Learning Mentor & Parent Support Adviser Network 13th November 2013 Shrewsbury Training and Development Centre

Programme Healthy Child Programme Children with Disabilities/additional needs Family Information Service Early Help

Healthy Child Programme Pregnancy- 19 years Anne-marie Speke Shropshire Council Healthy Child Programme Coordinator Intro my role

Healthy Child Programme 0-19 years Healthy Child Programme (HCP) is the government’s early intervention and prevention public health programme from conception to 19 years The guidance is directed at statutory agencies, commissioning bodies, GPs, midwives, practice nurses, school nurses and health visitors. Delivery includes all agencies working with children and young people.

Health Child Programme Evidence-informed practice The use of new developments; Responding to changed public health priorities Integrated service provision, including GP’s and children’s centres, and through better integration between maternity services; An increased focus on vulnerable children and families; Parenting support, including support for fathers. Evidence-informed practice, reflecting a shared understanding of attachment, positive parenting, maternal mental health, and responses to risk factors; The use of new developments in vaccination and immunisation programmes, newborn hearing screening, and information systems; Responding to changed public health priorities (eg, increasing the prevalence of breastfeeding, reducing childhood obesity), including taking a more proactive role in promoting the social and emotional development of children; Integrated service provision, including GP’s and children’s centres, and through better integration between maternity services; An increased focus on vulnerable children and families; Parenting support, including support for fathers.

Healthy Child Programme Schedule of interventions to address the priorities for the health and well-being of children. Offers every family a programme support Healthy Child Programme, reflecting that the early years and transition stages are a critical time in a child’s life Offers every family a programme of screening tests, immunisations, developmental reviews, and information and guidance to support parenting and healthy choices. Healthy Child Programme for 0-5’s split in stages: pregnancy up to 28 weeks, after 28 weeks, birth to 1 week, 1-6 weeks, 6 weeks to 6 months, 6 months to 1 year,1 to 3 years, 3- 5 years which reflects the critical time of life for younger children 5-11, 11-16 and 16-19.

Healthy Child Programme 0-5 years Universal: health and development reviews, screening and physical examinations, promotion of health and well-being, preparation for parenthood and promotion of sensitive parenting and child development, involvement of fathers, mental health needs assessment, signposting. Progressive: emotional and psychological problems addressed, promotion and extra support with breastfeeding, support with behaviour change e.g. smoking, parenting support programmes, promoting child development, additional support and monitoring for infants with health or developmental problems, CAF/EHAF, topic based groups. Higher risk: high intensity based intervention, intensive structured home visiting programmes by skilled practitioners, referral for specialist input, action to safeguard the child, contribution to care package led by specialist service

Healthy Child Programme 5-19 years A national public health programme for children and young people from 5-19. Provides a robust evidence based framework and sets out good practice for prevention and early intervention services Identifies the school nursing service as crucial to the effective delivery of the Healthy Child Programme Assists local areas to ensure services: are based on a robust needs assessment utilise effective practice and prioritise evidence based programmes make best use of their workforce

Healthy Child Programme 5-19 Universal- Heath Assessment at School entry, vision and hearing, emotional health, psychological well being and mental health, promoting healthy weight, on going support through primary school, support for parent carers. (11-16 includes sexual health, immunisations transition health review, 16-19 also includes emphasis on transition into further education) Progressive- immunisations for at risk CYP, emotional health, psychological well being and mental health tier 2,3,4, overweight and obese children, specific groups of at risk children and families, support for parents and carers

Links to Shropshire Children’s Trust priorities Priority 3 Ensuring the mental wellbeing of children and young people by focusing on prevention and early intervention Priority 4 Keeping more children healthy and reducing health inequalities. Priority 3 Provide support for parents and carers to help them promote emotional well-being for their children Provide better information to enable children and young people to access the help they need. Develop a more integrated approach to supporting mental wellbeing outside of school and health settings, such as youth clubs and children’s centres. Priority 4 Focus on preventative support such as around breastfeeding, healthy eating, smoking cessation and alcohol misuse, targeted at our most vulnerable communities through our Children’s Centres. Increase the number of children and young people who are a healthy weight by contributing to the development of a coordinated obesity strategy and evaluation of the effectiveness of current programmes. Reduce numbers of young people requiring hospital treatment for alcohol abuse. Maintain low levels of teenage conceptions

HCP links to Public Health Outcomes 2013-2016 Increased healthy life expectancy Reduced difference in life expectancy and healthy life expectancy between communities.

