Leading and delivering early childhood services: Case examples
Over 50 short case studies on early years and maternity support services, from EIF's 2022 report 'Leading and delivering early childhood services: 10 insights from 20 places across England and Wales'.
For important additional commentary and context, and more on the process of local support and self-assessment through which these case studies were identified, see Leading and delivering early childhood services: 10 insights from 20 places across England and Wales.
Caerphilly: Vision for change
Caerphilly worked with Public Health Wales to create an Early Years Logic Model which used a theory of change structure to describe the current challenges and set out a new integrated approach to improve services and outcomes.
The approach responded to feedback from families about the need for more individualised support, and local concerns about inequality, a lack of consistency and silo working.
The Early Years Logic Model described a vision of a single early years services team which shared data and decision-making, and focused on identifying and addressing needs early, and supporting families to be in control of decisions. It also described long-term benefits for families, staff, and system effectiveness more broadly.
Islington: Stressors and resilience factors
Islington had a multi-agency vision for early childhood services, based on reducing stressors and building resilience for families in order to give every child the best start in life. Stressors were described as ‘factors which can make parenting, relationships and healthy development more difficult’, and resilience factors as those which ‘empower and enable families to work together with others to manage the difficulties in their lives.’ The approach was inspired by the work of Better Start Blackpool.
Warrington: Starting from the research evidence
Warrington’s system-wide approach to improving the identification and support of speech, language and communication needs was based on a comprehensive, documented analysis of research evidence demonstrating the critical importance of the first 17 months in determining later language, and the role of the home learning environment. Research evidence also drove the choice of assessment tools.
Newham: The 50 Steps to a healthier borough
The first priority in Newham’s Health and Wellbeing Strategy for 2020–2023 is enabling the best start through pregnancy and early years, and includes five ‘steps’:
- promote and support healthy pregnancies, childbirth and postnatal care for parents
- give every child in Newham the best start to life
- improve rates of childhood immunisations
- support school readiness for all children
- strengthen partnerships across local authority, clinical commissioning group, maternity, and voluntary, community and faith sectors to ensure a joined-up approach to support families.
The 50 Steps is described as a call to action to partners, the council and the wider community to work together. It is underpinned by a population needs assessment, and is supported by an implementation plan and outcomes framework.
Carmarthenshire and Ceredigion: Early years integrated system
Carmarthenshire and Ceredigion Councils, Public Health Wales and Hywel Dda University Health Board collaborated to create a programme to ‘transform the delivery of early years services from those that are segmented, and aligned along statutory boundaries, to those that use a placed-based approach’. The business plan set out guiding values, an analysis of the strategic context, the case for change (including benefits, outputs and outcomes), and how the approach can be sustained and scaled.
Each local authority area also published a pathfinder pilot plan describing how they would deploy this programme at a more local level, for example prioritising the capacity and skill mix in health visitor and family centre teams in Ceredigion; and establishing an early years integrated team covering the Gwendraeth Valley in Carmarthenshire.
Islington: Bright Start Profile
A specific early years needs assessment underpinned the development of Islington’s Bright Start integrated locality provision. The first Bright Start Profile was completed in 2018 and updated in 2021. It covers a range of indicators aligned to the Islington model of stressors and resilience factors, with datasets at both locality and borough level. A wide variety of factors are included, such as food poverty, key health priorities such as adult lifestyle health risks and children’s weight, and the availability of nursery places, and child outcomes at age 5.
Early childhood services in Islington are provided in three localities (Bright Start North, South and Central) which are coterminous with ward boundaries. This meant that a picture could be drawn of needs in each locality. While levels of overall disadvantage are similar in each, Bright Start South, for example, had a slightly lower achievement gap at age 5 than other areas.
A survey of family satisfaction with all services provided as part of the early childhood offer was completed by over 200 families. In addition, the health visiting service continued with the national Family and Friends Test.
A number of other needs assessments have been completed which focus on specific areas of the healthy child programme, for example the perinatal mental health needs assessment which brought together data from all relevant services available in the perinatal period. The review used national data to predict probable level of need and compared this with the actual numbers accessing services. It also included a deep dive exploration of 50 cases to explore assessment, provision, user experience and impact. The needs assessment led to plans for a range of support to match need from mild through moderate to acute, including the development of a specialist post in the health visiting team.
Other needs assessments include the health visiting high needs review, with a focus on the proportionately of health visiting input to the universal offer, versus additional support, and a review of obesity in the 0–4 age group, both of which have led to further development work on strategy and partnership.
North Wales: Regional population needs assessment
The North Wales Social Care and Wellbeing Services Improvement Collaborative published a regional population assessment in 2017, and a rapid review in 2020 to take account of the impact of Covid-19 on people who receive care and support in North Wales, including children.
Newport: Mapping local assets
Partners and key stakeholders in Gwent(including those in Newport) took part in an intensive six-day mapping exercise to better understand the universal journey for a family and their lived experiences, including when and how they came into contact with services. Families and frontline staff were interviewed and family records were studied so that a picture was gained of families’ real experience. The mapping exercise included, amongst others, health, education, child development, childcare, family support, parenting, and mental health. It took account of ‘hyper-local’ services which are provided by the third sector. It highlighted service duplication and gaps.
The mapping exercise generated a set of principles for Newport’s early years transformation programme:
- Build on the person’s strengths, skills and interests, current and historical networks; only then
- use community assets; only then
- use statutory or commissioned services.
