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The earliest years of child’s life represent the single greatest chance to make a lasting impact on a child’s future We’re all here because we all know that…

The Evidence Base Joining the Dots (Professor Susan Deacon, 2011) Chief Medical Officer’s Report (CMO, 2007) Early Intervention (Graham Allen, 2010) Early Years Framework (2008) ‘Getting it Right for Every Child’ (GIRFEC, 2004) Neuroscience and Brain Development Research (Dr Bruce Perry) Scottish Government Economic Modelling (2010) The Evidence Base The evidence is there and has been for some time. Now we need to act on it

Toxic Stress Scientists now know that chronic, unrelenting stress in early childhood, perhaps caused by extreme poverty, neglect, repeated abuse, or sever maternal depression for example, can be toxic to the developing brain. While positive stress (moderate, short lived physiological responses to uncomfortable experiences) is an important and necessary aspect of healthy, toxic stress is the strong, unrelieved activation of the body’s stress management system in the absence of the buffering protection of adult support.

Toxic Stress Damages Developing Brain Architecture Typical neuron: many connections Neuron damaged by toxic stress: fewer connections Scientists now know that chronic, unrelenting stress in early childhood, perhaps caused by extreme poverty, neglect, repeated abuse, or severe maternal depression, for example, can be toxic to the developing brain. While positive stress (moderate, short-lived physiological responses to uncomfortable experiences) is an important and necessary aspect of healthy development, toxic stress is the strong, unrelieved activation of the body’s stress management system in the absence of the buffering protection of adult support. This image depicts the structure of neurons in the areas of the brain that are most important for successful learning and behaviour in school and the workplace—the hippocampus and prefrontal cortex. The neuron on the right, which has been subjected to toxic stress, clearly displays underdeveloped neural connections, or weaker brain architecture.

We know that when we experience this toxic stress in early childhood it can have an impact on our health and education, with serious life long consequences

To ensure that all children have appropriate, positive experiences Scotland needs to work to bring together the many people involved in young children’s lives To ensure that all children have appropriate, positive experiences

Let’s promote the development of healthy brain architecture Let’s provide a strong foundation for future learning, behaviour and health

Context National Outcome 2007 Our children have the best start in life and are ready to succeed Early Years Framework 2008 10 key elements Early Years Taskforce 2011 In partnership with local government, the NHS, the police and the Third Sector We know the evidence Let’s put the EYC into some sort of context National outcome Early years framework published – lay down 10 key elements of transformational change such as offering a coherent approach, using the strength of universal services to deliver prevnetion and early intervention and key to the EYC, more effective collaborative The early years taskforce will accelerate the change programme putting in place practical action Which brings us to the EYC

Threaded throughout the early years agenda is getting it right for every child which is founded on the principles of early intervention through appropriate, proportionate and timely intervention, ensuring that all Scotland’s children and their families have consistent and co-ordinated care when they need it

How? EYC is the practical action and the means to deliver all the aspirations from the framework, the task force and GIRFEC

Our Ambition To make Scotland the best place in the world to grow up in by improving outcomes, and reducing inequalities, for all babies, children, mothers, fathers and families across Scotland to ensure that all children have the best start in life and are ready to succeed

What does a collaborative look like? Action Phases P P P Pre-work A D A D D A S S S LS1 2 day Kickoff 2 day LS4 2 day LS2 2 day LS3 Etc… Supports Expert QI & Early Years Faculty Networking events Local Learning WEBEX Site Visits Phone conferences PDT Monthly Reports Extranet Key Changes Improvement Measures So what does the EY Collaborative look like so far, first CPP areas were asked to complete some pre work looking at their local priorities and where the EYC sat with what was happening locally. Then the 1st big learning event in Glasgow where we saw delegates from all over Scotland gathered and there was a commitment made to be part of the Collaborative otherwise known as the ’Kickoff’, then into the 1st action period, where areas were gathering their home and away teams, having local learning sessions and starting to carry out small tests of change, using the Plan, Do, Study, Act, cycle with many support structures in place Action Periods are where the home teams do the improvement work with support continuing from the national team October 2013 January 2014 June 2014 October 2014 4 4 4 13 13

