Saving the human race – delivering health and care beyond the walls

Introductions and aims of the session – Chair, Elaine Meade Understand key success factors from early years improvement work Understand how Asset Based Community Development can help focus improvement work Explore techniques for engaging communities and families in the improvement work

Judith Ainsley

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

Early experiences actually get into the body, with lifelong effects—not just on cognitive and emotional development, but on long term physical health as well. A growing body of evidence now links significant adversity in childhood to increased risk of a range of adult health problems, including diabetes, hypertension, stroke, obesity, and some forms of cancer. This graph shows that adults who recall having 7 or 8 serious adverse experiences in childhood are 3 times more likely to have cardiovascular disease as an adult. >50% of the incidence of depression and suicide attempts could be attributed to adverse childhood experiences Boys assessed as “at risk” at age 3 had 2.5 times as many criminal convictions at age 21 than those “not at risk”

Early experiences actually get into the body, with lifelong effects—not just on cognitive and emotional development, but on long term physical health as well. A growing body of evidence now links significant adversity in childhood to increased risk of a range of adult health problems, including diabetes, hypertension, stroke, obesity, and some forms of cancer. This graph shows that adults who recall having 7 or 8 serious adverse experiences in childhood are 3 times more likely to have cardiovascular disease as an adult. And children between birth and three years of age are the most likely age group to experience some form of maltreatment–16 out of every thousand children experience it.

Our context Community Planning Partnerships - Partners work together to achieve positive outcomes for citizens (5m) Multi agency approach Children from 0-8 Health inequalities Social inequality 170,000 children live in poverty Early Years experience has a substantial impact on outcomes We have similar problems in terms of smoking, diet, activity etc. to other developed societies. However recent evidence suggests that the additional disparities are down to 4 causes: Drink Drugs Suicide Violence All have psychosocial roots which can be heavily influenced by elevated stress responses and other issues with brain chemistry and brain architecture that can be traced back to adverse early years experiences. This is the reason Scotland has placed such an emphasis on the early years.

The Early Years Collaborative been building will & generating ideas for a while! Brain develo-pment Perry Pre-School Ed (2004) GIRFEC CMO report (2007) Early Years Frame-work (2008) Early Interv-ention (Allen 2010) Joining the Dots (2011) Collabo-rative (2012) Knowing is not enough; we must apply Goethe

Early Years Collaborative -9 months to 1 year 1 year to 30 months 30 months to Primary school Leadership 5 – 8 years Scotland – the best place in the world to grow up The EYTF considered how we might make this into manageable chunks so that partners can coalesce around particular communities of interest. So we have the workstreams set out on this slide. Recognise that these interact and merge with each other. Note the new workstream Leadership – ensuring that the right conditions exist to create, stimulate and facilitate an improvement culture and to ensure barriers to improvement are removed quickly.

Stretch Aims Positive pregnancies which result in the birth of more healthy babies by end 2015, through a reduction of 15% in the rates of stillbirths and infant mortality. 85% of all children reached all of the expected developmental milestones at the time of the child’s 27‐30 month child health review, by end‐2016 90% of all children reached all of the expected developmental milestones at the time the child starts primary school, by end‐2017 90% of all children in each Community Planning Partnership area will have reached all of the expected developmental milestones and learning outcomes by the end of Primary 4, by end-2021

The story so far Year 1 practitioners chose tests of change and became familiar with the method Year 2 we identified key changes Now have 40 Pioneer Sites Faster learning for scale and spread 4 Learning Sessions Learning Session 5 on 9 and 10 June

Importance of using our Assets Massive change across the public sector Scarcity of economic resources Health and Social Care Integration Children and Young People’s Act Lots of improvement activity All working to improve things for the same children and families

grow diminish Economic resources diminish with use money materials technology Natural resources grow with use relationships commitment community Adapted from Albert Hirschman, Against Parsimony & @helenbevan

1140 -1145 1410 -1415 Video ABCD in the Early Years Collaborative

Angela Glassford – Head Teacher 1145-1200 1415-1430 Angela Glassford – Head Teacher ABCD – Assets Based Community development Shared understanding of asset based work - what this looks like in your context (values and approach) What did we set out to achieve and why? What was the plan and how things happened? Sharing some of the specific ways in which we engaged with children and their families to develop both individual and community assets (our change ideas) How this enabled us to deliver better health and wellbeing outcomes and experiences for the children in our locality How this fitted with our local priorities? The infrastructure to support it.  How we plan to spread and sustain this approach as we move forward

Early Years Strategy Recognised need to focus on early years Multiagency responses Workshops to develop model Culture Change Family Focussed Approach £6.8 Million investment

Growing health and wellbeing Delivering! Salutogenesis Growing health and wellbeing

Locality Model Ferguslie and Linwood (Pathfinder Areas) Core Teams in each locality Mapping of existing community assets Strengthening of links between existing services, including third sector Integrated practice across the disciplines Building universal services and increasing community capacity Targeting support in partnership with families

What do families tell us? Someone to listen to me…not numerous people I have to tell the same thing to again and again More support with mental health Someone to help me see what my problems are and with support, how I can solve them Someone to look at my whole family and not just judge me More time with someone helping me Contact with others so I don’t feel alone Someone to tell me when I’m doing well…this really worked!