The mapping exercise was very powerful in identifying and highlighting service gaps and duplication for senior leaders and elected members, supporting the principle of ‘right help at the right time’, and helping to better align resources across agencies.
Kirklees: Health and Wellbeing Partnership
Kirklees Council and the two Kirklees clinical commissioning groups commissioned a new partnership in 2017 to deliver an integrated healthy child programme in Kirklees. The partnership, now known as ‘Thriving Kirklees’, is made up of NHS and voluntary sector organisations, and is responsible for delivering a range of services to support children and young people and their families to thrive and be healthy. Including mental health, health visiting, school nursing, and volunteer-led family support.
The purpose of the Kirklees integrated healthy child programme was to transform the commissioning and provision of children and family-centred services, ultimately changing the way in which Kirklees communities received and interacted with the services they required. The initial contract was for five years, with provision for a five-year extension.
A key part of the vision for Thriving Kirklees is to develop voluntary sector-led initiatives, engage with stakeholders across diverse and marginalised communities and provide opportunities for local people to volunteer. A community grants scheme, implemented and managed in partnership with Third Sector Leaders Kirklees, provides funding to pilot and develop community-led health and wellbeing projects.
Cheshire East: Child Health Hubs
Cheshire East has a children’s joint commissioning group and strategy, which involves the clinical commissioning groups, the local authority, health trusts, public health, representatives from the parents’ forum, and young people supported by a participation team.
One joint commission has been the Child Health Hubs. Devised by the Integrated Care Partnership, working with paediatricians, GPs, and the local authority Early Start Service in children’s centres, the hub programme aims to improve child and family access and experience across the paediatric system.
Data showed that parents were taking children to hospitals when that could have been avoided. After listening to families’ views, some services were located in children’s centres, and there are now two Hubs, one for each hospital trust, in which advanced nurse practitioners provide unsettled infant clinics, a jaundice clinic, and drop-in blood tests. The services are very well used, and provide an opportunity to promote the wider children’s centre offer to families. GPs have also become more aware of the children’s centre offer and more active in signposting families to it.
Cheshire East does not see pooled budgets or shared commissioning posts as essential. Instead their approach is to use data and user experience to identify gaps in services, and then establish which partners are best positioned to draw on national grants or other pots of money to meet needs.
Flintshire: Creating a learning culture
Flintshire had established a multi-agency task and finish group to plan for workforce development for all those working with children prebirth to 7 years old. The group brought together partners from health, local authority, childcare and the third sector, and reported to the Early Years Pathfinder Partnership. It aimed to analyse and understand workforce needs, address capacity gaps through staff training, service redesign or recruitment, and put in place an agreed and high-quality training and supervision offer which supports the workforce to apply the latest evidence and policy to their practice. Outputs were expected to include an Early Years Workforce Matrix identifying needs across the system, and a roadmap setting out next steps over a two to three year period.
The work is expected to include mapping the existing training offer, and will explore how this might be reconfigured, building on strengths and maximising funding through pooled budgets. A key aim is to create a learning culture where networking and feedback informs future training and practice, and put in place a framework for evaluating the impact of workforce development activities on practice. The group is planning to work with both practitioners and service users to bring their perspectives on training and development needs and activities.
Cardiff: Training needs analysis
An annual training needs analysis is undertaken across early help in Cardiff. This covers the early intervention workforce, including Families First working partners, Flying Start practitioners, and staff in education and social services and the non-maintained childcare sector. The results are used to develop training programmes for these audiences. There is a core programme of training available to all early help staff, which includes:
- understanding the roles of different services, such as Cardiff Family Advice and Support, Cardiff Parenting Teams and the Flying Start Advisory Team
- relational and attachment-based practices
- developing children’s communication skills
- supporting breastfeeding and understanding the responsibilities of the health visiting service
- eating well in the early years
- additional learning needs
- safeguarding children.
The core programme is also available to partners across Cardiff who work with children and families, including schools-based staff, social care and housing professionals.
Tower Hamlets: Multi-agency training
In Tower Hamlets staff from different professional backgrounds, including early years practitioners, children and family centre staff, health visitors, family support workers, school staff, and staff working in early help) participate in a range of multiagency training programmes such as the national Every Child a Talker training.
There are plans to build an overall programme of cross-organisational training which connects learning opportunities for working at a universal level with every family, as well as with children and families who need more specialist support.
Cheshire East: Speech and language therapists
Cheshire East used a two-year invest-to-save pilot to test the impact of employing speech and language therapists to work with targeted early years settings in the most disadvantaged areas. They provided training for staff and supported the use of an assessment and intervention tool. Evaluation showed a strong impact on outcomes, not only in communication and language but also in personal, social and emotional development. As a result the programme has been mainstreamed.
Wrexham and Flintshire: CAMHS training the wider workforce
The Early Years (0–7 years) service within North East Wales CAMHS (Wrexham and Flintshire) is a multidisciplinary team which offers specialist support for infant, child and parent mental health, and for parent–infant/child relationships. The service provides specialist psychological assessment and intervention, training and consultation for the local workforce, along with advice to service leaders.
CAMHS has prioritised working with partners to support the skills development of the wider early years workforce. CAMHS collaborated with Flintshire and Wrexham local authorities to develop Video Interaction Guidance (VIG) in early intervention services across both counties, with CAMHS leading the local training of VIG practitioners. Two CAMHS-based clinical psychologists have been funded by the Flintshire Early Years Pathfinder to become accredited supervisors for two cohorts of trainee VIG practitioners. In Wrexham the local authority has committed to fund an additional cohort of trainee VIG practitioners. CAMHS facilitates regular local peer supervision groups known as ‘intervisions’ and evaluates intervention outcome data.