Workstreams Conception to 1 year 1 year to 30 months 30 months to start of Primary School Start of Primary School to end of Primary 4 Leadership Scotland – the best place in the world to grow up Anncris has already told you how he EYTF considered how we might make the EYC into manageable chunks so that partners can collaborate around particular communities of interest. So we have the workstreams set out on this slide. Recognise that these interact and merge with each other. Leadership – ensuring that the right conditions exist to create, stimulate and facilitate an improvement culture and to ensure barriers to improvement are removed quickly. Many areas working across themes & this may help you id where you could fir in at a local level

Stretch Aims - Workstream 1 To ensure that women experience positive pregnancies which result in the birth of more healthy babies as evidenced by a reduction of 15% in the rates of: - stillbirths (from 4.9 per 1000 births in 2010 to 4.3 per 1000 births in 2015) - infant mortality (from 3.7 per 1000 live births in 2010 to 3.1 per 1000 live births in 2015) The taskforce, consisting of experts and professionals from early years across Scotland developed three stretch aims, focusing on three main areas Pre-conception to 1 year 1 year to 30 months And 30 months – primary school There will also be a fourth workstream around leadership and how leaders across scotland can lead the change Let’s look at more detail at the stretch aims and a little look at the driver diagrams for these

Workstream 2 85% of all children within each CPP have reached all of the expected developmental milestones at the time of the child’s 27-30 month child health review by end-2016

Workstream 3 90% of all children within each CPP have reached all of the expected developmental milestones at the time the child starts primary school, by end-2017

Workstream 4 90% of all children within each CPP have reached all of the expected developmental milestones and learning outcomes by the end of Primary 4, by end 2021

Leadership Workstream Provide the Leadership System to support quality improvement across the Early Years Collaborative Timely delivery of all three workstream “stretch aims”

Stretch Aims ‘Be the Change You Wish to See in the World’ – Mahatma Ghandi Going back to the stretch aims and the magnitude of them, this has a purpose. If we make the improvement target only 1%, we would just work harder, we wouldn’t change the system Stretching the aims and make the improvement task harder means we have to stand back and take stock. We have to get off the hamster wheel and look at what we need to do. We can’t do it by hard work alone. We need to change the system

Key Changes The Big Ticket Items for Scotland Informed by Early Years Collaborative testing across Scotland and experts in early years Now the EYC has been spreading and testing across Scotland, we can see common testing themes emerging. These are the things that we think will make the biggest different to working towards our stretch aims

Early Support for Pregnancy & Beyond Attachment and Child Development Continuity of Care in Transitions 27-30 month Child Health Review Developing Parenting Skills Family Engagement to Support Early Learning Addressing Child Poverty Key Change Themes Although many people are now testing under these themes, we recognise there there is still lots of other important work than happens out with them

Model for Improvement Act on the plan - Testing The tool that the EYC is going to use is call the model for improvement. This was developed in industry and borrowed by health, where it has got some really excellent tangible results. So we’re going to give it a go in the early years world MFI is made up of 2 parts – the thinking part and the doing part The 3 questions – the thinking part prepares you for the test by asking the ‘so what’ question They need to be thought through, answered and written down by the improver to ensure that they, and therefore their colleagues, are clear on the benefits to them and their work. That message often gets lost in the many things we are expected and asked to do and is one of the reasons why so many interventions are not implemented reliably. If we are not clear on the benefits of something we are much less likely to do it. The Plan Do Study Act cycle is a simple tool that’s used to test out ideas that will improve your systems and processes while learning what works and doesn’t work. It’s a structured approach for making small incremental changes to systems that allow you to test on a small scale, learn from successes and failure and redesign as you go It builds learning and buy in incrementally as tests ramp up and allows clinicians knowledge about their own system is built in to the process 23

This is the start of our improvement journey in early years using this model Some people have already begun testing and exciting changes are happening

This is new, so be brave! Whilst the early years of a child’s life have always been critical – this is a new way of working & changes in organisations can take time so we need to be brave & make the most of this opportunity

@EYCollaborative #bestplacetogrowup EYCollaborative@scotland.gsi.gov.uk www.scotland.gov.uk/earlyyears Just a reminder of how to keep in touch – add local contact details as appropriate Thankyou – any questions?