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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)

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Dawn Moss

NHS Borders

Early Years Collaborative Improvement Adviser

Child Protection Health Needs Assessment


Background
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



Establish data collection process for HNA Ideas to Test

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PDSA RAMP 1: Test data collection tool

Cycle 5: All members of Child Protection Team to take a turn in collecting and inputting data to ensure consistency.

Cycle 4: Repeat cycle 3 now that problems accessing excel spreadsheet are resolved.

Cycle 3: Senior Nurse Child Protection has responsibility for collecting and inputting data onto excel spreadsheet

Cycle 2: Senior Nurse Child Protection has responsibility for collecting data, additional information identified, Nurse Consultant inputs data onto excel spreadsheet

Cycle 1: Child Protection Team collects data at weekly Child Protection Unit Business meeting


Improve HNA process aligned to GIRFEC Ideas to Test

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PDSA RAMP 2: Test new Health Needs Assessment

documentation

Cycle 3:Test introduction of new form as part of HNA process with one health visitor (currently underway)

Cycle 2: Test new HNA form with school nurse, no changes

Cycle 1:Test new HNA form with health visitor, changes made


Staff have knowledge and resources for HNA process Ideas to Test

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PDSA RAMP 3: Communication with staff

Cycle 4: Test written guidance for staff (currently underway)

Cycle 3: Test briefing/workshop format (currently underway)

Cycle 2: Test feedback form to health visitors/school nurse when HNA request (currently underway)

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


Reflections
Reflections Ideas to Test

  • 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”


Michelle Dowling Ideas to Test

South Lanarkshire Pioneer Site:

Maximising income for pregnant women


Background1
Background Ideas to Test

  • 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
Phase 1 testing Ideas to Test

Aim: to increase referrals from community midwifery services to the TAL

Measure(s): NO. of referrals from midwifery staff to TAL:

Result: initial rise; but slows. Think again

Change Ideas: midwife speaks to

women routinely as

part of visit;

use of case studies;

Are we ready to scale up?

Learning from data

Cycle 5: start test with another midwife in EK.

Cycle 4: stop using case studies but feel change is embedded.

Cycle 3: case studies used to promote the service with women.

Cycle 2: information about service given to women as part of visit as well as discussion with midwife:

Cycle 1 : Helen in Hamilton is recruited to test new ways of promoting service. She starts speaking to women as part of routine visits.


Run chart data
Run chart data Ideas to Test

Use of case studies – stopped following data protection concerns


Add a new site run chart
Add a new site...Run Chart Ideas to Test

Data suggests no increase in Hamilton overall and EK little or no change.


What changes will make a difference? Ideas to Test

Secondary drivers

Primary drivers

Aim

Focus of current tests

Women allow midwifery staff to pass details to TAL for phone back

Staff working with ante-natal women refer clients to service

Financial advice services and information are available and accessible

Midwifery staff routinely talk to women about the TAL

FNP/First Stepsstaff routinely refer women to TAL or other service

Financial advice services have specialist knowledge to support pregnant women

Women get the information they need when they need it

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

Staff member with good generic knowledge of financial issues linked to midwifery team

Opportunities for other forms of income support are available and accessible

Redesigned leaflets with input from potential and past service users increase women’s knowledge

Women take up Healthy start vouchers and vitamins

Women and their partners have access to information on training and employment schemes

Pregnant women need support to be able to budget and manage their money

Opportunities for training and education are available and accessible

Parents have access to affordable childcare


South lanarkshire cpp phase 2
South Lanarkshire CPP: phase 2 Ideas to Test

Aim: to increase referrals from community midwifery services to the TAL

Measure(s): number of referrals from midwifery staff to TAL:

Result: initial rise; volume becomes an issue

Change Ideas: pass contact details to TAL who

phone back the women for

initial discussion.

Learning from data

Cycle 3: (planned):more midwives in the team use this method with women in their clinics.

Cycle 2: Continue to monitor Helen’s progress and a second midwife starts using the new approach :

Cycle 1 : Helen starts asking women if details can be passed to TAL. Initial results seem favourable :


Run chart data1
Run chart data Ideas to Test


Reflections1
Reflections Ideas to Test

  • Complexity of testing across services and organisations

Local Authority

NHS

Tackling poverty (Com & Ent)

EYC

FNP

Midwifery services

Money Matters Advice Service (SW)


Reflections 2
Reflections (2) Ideas to Test

  • 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 Will Ideas to Test

Aberdeen City CPP

Early Years Collaborative Improvement Adviser

Improving Attachment-led Practice


Background2
Background Ideas to Test

  • 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.


2 Ideas to Test⁰

1⁰

Tests of Change

Improving attendance at Ante Pre-School provision (WS3)

Optimise development of children’s emotional well being and resilience.