CAMHS has also developed regular group consultation sessions for local parenting practitioners working within early intervention services. These are led by a clinical psychologist, and focus on increasing skills, knowledge and confidence by supporting practitioners through a shared problem-solving process. Practitioners and service managers who have taken part report feeling more skilled in the way that they support families.
Tower Hamlets: Maternity and early years governance
Partnership working across maternity and early years services is coordinated through a well-established maternity and early years working group. Although planning was paused for a time during the pandemic, the working group leads work on an early years integration plan, with shared key performance indicators, and shared workplans that lead into service workplans and individual performance targets.
The working group brings together senior stakeholders representing maternity commissioning, public health, midwifery, health visiting, early years, early help and the voluntary sector.
The maternity and early years working group is one of four thematic subgroups that deliver objectives agreed by the Children and Families Executive, which is part of Tower Hamlets Together, a strategic partnership between NHS commissioners and providers, the local authority and the Council for Voluntary Services to deliver ‘better health through partnership’.
Anglesey: Early years board
Anglesey is a small authority, so a key driver for multi-agency working is to make best use of resources to avoid being overwhelmed by different initiatives and projects. This is a key function of the Anglesey Early Years Board, which brings together senior managers from family support, social services, school nursing, health visiting, midwifery, Public Health Wales, leisure, housing, primary schools, childcare and the third sector.
The board share information about current and new projects, support collaboration on funding bids and explore connections and opportunities to link up. Working groups take forward more detailed work across partners, for example embedding Welsh language in the service offer, or support for children with additional learning needs.
One of the working groups focused on looking afresh at the parenting pathway from prebirth. Take-up and engagement with evidence-based programmes was falling, and training staff to deliver these programmes was difficult because of the wide range of programmes, the cost of training and staff turnover. Partners were keen to review how evidence-based programmes fitted into a county-wide support pathway that focused on building confidence, resilience, relationships and social networks. This work included mapping who is trained in what and how they apply this; and creating a new induction process and annual cycle of training for key programmes.
Islington: Local area partnerships
The Bright Start governance structure facilitates joint leadership working at every level from the overarching Maternity and Early Childhood Board to the local parent forums.
Each Bright Start locality is led by an area lead (London Borough of Islington) and locality manager (Whittington Health Trust), working in partnership with other agencies including voluntary services, midwifery, social care and education.
Every locality has an Early Childhood Area Partnership Group chaired by parents and attended by families, community groups and professionals, including nursery managers and partners in speech and language therapy, and community learning. These groups look at issues in their area and provide reports and challenges on what provision they would like to develop locally. The meetings are seen as invaluable not only for the formal agenda discussions but also through the incidental conversations and connections made.
Caerphilly: Local and regional partnerships
Caerphilly has an active operational partnership group which is open to service managers from across the local maternity and early years system. The group includes midwifery, health visiting, Flying Start, Families First, and is a key group for information sharing, discussion and debate. The group also creates task and finish working groups on key priorities where there is a shared interest or concern. This has included, for example, work on the relationship between generic and Flying Start health visiting; the speech and language local pathway; and scaling up learning from the New Tredegar transformation pilot across the wider area. Managers taking part in the working groups have a mandate to make decisions.
Caerphilly also supports the Gwent early years steering group which coordinates work across the region and reports in to the new Gwent Public Service Board. The steering group helps to avoid unilateral local decisions by focusing on common principles and a unified model which is then adapted to each local context.
Cheshire East: Modelling leadership
Like other local areas, Cheshire East has had to work hard to ensure that children’s issues take their place alongside adult social care in discussions about integrated services, and that partners engage fully with early intervention and prevention. The team feel that a number of key factors have been important in making this happen:
- political support and executive-level leadership within the local authority
- enabling partners to listen to the experience and wishes of families
- finding the people who may not initially know the territory but are keen to make a difference
- persistence in being at the table
- practical demonstrations of how partners can help each other meet their respective organisational goals, for example by using existing assets (buildings and people)
- initially focusing joint work on tangible programmes that have high visibility, so that partners can see work on the ground.
Devon: Leadership roles
Devon’s Best Start in Life Programme aims to ensure every baby and young child in Devon will be provided with the best start in life by their families, local communities and integrated services, and that families will receive a seamless experience with access to the information and services they need when they need it.
The programme is governed by a multi-agency board consisting of representatives from children’s services, early years, health visiting, midwifery and the community and voluntary sector. The board reports into the Devon Children and Families Partnership and has responsibility for the progress of the programme and programme resources.
A public health consultant is the senior responsible officer (SRO) for the programme and chair of the programme board. The SRO has overall responsibility for the delivery and outcomes of the programme.
A programme change manager is responsible for the day-to-day management of the programme, with the authority to lead programme work on behalf of the Programme Board. The programme change manager manages relationships with a wide range of stakeholders and contributors, and reports to the SRO and Programme Board.
Data analysis and intelligence for the programme is provided through the supporting Children’s Management Information and Public Health Intelligence Teams. The One Devon Dataset is used to inform delivery – a linked dataset of pseudonymised data that can track individuals, families and communities through the lifespan to develop understanding of system interdependencies, inequalities, needs and costs.
