be
r
Month 2014
Per
cen
tag
e o
f ch
ild
ren
ass
esse
d
Data for Setting 1
Percentage of children who have received individual support for emotional wellbeing
(following need identifed through assessment)
Assessment Tool introduced
Individual plans introduced
No process 0%
10%20%30%40%50%60%70%80%90%
100%
Janu
ary
Febr
uary
Mar
ch
Apr
il
May
June Ju
ly
Aug
ust
Sep
tem
ber
Oct
ober
Nov
embe
r
Dec
embe
r
Month, 2014
Per
cent
age
of c
hild
ren
with
su
ppor
t pla
n
Data for Setting 1
Percentage of Staff Trained in use of Leuven Scale in Setting One
Leuven Tool introduced
Target 100% by Dec 2014
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Janu
ary
Febr
uary
Mar
ch
Apr
il
May
June July
Aug
ust
Sep
tem
ber
Oct
ober
Nov
embe
r
Dec
embe
r
Month, 2014
Per
cen
tag
e o
f S
taff
Tra
ined
Pre-school Setting 2Aim: Introduce use of transitions worker and transitions ‘bundle’ to improve support
provided for all children during settling and transitions by October 2014.
AP D
S
AP
D S
APD
SA P
DS
Learning from data
Cycle 2: Introduce use of ‘key worker’ system for children who are transitioning between rooms
Cycle 3: Test use of Leuven Scale for assessing children’s wellbeing during transitions
Cycle 1: Identify areas for improvement in our transitions process
Cycle 4: Develop ‘transitions checklist’
Data for Setting 2
Percentage of children receiving 'Transitions Bundle'
'Bundle' introduced
Target = 100%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jan
ua
ry
Fe
bru
ary
Ma
rch
Ap
ril
Ma
y
Jun
e
July
Au
gu
st
Se
pte
mb
er
Oct
ob
er
No
vem
be
r
De
cem
be
r
Month, 2014
Per
cen
tag
e o
f C
hild
ren
Pre-school Setting 3Aim: Improve ‘dropping off’ and ‘picking up’ routines for all children by October 2014.
AP D
S
AP
D S
APD
SA P
DS
Learning from data
Cycle 2: Share information with parents to identify new ‘drop off’ process
Cycle 1: Use Leuven Scale of Wellbeing & Involvement to gather baseline data regarding impact of interruptions during ‘drop off’ process
ReflectionsMessiness of life
Making assumptions is a trap!
PDSA cycles help you to pay attention to the detail
Always make predictions BEFORE you start to test
The value of learning from others
Run Charts make life easier!
EYC Leith Pioneer Site:income maximisation
and maternal & child nutrition
Graham Mackenzieon behalf of the Leith Pioneer Site team
Early Years Collaborative: Learning Session 5
Income Maximisation
Healthy Start:
- Food and vitamin vouchers
- Benefits recipients
- All pregnant women under 18 years of age
- Pregnant women (from 10 weeks gestation) and children under 4 years old
- £3.10 per week food vouchers
Aims
Improvement project: To improve uptake of Healthy Start (food and vitamin voucher scheme) to 90% of eligible participants (benefits recipients, child tax credit recipients if household income < £16,190 and pregnant women under 18 years old) in selected areas of Edinburgh (initially north east Edinburgh) by March 2015
Pioneer site: To learn lessons that can be scaled up to other areas and parts of Scotland
One midwifeWoman’s antenatal care
Woman finds out she is pregnant
Calls central booking line
“Booking” appointment with midife
Ultrasound scan
Midwife appointment
Midwife appointment
Timeline
6 weeks?
8-9 weeks
10 weeks
11-13 weeks
16 weeks
25 weeks
HS process: Before
Appn form may be given at this point
Appn form completed now…
…if remember to bring it…
…or now
HS process: After
Appn form completed
PDSA Ramp (for antenatal work)
Increase
d
regist
ratio
n
at ante
natal
booking
PDSA 1. The health records team identified women from two postcode sectors calling the centralised booking line. They inserted a letter and Healthy Start application form into the booking pack. Health records staff sent details to midwives who met women at booking visit. Shared data with health records team that showed that some women from postcode sectors were not being identified (PDSA cycle 2).
PDSA 3. Time between centralised booking call and appointment was 2-4 weeks, and first 8 women were seen by 5 different midwives, so shifted to look at caseload of single midwife, with routine enquiry about eligibility for Healthy Start (n=1).
PDSA 5. Identified simpler application process and tested this with same midwife: no need for ultrasound as proof of pregnancy, complete midwife section of application form at booking visit (initially n=1).
PDSA 6. Midwife shared simpler application process with colleagues at team meeting (n=19 midwives in team).
PDSA 7. Reinforced messages with team by collecting information in survey and fed back results at team meeting (n=19).
Scaling up: Survey with other team identified similar areas for improvement (n=7). Working with two midwives in that team to incorporate lessons from Leith team. Preparing to spread simple messages across Lothian (Further survey completed by 61 midwives).
(PDSA 4. Work with Health visitor team and welfare rights advisor).
0
5
10
15
20
25
30
35
40
06/0
1/2
014
20/0
1/2
014
03/0
2/2
014
17/0
2/2
014
03/0
3/2
014
17/0
3/2
014
31/0
3/2
014
14/0
4/2
014
28/0
4/2
014
12/0
5/2
014
% antenatal bookers eligible for Healthy Start in Leith (self report)(n=410; source Maternity Trak)
Monthly data
release
Monthly data
release
Leith Pioneer site work
started 3 March
Universal enquiry re HSComplete form
at booking appt
Team meeting
Leith Survey Monkey
Team meeting
and survey results
Focus on Trak docu-mentation
“Shift” on run chart (6+ points above median)
Median