HCP links to Public Health Outcomes Indicators Health improvement Objective: People are helped to live healthy lifestyles, make healthy choices and reduce health inequalities. Health Protection Objective: The population’s health is protected from major incidents and other threats, while reducing health inequalities Healthcare public health and preventing premature Objective: Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities Health Improvement indicators Low birth weight of term babies Breastfeeding Smoking status at time of delivery Under 18 conceptions Child development at 2-2.5 years (Placeholder) Excess weight in 4-5 and 10-11 year olds Hospital admissions caused by unintentional and deliberate injuries in under 18s Emotional wellbeing of looked-after children (Placeholder) Smoking prevalence – 15 year olds Hospital admissions as a result of self-harm Diet (Placeholder) Health protection includes: Chlamydia diagnoses (15-24 year olds) Population vaccination Health care public health includes coverageInfant mortality, Tooth decay in children aged 5

Complexity of new commissioning arrangements PH came to LA in April 2013 and with it commissioning responsibility for 5-19 including SN Need clear and strong links with between commissioners and providers create greater links with GP’s

School Nurse Review Commissioning for the Healthy Child Programme 5- 19 years became the responsibility of LA in April 2013 this included the School Nursing Service An initial report re 5-19 years went to Children’s Trust 3rd September 2013 In Mat 2013 a review of the current school nursing service began. The first stakeholder event held in May enabled us to put together a local economy shared vision based on DH vision for School Nursing

Local Health Economy Shared Vision Key questions that need to be asking ourselves: What role do we play in this how can we assist? What does this mean for you? How might it help? How do we ensure that it happens? Activity To come up with potential 1 short term and 1 long term solution for the priority.

Consultation methods Focus groups/ interviews/ presentations Questionnaires Stakeholder Events School Nursing Leads Public Health Leads Health Visitors and Children’s Centres Family Solutions Early Help Safeguarding Domestic Violence Looked after children Targeted Youth Support Youth Offending Service Leads for children not in mainstream education Lead for travelling communities Voluntary Sector Police Children and young people Parents Staff Primary Care CCG Commissioners Providers Schools Healthwatch Looked after children lead NHS England Public Health England School Nurses Individual interviews/ focus groups Collective feedback from stakeholder events and individual interviews on table

National maximum caseload requirements National estimates suggest that a school nurse (Band 6) has a maximum of 2,500 children on caseload. This shows actual levels but doesn’t take into account workload or travel Area the school is in Number of children Actual WTE Band 6 school nurses Caseload per WTE Estimated WTE required school nurses Difference in WTE North East 8,460 2.56 3,305 3.4 2,500 -0.8 North West 4,456 1.22 3,652 1.8 -0.6 North 12,916 3.78 3,417 5.2 -1.4 S&A 11,636 3.32 3,508 4.7 -1.3 South East 6,182 2.52 2,453 2.5 0.0 South West 4,868 1.75 2,782 1.9 -0.2 South 11,050 4.26 2,593 4.4 Shropshire 35,602 11.36 3,134 14.2 -2.9

WTE Activity Model by Work stream   NE NW North SA SE SW South Shropshire Core HCP activity 0.2 0.1 0.3 1.4 (4.3%) Delivery of health promotion programmes 0.0 0.3 (0.9%) Safeguarding 1.8 1.0 2.8 2.4 0.8 6.9 (20.9%) Teacher training 0.6 (1.7%) Other activity 3.2 2.0 5.2 3.6 6.9 15.9 (48.2%) Public health leadership 0.0 (0.0%) Travel time 0.4 0.7 1.5 (4.7%) Total workstreams 5.7 3.3 9.0 8.5 4.7 9.9 26.6 (80.7%) Additional admin 1.4 2.5 1.7 2.1 3.8 6.3 (19.3%) Total WTE 7.0 4.3 11.4 11.1 13.8 32.9 (100%) Look at far right column which shows where work stream is coming from need to find creative ways to readdress this balance Activity What creative solutions one long term one short term can you think of that for your priority?

Next Steps Feedback of School Nursing Service consultation with recommendations New School Nursing service specification in place From April 2015 commissioning responsibility for Health Visiting Service will be transferred to Local Authority Re-establish Healthy Child Programme Steering Groups 0-5 and 5-19 years Stakeholder event held at end of October to feedback key findings from consultation Report to Children’s Trust and Health and Well Being Board November Provider response December 2013 New service specification written April 2014 in place Autumn 2014