An early years research and evaluation manager was part of the programme team during the initial stages. The role was important in gathering and analysing information on families’ experiences of services, including experience of digital delivery during the pandemic response, and worked closely with organisations such as EIF to evaluate the effectiveness of Devon’s early years and maternity services.
Kirklees: Codesign and peer support
Auntie Pam’s is a pregnancy and family support service developed with local women, which is described as seeking to engage with the easy-to-ignore, disengaged or marginalised women and family members. Auntie Pam’s 1:1 volunteer peer support offers women the chance to identify and talk through their issues; prioritise needs, solutions and goals; and with support, improve their personal circumstances.
Volunteers are trained to work through basic motivational change cycles that lead to long term improved health and wellbeing change. Women are signposted to other support services and networks where needed. Crucially, volunteers offer a time-rich service, allowing women to set their own pace for engagement and discussion. This is a person-centred approach, enabling women to identify solutions and make their own choices.
Auntie Pam’s volunteers have the opportunity to gain a range of Level 2 qualifications. They represent local women on partnership groups, and help shape the local health provider’s services and information for families.
Ceredigion: Building a sense of community
Termly reference groups in Ceredigion bring together parents, grassroots community groups, local councillors, third sector organisations, faith groups, employment agencies, play and childcare providers, and family centre and local authority staff to discuss the issues facing their local area and to solve problems.
Building a sense of community is an important strand of Welsh policy. An example is the West Wales Care Partnership of councils, Health Boards and Public Health Wales, and the Pembrokeshire Association of Voluntary Services, which has created a timebank platform to bring communities and individuals together. This is a place where individuals can offer support to or request help from their neighbours and the wider community. Connect 2 Ceredigion has been created not as a place for traditional volunteering, but as a timebank and ‘a place for small random acts of kindness between people in Ceredigion, based on the individual skill they have to offer or the specific problem they need to be solved.’
Tower Hamlets: Parent volunteers
In Tower Hamlets a volunteer coordinator funded by Job Centre Plus, works across the 12 children and family centres to support parents with work experience in the centres, such as clerical work, supporting universal sessions, or providing conversational English practice. Where parents are interested in getting into employment, the centres support the engagement with the council’s work path team for advice and support.
Parents often progress from volunteering to becoming members of the centres’ parent forums, where they look at outcomes, explore issues such as low take up in some families, and advise on activity programmes. Forums have become more diverse over time, with new leaders emerging from a younger generation, including many first-time mothers from local estates.
One of the home learning environment programmes used in the borough is the National Literacy Trust’s Early Words Together, where parents initially codeliver sessions alongside nursery staff, and later run them independently. The parents involved have become a powerful group, speaking at local conferences and taking part in workshops alongside professionals.
Hammersmith and Fulham: Community champions
Hammersmith and Fulham fund a community champions volunteer programme of local people who promote health and wellbeing knowledge and services for local residents. The programme at Old Oak Community and Children’s Centre includes maternity champions, who help new and expectant parents from pregnancy through to a baby’s first birthday in a range of ways, including preparing for birth, bonding with baby, breastfeeding, and first aid.
Carmarthenshire: Community Connectors
An important development in many parts of Wales is the role of Community Connectors, employed by the local authority and working on asset-based community development. Community Connectors map local services, talk to local people to find out what is missing, and aim to create a movement of change, empowering individuals to become community champions.
Carmarthenshire has piloted this role within the early years team. The Community Connector has identified community assets previously unknown to statutory services, and developed new initiatives like a walking group for mums and active story times, always identifying people in the community who can run these themselves.
Caerphilly: A core offer, not a menu of interventions
Caerphilly used The Vanguard Method for systems thinking to better understand the relationship between different kinds of support for families with different levels of need, and this helped to design an early years core offer. The What Matters core team includes health visitors, family workers, midwives and parent–infant mental health practitioners who collaborate rather than refer on. They coordinate support for families, and make sure that interventions are well matched to individual family needs.
Staff are trained in the delivery of a variety of different evidence-based programmes, including Parents as First Teachers, Solihull Approach, Video Interactive Guidance and Circle of Security. There are also a number of locally grown interventions which are more family focused and important for building parent engagement and self-esteem. However, overall , the focus has shifted from group interventions to one-to-one support.
Devon: Intervention mapping
Devon County Council worked with EIF to review current maternity and early years support for children and families. The mapping process explored how effective interventions were individually and as part of a local system, and proposed specific ways to increase impact.
The process rated interventions for the clarity about their theory of change, quality of local implementation, fit with the local context, strength of evidence about impact, and the local arrangements for monitoring and evaluation.
The conclusions of this work focused on ways to strengthen the local monitoring of implementation quality and outcome measurement, and using the local population needs assessment to drive the way that interventions were designed and delivered in Devon.
Torfaen: Service mapping data
Torfaen worked with an independent consultant to create an online database which is used for mapping local services and programmes. The database includes universal, targeted and specialist services for children up to the age of 7, and describes what the services do, how they are funded, who they are for and which partners are involved in delivery. A new early years operational group is being developed which will help grow the database, for example including more of the services delivered by local voluntary sector partners.
The service mapping data is used by the Torfaen Early Years Strategic Group to understand gaps in support for families, and to inform strategic planning and prioritisation. It also supports Torfaen’s Early Years Integration Transformation Programme pilot to integrate nationally recommended evidence-based programmes alongside locally identified interventions, and offer more flexible support based on family vulnerability rather than postcodes.