Attachment

Evaluate support for parents (incl. Foster Carers)Pre-birth and Beyond

Provision of Antenatal Education-universal as well as targeted

Optimise Family Relationships

Wider Communication Strategy

Promoting skin on skin/ eye contact (WS1)

Improve Maternal Health and Wellbeing

Enhancing Secondary Education PSHE

Parent/Caregiver is attuned and responsive to children’s needs.

Engagement with PEEP

Aim

Content of Ante-natal classes

Optimise Workforce Capacity to implement attachment-led practice

Development of Peer networks to reduce isolation and share knowledge & understanding

Developing Dad’s Work

To ensure that 90% of children experience positive and secure relationships with their caregiver by June 2015, when assessed

Evaluation of Attachment Training (WS4)

Engage with Private Sector

Consistent/ clear assessment of attachment/emotional wellbeing

Workforce Development and Training

Attachment Training

Access to Bumps programme

Developing Community Assets

Develop Assets to support positive and secure attachment (Co-production)

Access to support when needed.

Linking Roots of Empathy

Developing Co-production methods

Parental engagement with projects.

Early identification of Health Plan Indicators (WS1)

Early Identification of parents that need support (Inc. pre-birth)

Version 2: 120913


Pre school setting 1
Pre-school Setting 1 Ideas to Test

  • Aim: Introduce use of assessment tool and individual support plans to improve support provided for children’s emotional wellbeing by September 2014.

Learning from data

Cycle 5: Test use of run chart to display progress for individual children

Cycle 4:Develop individual support plans for specific children

Cycle 3: Test use of Leuven Scale with three practitioners and all children.

Cycle 2: Test use of Leuven Scale with two practitioners and small group of children

Cycle 1:Test use of Leuven Scale of Wellbeing & Involvement with one practitioner and small group of children


Data for setting 1
Data for Setting 1 Ideas to Test


Data for setting 11
Data for Setting 1 Ideas to Test


Data for setting 12
Data for Setting 1 Ideas to Test


Pre school setting 2
Pre-school Setting 2 Ideas to Test

  • Aim: Introduce use of transitions worker and transitions ‘bundle’ to improve support provided for all children during settling and transitions by October 2014.

Learning from data

Cycle 4: Develop ‘transitions checklist’

Cycle 3: Test use of Leuven Scale for assessing children’s wellbeing during transitions

Cycle 2: Introduce use of ‘key worker’ system for children who are transitioning between rooms

Cycle 1: Identify areas for improvement in our transitions process


Data for setting 2
Data for Setting 2 Ideas to Test


Data for setting 21
Data for Setting 2 Ideas to Test


Data for setting 22
Data for Setting 2 Ideas to Test


Pre school setting 3
Pre-school Setting 3 Ideas to Test

  • Aim: Improve ‘dropping off’ and ‘picking up’ routines for all children by October 2014.

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


Data for setting 3
Data for Setting 3 Ideas to Test


Reflections2
Reflections Ideas to Test

Messiness 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!


Early Years Collaborative: Learning Session 5 Ideas to Test

EYC Leith Pioneer Site:income maximisation and maternal & child nutrition

Graham Mackenzie

on behalf of the Leith Pioneer Site team


Income Maximisation Ideas to Test

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 Ideas to Test

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


Project driver diagram
Project Driver Diagram Ideas to Test



Population segmentation Ideas to Test

5 women per week,

20% eligible

= small enough?


One midwife Ideas to Test

Timeline

6 weeks?

8-9 weeks

10 weeks

11-13 weeks

16 weeks

25 weeks

Woman’s antenatal care

Woman finds out she is pregnant

Calls central booking line

“Booking” appointment with midife

Ultrasound scan

Midwife appointment

Midwife appointment

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) Ideas to Test

DATA FEEDBACK TO FRONTLINE STAFF: Compliance w PVC check

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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).

Increased registration at antenatal booking

PDSA 7. Reinforced messages with team by collecting information in survey and fed back results at team meeting (n=19).

PDSA 6. Midwife shared simpler application process with colleagues at team meeting (n=19 midwives in team).

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 4. Workwith Health visitor team and welfare rights advisor).

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 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).


% antenatal bookers eligible for Healthy Start in Leith (self report)

(n=410; source Maternity Trak)

“Shift” on run chart (6+ points above median)

Universal enquiry re HS

Complete form at booking appt

Team meeting

Focus on Trak docu-mentation

Monthly data release

Monthly data release

Leith Survey Monkey

Team meeting and survey results

Median

Leith Pioneer site work started 3 March


Conclusions (self report)

Plan small, start smaller

Deming’s Lens of Profound Knowledge

  • understanding variation

  • appreciation for a system

  • building knowledge

  • human side of change

    Having an existing electronic record has

    been really useful

    We still have a long way to go


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