Short Breaks/ Participation Fund Harry Cade Short Breaks/ Participation Fund

Family Information Service (0-19) Free information, advice and support on all aspects of family life, whether you are expecting a baby or are the parent or carer of a toddler or teenager. Research shows that 75% of parents say there are times in their lives or the lives of their children when they need information to support them in their roles as parents. The Family Information service has been established to help parents access information about options and possibilities which they may not have known about and to support parents in their role as parents. We could provide the information there and then, or we could undertake research into a specialist subject or we could signpost you to a specialist service. The FIS as the first universal point of contact for vulnerable families whose children who do not meet the thresholds for safeguarding but who are experiencing crisis in the home. We are therefore a key service for the Early Help Offer

Childcare Act 2006 Local Authority statutory duty to provide information, advice and assistance Brokerage service Care, advice and support services for disabled children Services, facilities or publications which may be of benefit to parents, young people or children The Childcare Act places a legal duty on the LA to provide information to parents – showing how important information is Brokerage service – for those parents who can’t find childcare to meet their needs, or for those parents who are struggling to access services, and who need some extra support. Childcare Act places additional responsibilities on supporting parents of children with a disabilities – who face additional barriers for accessing services. The services, facilities and publications shows the vast range of information required to provide – it could be anything and everything – as no two family are the same.

FIS Vision For families to have access to quality, up to date and comprehensive information to help make a difference to their lives and the lives of children and young people in Shropshire. Information could be provided directly to parents, or family members or through Practitioners to pass onto families.

FIS Aims To ensure Shropshire Council is meeting its statutory duty as detailed in section 12 of the Childcare Act 2006, and referred to as the Information Duty. To ensure children, young people and families are at the heart of the service. We will operate in a family focused and child centred way. For services to be integrated and co-ordinated around individuals and to work in partnership for the benefit of children, young people and families. To provide free, impartial access to high quality information that supports families and their children. 1 – already spoken about this 2 – we value children, young people and parents and operate in a very customer centred way 3 – we look at the needs of the families and tailor information to meet those needs. 4 – we have to be impartial and so can not recommend but we can support parents in making informed choices. We work hard to ensure the information is up to date and accurate, but obviously rely on a lot of services keeping us up to date – which is vital in the current climate with services changing so frequently.

Aims Cont… To ensure the service is delivered by a trained and skilled workforce. To ensure information is available through a variety of channels. To work with other agencies and departments to deliver a co-ordinated and seamless approach to services for families. Meet current and future information needs through ongoing consultation. Embrace and evaluate new technologies to ensure further access to the FIS. To provide the best value for money service. 1 – we have a team of 6 Information Assistants, and 2 modern apprentices. 2 – we try to look at how parents want to access information, and to try to meet those needs by offering a multi channel approach to information delivery 3 – it’s easy to loose track of the services or to be confused if families are accessing different services, so we try to make it as clear and seamless as possible 4 – some of the best ideas for service developments have come directly from parents and other service users so it’s important for us to ask them for their ideas. 5 and 6 go hand in hand, we are trying to look at new, cost effective ways of delivering the information service

This is just an example of the information we can provide and some of the topics of enquiries we can get. We respond to approximately 6500 request for information annually. We will always get enquiries about registered childcare as we are the only service that can provide that comprehensive information, as we get daily updates from Ofsted Things to do and places to go is a key information need for parents, and one of the top enquires we receive Finance, benefits and money matters is on the increase in these current economic times. Family health, healthy eating Safety, child protection A significant number of enquires are around family support – parents, or professional supporting parents, looking for information to help them in their role as parents, relationships, bereavement, behaviour, SEN and disabilities, housing

Delivery Routes Telephone helplines Face to face appointments Outreach events Email/website Social Media On-line directory of services Ebooks/Apps Telephone helpline – Mount McKinney and Customer Service Centre Face to face – Information assistants working in the MATs and within a geographical area Email/website Outreach events Social Media – trailblazer for the use of social media On-line directory of services – which have over 2000 live records Ebooks/Apps a deliver model which enables the service to continue to support the most vulnerable families in Shropshire through more targeted intervention and early help, whilst also making best use of online tools to deliver information to the majority of families.

Especially want to highlight the Family Information Directory It has over 2000 entries on there – local, regional and national groups and organisations that support families, children and young people.

FIS Enquiry Statistics The majority of request for information comes directly from parents but over recent years we have seen a significant increase in the number of enquiries that have come from professionals and partner agencies that are supporting parents and young people. Those practitioners accessing the FIS on behalf of families include: social workers, children’s centre support workers, targeted youth support, teachers and school staff, health visitors, community safety officers, family support workers, GPs, housing officers, CAMHS, refuge workers, Job Centre Plus.

There is a higher percentage of families with under 5s accessing the service – but this is mainly with childcare requests.

Family Information Service Information to make a difference

Tina Dyke & Suzanne Treherne Early Help