Flintshire: Delivering evidence-based programmes with fidelity
Flintshire has a strong reputation for using evidence-based and evidence-informed programmes. Much of this has come through the long-standing work on a Flintshire parenting strategy and the work undertaken as part of the Flying Start programme on speech, language and communication.
Parenting programmes are consistently evaluated using the Warwick Edinburgh Mental Health and Wellbeing Scale tool alongside distance travelled measures and, for language, Therapy Outcome Measures (TOMS). Supervision and peer network master classes are in place to ensure programme fidelity. The portfolio of evidence-based programmes also reinforces the importance of building community capacity, through the choice of the volunteer parent-led Empowering Parents Empowering Communities (EPEC) programme.
Cheshire East: The Parenting Journey
Cheshire East’s Parenting Journey describes the universal and targeted offer for families from prebirth to when the child starts school, bringing together the Healthy Child Programme, the work of children’s centres and the work of early years settings. It is presented as a series of 12 bus stops, from antenatal visits at stop one, through Toddlers Together play and learning sessions at stop eight and advice on school readiness at stop 12.
Parent-facing information about the parenting journey is underpinned by guidance for professionals, which describes the offer in more detail and sets out assessment points. These include a developmental assessment at the end of the free education and childcare entitlement for 2 and 3 year olds, undertaken by the early years setting, as well as the usual Healthy Child Programme checks, and the Early Years Foundation Stage profile. Each bus stop has its own key messages to communicate to families.
The Parenting Journey supports early identification of need and provides a gateway to targeted and specialist services through clear, targeted and intensive support pathways linked to the stops on the journey. Integrated pathways have been developed for Communication and Language, and for Personal, Social and Emotional Development.
The Parenting Journey is overseen by a group of senior managers from Early Start, health visiting and midwifery, who scrutinise output and outcome data and ensure integrated working is embedded.
Ceredigion: Multidisciplinary family support
Family support workers in Ceredigion undertake delegated packages of care under the supervision of health visitors. This includes, for example carrying out Healthy Child Wales Programme home visits and WellComm language assessments, involving the health visitor in a full developmental check if the assessment suggests any issues.
Midwives identify risks of perinatal mental health issues early on and involve health visitors and family support workers in providing support before and after the birth. This support could be one-to-one, or attending stress control and emotional wellbeing courses, which are run by family support workers.
As a result, up to 50% of consultations with and referrals to the specialist perinatal mental health team are dealt with by the wider workforce, leaving the specialist team to deliver more intensive support for women with the greatest needs.
Devon: Vulnerable Pregnancy Pathway
Devon has developed a multiagency pathway for providing wraparound support for mothers who are identified as needing extra help. The Vulnerable Pregnancy Pathway ensures that the right support is in place for mothers, unborn and newborn babies, and the wider family. It provides a robust interface into wider support services as required, and is underpinned by a comprehensive information-sharing agreement.
Monthly interagency vulnerable pregnancy meetings are the gateway to the Help Us Grow Supported (HUGS) Programme. HUGS is provided by Devon Public Health Nursing health visitors and Action for Children children’s centre practitioners working closely with other health and social care professionals through pregnancy and over the first 2.5 years of a child’s life.
The pathway facilitates a partnership approach with families, and is intended to: provide better support for pregnant, care-experienced young adults; help children to stay out of care, and support pregnant women who have already had children removed to care; and improve the identification and prevention of neglect.
Newport: Key workers and ‘What Matters’ conversations
Pregnant women are allocated a family key worker as part of the early years integration transformation programme in Bettws, Newport. The key worker invites other professionals to work with them and the family, during a weekly ‘What Matters’ multiagency professional meeting. The family’s views are shared at this meeting, and they are revisited if more in-depth discussion is needed.
The process starts with a focus on the family and their presenting issues, and the regular ‘What Matters’ multi-agency conversations avoid complicated referral routes and service-level threshold requirements.
The needs of the family are considered, with the lead professional allocated up to 10 minutes to outline the issues. The group find a way forward, seeking to support and upskill the family’s key worker through joint work. As an example, the key worker will attend the Circle of Security parenting sessions alongside the family, so that ‘the family can see that their key person can continue that intervention or support’.
The ‘What Matters’ conversations are seen as an opportunity to raise awareness and upskill staff across services, including housing for example. The strong collaboration with housing and the voluntary sector is responding to specific needs within the Bettws area.
Torfaen: Person-centred practice
The person-centred practices which are at the heart of the Additional Learning Needs Code for Wales have been important for embedding multi-agency working in Torfaen.
Person-centred practice is a collection of tools and approaches, based upon a set of shared values, which can be employed to effectively plan with a child, rather than for them. A person-centred approach helps to develop the child’s circle of support by involving all the people who are important in their life, including parents and carers, and professionals working with them.
There are five key principles of person-centred practice:
- The person is at the centre.
- Family members and friends are partners in planning.
- The plan reflects what is important to the person now (and for the future), their capacities and what support they require.
- The plan helps build the person’s place in the community and helps the community to welcome them. It is not just about services and reflects what is possible, not just what is available.
- The plan results in ongoing listening, learning, and further action.
Person-centred practice in Torfaen has helped partners to work together well and has enhanced family confidence in engaging with services. The local approach has been developed using feedback from families on the benefits of having partners around the table and working through the support that is most helpful to them.