Core Team Structure Locality Manager Family Core Team Co-ordinator Family Wellbeing Worker (across both areas) 3 Family Keyworkers Admin Worker

Evaluation criteria Family centred Responsive early intervention Integrated working Flexible delivery of services Adding value Minimising barriers Scalable Measured against shared goal setting

John Trainer Angela Glassford Giving Our Children the Best Start in Life – A Strategy for the Early Years in Renfrewshire John Trainer Angela Glassford

Sustain and Spread “It’s not what you do it’s the way that you do it.....” Link back to families as the driver of change and development Outreach Organisational change Convert and enable Security of funding commitment Political will

1200-1215 1430-1445 Driver Diagrams

Knowledge for Improvement Subject matter Knowledge Appreciation of a system Theory of Knowledge Psychology Understanding Variation Knowledge for Improvement Values

Where in the System of Profound Knowledge are we learning? Appreciation of a System Where in the System of Profound Knowledge are we learning? Theory of Knowledge Psychology Understanding Variation Values

What is a theory? A description of our best understanding about why things are the way they are Theories/beliefs in other contexts? Economics – game theory Biology - theory of evolution Physics – string theory Metereology – chaos theory Assets Based Community Development…?

How is a theory different from a belief? A theory can be tested scientifically Theories are predictions of the outcome of future events Theory is the starting place for generating new knowledge

Project Driver Diagram do study act plan

What do we believe about why things are the way they are? Evidence – what objective evidence have we collected locally or is available to us through the relevant literature? Local subject matter experts – people who work at the frontline who experience the system day to day and have strong experiential beliefs about where change is needed

Some guidance on creating a driver diagram Start with the outcome in mind – develop an aim statement that reflects the desired future state Primary drivers should be nouns that reflect the key leverage points in the system of interest from three areas: Structures – physical, financial, administrative, management and improvement, delegation and accountability Processes – workflow of the system, how things are accomplished Operating norms – written and unwritten rules that govern behaviour

Some guidance on creating a driver diagram Secondary drivers must be tangible things where action can be taken on the system Change ideas should link directly to secondary drivers and should exhibit these characteristics: Specific - each change idea needs to be clear and concise and it must be obvious how its introduction is different from the status quo How to - each change idea must include a statement about how and where it will be put into practice within the system

So can we use this approach today? 1215-1220 1445-1450 So can we use this approach today? Table time to develop your own aim – 5 minutes

1225-1240 1455-1510 TRIZ Change ideas - using Triz as a mechanism to get the elephant in the room and the change ideas on the table! TRIZ is the science of creativity derived from all scientific and engineering solutions. TRIZ is a problem solving toolkit; the principal TRIZ tools direct us to find all the ways of solving a problem, to find new concepts and the routes for developing new products. TRIZ has simple general lists of how to solve any problem; these TRIZ solution triggers are distilled from analysing all known engineering success. There are also tools for problem understanding, for system analysis and for understanding what we want. TRIZ offers systematic innovation; by learning TRIZ and following its rules we can accelerate creative problem solving for both individuals and project teams. Companies that successfully apply TRIZ are using the success and knowledge of the whole world, and are not dependent on the spontaneous and occasional creativity of individuals, or groups of engineers, within their organisation. TRIZ is not just powerful for technical problem solving but is also successfully used on a wide range of management issues. What can TRIZ do? It can help us solve problems It can help us think clearly, powerfully and see the wood for the trees when confronted with a complex problem situation It can help us be creative (invent new systems, find next generation systems, come up with lots of new ideas etc.) It can help us be innovative (find new ways of using and improving existing systems, existing technologies etc.) It can help teams work together to pool their brain power and experience, enhanced by the distilled world’s knowledge of the TRIZ tools It can help us improve existing systems and increase the ideality of systems by lowering costs, removing harms or increasing benefits It helps us use our resources: we can often find quick, cheap solutions to problems with TRIZ and it will help us turn harm into good It gives us quick solutions It gives us a structure to brainstorm around difficult problems – even with those unfamiliar with TRIZ It will help us structure and use our thinking time effectively - we know that we’ll be looking in the right direction and places

How could we STOP Assets Based Community Development? 5 minutes table work to get ideas – be as radical as you can be! Make a list of all you can do to make sure that you achieve the worst result imaginable with respect to ABCD

From your list – cross out everything ABSOLUTELY not possible 5 minutes Go down this list item by item and ask yourselves,: Is there anything that we are currently doing that in any way, shape, or form resembles this item? Be brutally honest to make a second list of all your counterproductive activities/programmes/procedures

So what are you left with? 5 minutes – feedback Go through the items on your second list and decide what first steps will help you stop what you know creates undesirable results Are these your secondary drivers or change theories to work on?

Group your change ideas at your table feedback

Now populate the Driver Diagram What will be different at the level of: 1 5 25 125 625 ????

1240-1245 1510-1515 SUMMARY Next steps What are you going to do by next Tuesday?