Warrington: Early Years Peer Challenge
In 2019 Warrington participated in an Early Years Peer Challenge which was led by the Local Government Association. One of the recommendations from the Peer Challenge was to improve the coordination of identification and support for speech, language and communication needs. A multi-agency steering group (involving speech and language therapy, health visiting and local authority early years services) was formed to develop a pathway that would create a system-wide approach.
In pilot areas, where a child is identified at 9–12 month universal health check as being at risk of an emerging language delay, they have a follow-up assessment from a health visiting nursery nurse, using the WellComm screening tool. Where this identifies a need, the child and their family take part in a six-week group intervention at a children’s centre, where trained practitioners model strategies and share resources that are agreed and developed across the system. Parents are encouraged to continue to use strategies at home. The health visiting team follow up three months after the initial screening to measure progress.
In addition, resources about early language development are now shared with all parents, whether they are in contact with antenatal services or making the transition into Reception, so that ‘parents get the same messages from any service they come across in Warrington regarding speech, language and communication’.
Islington: Maternity care
Maternity care in Islington is distributed across two main hospital providers, with several others seeing small numbers of parents as well. Links with the two main hospitals are strong, particularly at a local level with community clinics running from children centre sites, attendance at the maternity voices forum.
Consultant midwives from both hospitals are members of strategic groups leading multi-agency planning for children and families. Maternity support workers (employed by the two hospitals and variously funded by the hospitals, the CCG and Public Health) work in the locality team supporting midwifery community clinics, facilitating parent support groups and encouraging expectant parents to take up the wider services offered by Bright Start. Health visitors and midwifery teams jointly run the Solihull Journey to Parenthood six-week antenatal course.
Within the Bright Start team a specialist Transition to Parenthood Health Visitor was appointed to develop shared training for staff and streamline communication pathways from midwives to health visitors. One of the two main hospital midwifery services provides health visitors with full booking-in information, and details are shared at locality liaison meetings for other families.
Work with Maternity Voices showed that parents found the midwifery letter introducing a family to the health visitor was not memorable, so an introductory video is in development – one that will carry the Bright Start brand and share Bright Start key messages.
Cheshire East: Information sharing agreements
Some information sharing agreements are in place between Cheshire East Council and Wirral Community Trust. Health visiting and Family Nurse Partnership (FNP) teams seek agreement from clients to share information with the local authority’s Early Start team, which includes children’s centre staff, early years SEND staff and staff supporting quality in early years settings.
Early Start Hub meetings take place regularly to discuss support for individual children and families, involving the hub manager, lead for communication and inclusion, early years consultant, health visiting team leader, speech and language therapist, and linked nursery or schools. There are also termly multi-agency Locality Data Sharing Meetings to look at local data patterns and plan services based on the needs of the community.
The system means that, for example, children of FNP clients all receive access to specialist children’s centre support, while the FNP worker supports the parent to get back into education or work, with help from a children’s centre ‘Parents First’ programme that offers volunteering opportunities, help with CV writing and interview techniques. The developmental progress of FNP children is tracked in their early years setting, using a simple tracking tool developed for use by settings with all funded 2, 3 and 4 year old children. The current tracking system provides an overview of the progress of all vulnerable children in the setting and allows support programmes to be put in place where needed.
Ceredigion: Information sharing protocol
An information sharing protocol has been developed for the Ceredigion Early Years Integration Transformation Programme pathfinder between the Health Board, Ceredigion County Council, Home Start, and other voluntary sector organisations working with children, domestic abuse, and fire and rescue services.
The protocol, developed under WASPI (Wales Accord on the Sharing of Personal Information) describes the types of personal information that will be routinely shared, the ways in which it will be shared and the methods to be used to keep the information secure. It includes a copy of the Privacy Statement Pathfinder Pilot Programme leaflet that is given to families at the first contact by the midwife or health visitor. The leaflet explains: why information is shared (‘so that we can ensure that the services offered best match the services you tell us you need or would like’); what information will be gathered (about the child’s development and health, and family wellbeing); and who is involved (‘the only people who will have day-to-day access to your personal information are the workers who work directly with you or staff who help them to work with you’).
Ceredigion have also created a proforma for their pathfinder which records any support a child and their family have had in the early years (0–7 years), pulling together information from a number of databases. It includes the child’s Unique Pupil Number, and NHS number; main language; level of health visiting service received; whether development on the Schedule of Growing Skills and WellComm was age appropriate; services and agencies involved; parenting courses attended; uptake of the free childcare offer, and any additional support provided in the childcare setting. The aim is to use the information to populate the ‘Teacher Centre’ one-pupil, one-record online management information system developed by, and used in Ceredigion schools.
Tower Hamlets: Developing confidence to share
After 18 months of consultation with information governance teams from health and the local authority, there is now a generic NHS email inbox which NHS staff use to share information with council staff. The system is overseen by a quality assurance manager, who forwards information, queries and referrals to the relevant non-NHS member of staff. Before the system was developed, health staff were unsure about what personal information they could pass on, but the secure NHS inbox system has given them greater confidence to share.
Cardiff: Multi-agency data platform
Cardiff are working with a developer on a case management system called Eclipse which will record child and family information. Eclipse can show a family’s journey and timeline, and can capture all interventions and professional involvements recorded. The aim is for this system to be used by multiple partners.
Islington: Integrated business support
Islington’s integrated Bright Start offer for families has brought together community maternity services, health visiting, family support and engagement, speech and language therapy, and CAMHs, which are colocated in children’s centres and community health centres in the borough’s three localities. In 2018 the post of an integrated Business Support Officer was created with access to all the service data systems. This has supported the development of targeted approaches such as improving uptake of nursery placements. An information sharing agreement is in place and information governance training is provided to all staff.
Wrexham: Family information service
The family information service (FIS) in Wrexham provides free, impartial help, support and advice on a range of family issues including: childcare and help with the costs of childcare; health care; education and training; leisure services; and finances.
The service actively connects with families through social media, including Facebook pages in English and Welsh, which have over 4,000 followers and posts that regularly receive more than 10,000 reads. Posts include prerecorded and live videos, and during the pandemic there were virtual coffee and chat sessions for families.
Families wanting advice or information can call an FIS helpline, make contact by email, Facebook or Twitter, or come to a regular FIS drop-in at community venues or health clinics. The drop-ins are run by an outreach team of parent support advisers who can also work one-on-one with families, accompanying them to appointments, supporting them to attend groups or connecting them with services. Each adviser has an area of specialism, such as work with asylum seekers, children with additional learning needs (ALN), and early years.
They also work with services to raise awareness of the support available for families, and identify Information, advice and guidance champions. Where families do not meet thresholds for social care there is a loop from the single point of access to offer support to the family through the FIS. There is a similar loop with the Housing Support Gateway, so that families can be supported by FIS with other issues they face whilst their housing needs are being dealt with.
Service evaluation includes a follow-up with families two months after an initial enquiry, and the use of a ‘distance travelled’ tool where one-to-one support is provided.
Ceredigion: Parent guide on early years development
The ‘Getting Ready for the Big World’ initiative in Ceredigion was a response to concerns that children were coming into nursery and school provision without the necessary skills they needed to succeed. Families tended to be ‘in echo chambers’, with their expectations for their child’s developmental levels shaped by what they saw around them in their community. Families reported that they were missing the reassurance of regular advice and support as a result of shortages of health visitors.
In response, a new short electronic guide for parents was created. The guide provides information about stages of social, personal and emotional development in the early years, plus tips and resources to help parents boost their child’s confidence, encourage positive behaviour, and support them during each stage of their development. The guide was developed through a collaboration between the Council, third-sector run family centres, the community, health visitors, and childcare providers.
Cheshire East: ‘No app to replace your lap’
The Parenting Journey has a website with a wealth of information to support parents at each stage in their child’s development, including videos available on a dedicated YouTube channel. There is a Facebook page with refreshed and engaging content that provides tips and activity ideas for each day of the week. ‘Hot topics’ such as infant crying and screen time have attracted almost 1,000 views. Messaging like ‘there’s no app to replace your lap’ is carefully crafted and catchy.
Tower Hamlets: Outcomes Based Accountability
The Outcomes Based Accountability framework in Tower Hamlets includes both long-term outcomes (school readiness as assessed by the Early Years Foundation Stage Profile at age 5) and medium-term outcomes around improving the home learning environment. Pre- and post- intervention surveys are used to evaluate behavioural change. For example, in an initiative targeting speech and language, 300 families were identified based on health and other local data, and invited to targeted sessions in children and family centres. Early intervention workers used an initial home learning environment survey, asking families, for example how many times they read to their child or took them to the library. The survey was repeated two months later.
Outcomes-based Accountability (OBA) and Results-Based Accountability (RBA) both draw from the work of Mark Friedman and the Fiscal Policy Studies Institute: http://resultsaccountability.com/. Approaches are built around three simple questions: How much did we do? How well did we do it? Is anyone better off?
Vale of Glamorgan: Service level data on family distance travelled
The Vale of Glamorgan use quarterly RBA reports to track the data collected by key services such as Flying Start and Early Help. These reports include quantity and quality data such as:
- How many parents completed the Parents as Partners programme, and how many sessions did they attend?
- How many professionals attended an awareness programme facilitated by a social worker?
- What kinds of parents were being referred, what were their presenting issues, where did they come from and what kind of support did they receive?
- What was the distance travelled for parents receiving support on domains such as relationship skills, wellbeing, and routine and stability?
The data is reviewed with Flying Start parents and practitioners to explore what has worked well and what hasn’t, and used both to tailor the offer and to report on progress to the Flying Start management board.
Outcomes-based Accountability (OBA) and Results-Based Accountability (RBA) both draw from the work of Mark Friedman and the Fiscal Policy Studies Institute: http://resultsaccountability.com/. Approaches are built around three simple questions: How much did we do? How well did we do it? Is anyone better off?
Solihull: ‘Tartan rug’ performance scorecard
Partners in Solihull wanted to share ownership of their early years data and use this to take action, so they worked together to identify priority performance indicators. The process of agreeing the final set of indicators was important; choosing what to leave out and deciding on whether to include key indicators as success markers beyond age 5.
The agreed indicators include data on the Ages and Stages Questionnaire (ASQ), early years profile, children living in poverty, children with special educational needs and disabilities (SEND), and early education entitlement take up. Each is monitored at ward and borough level.
The data is shared widely as a red, amber or green rated chart known locally as the tartan rug, and a stakeholder group meets routinely to monitor the performance indicators.
The data is used to inform multi-agency planning to meet the needs of each ward area. For example, when the ASQ data for child development between 2 and 2.5 years showed a drop for the first time, key stakeholders came together to review the support they could give to children and families to support communication and boost language development. The process included colleagues from health visiting, education support for settings, public health, parenting support, and speech and language therapy services. It resulted in strengthening both the universal and targeted support available for families.
Cardiff: Acting on routine feedback
Cardiff Family Advice and Support was a new early help model developed in response to feedback from families about how many times they had to explain their situation. Family help advisers act as a key person, listening to the family’s story, providing interventions, advocating on the families behalf, and passing information on to relevant professionals such as those in housing or finance. Referrals for support are made via the Family Gateway, or as a step-down from the Multi-Agency Safeguarding Hub and statutory Children’s Services.
Calderdale and Kirklees: Using feedback on maternity services
An online survey was created in partnership with Maternity Services, the local authorities, University of Huddersfield, and the Maternity Voices Partnership (MVP) across Calderdale and Kirklees. The survey covered all aspects of the maternity pathway, including mental health and wellbeing, and the results were analysed by researchers at University of Huddersfield and the local MVP. Women described issues relating to restrictions on partner involvement; access to maternity-related information and antenatal classes; feeling lost in the system; continuity of care; Covid-19 safety measures; and opportunities for face-to-face support. As a result a number of actions were taken, including:
- changes to visiting arrangements to ensure partners could accompany women to all scans and midwifery or hospital appointments
- updated maternity webpages with key information in regards to the pandemic and a wider range of pregnancy and birth information in line with suggestions made by MVP
- a new ‘Who and Where to Contact’ guide to services, and a new ‘Community Midwifery Enquiry Line’ so there is always a midwife available to answer questions and support non-urgent issues
- reverting to face-to-face midwifery appointments as routine and restarting face-to-face antenatal classes in small, socially distanced groups.
Black, Asian and minority ethnic women were under-represented in the survey, so partners established a Health Inequalities Working Group and are conducting face-to-face discovery interviews with women who are less likely to give feedback through the usual channels.
Cardiff: Tracking the Flying Start cohort
Cardiff followed its 2008–2009 Flying Start cohort to the end of the Foundation Phase (at age 7), using national school test data to compare the performance of children in Flying Start areas who accessed the programme, with those living in the same areas who did not.
Accessing Flying Start was found to close 62% of the gap for reading, 37% of the gap for numeracy procedural, and 31% of the gap for numeracy reasoning. It was also associated with an increased likelihood of achieving expected outcomes on the Foundation Phase Profile.
The evaluation was used to pose questions about service design and delivery, such as whether there should be more focus in Flying Start on the prerequisite skills for later numeracy as well as language.
Possible reasons for lower Flying Start versus non-Flying Start differentials for language and communication in English than for other areas of learning assessed in the Foundation Phase Profile were explored. Whilst it was concluded that changes made to the Speech and Language Therapy Service and improvements to childcare may show improvements in future cohorts, data on language and communication in Welsh raised questions about the quality of Welsh language provision at the time.
Islington: Gathering qualitative data
Islington uses a range of methods to collect qualitative data about the Bright Start service, which supplements the quantitative data on key performance indicators, which match the stressors and resilience factors in the Bright Start vision.
These methods include, for example: gathering feedback at early childhood area partnership meetings and parent forums; conducting local surveys; collecting compliments and complaints, and individual case study examples; and interactive feedback opportunities in stay and play sessions at children’s centres where parents and their children can give their views verbally, or by drawing pictures which all inform and help shape services.
An annual staff questionnaire focuses on what and how integration is working, and the responses are used to support the development of improvements.
Caerphilly: Scaling up learning
New Tredegar, an area made up of three lower super output areas with high levels of deprivation compared to the Wales average, was selected as the focus for Caerphilly’s Early Years Integration Transformation Programme. An internal evaluation brought together the conclusions from the EIF maturity matrix process, Welsh Government evaluation, Vanguard evaluation, interviews with families and core staff, a survey of partners, and analysis of data from What Matters meetings. The evaluation identified significant improvement in communication between different teams and some important conclusions for wider scaling up of learning across Caerphilly, including:
- the need for larger scale pilot areas to ensure sustainability of the model
- the pressure on health visitor workloads
- the benefits of colocation which was a turning point, especially with GPs
- the need to bring together local authority and health staff at management levels to avoid silo working
- families are still having to repeat their story, which reinforces the need to develop one data sharing system
- further work needed on identifying the skill base, clarifying roles and developing skill mix
- the importance of capacity for change management including a coordinator and a strategic lead, and sufficient time to pause and reflect.
Tower Hamlets: Practice–research partnership
To better understand the reluctance in some families to take up the offer of funded childcare at age 2, Tower Hamlets worked with a local university on a research programme with the Bangladeshi community.
The new understandings from the research led to the development of extra stay and play sessions in children and family centres, where parents could learn more about early learning at age 2 and take away literature that they could use to convince other family member of the benefits. Grandparents and the second parent were invited to one session, and could see for themselves how their child responded to being in a group environment. Where families remain reluctant, this is understood and the child and family are offered a package of support in the children’s centre.
The initiative was set up after the university approached Tower Hamlets due to its large Bangladeshi population. The proposal went through an evaluation and ethics process before the local authority, including public health, agreed to take part. The study focused on nutrition, community values and perception as well as childcare. A further round of the research is due to start in the next few months allowing for further exploration of issues related to Covid-19 and the lockdowns.
‘The programme gave us in-depth feedback on the barriers faced by the local community on certain issues, details which we would not have been able to explore on our own. These types of partnerships allow us to independently verify the effectiveness of existing programmes, as well as gather structured data and feedback to inform commissioning of new services to meet identified and needs.’