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

2. 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

3. Judith Ainsley

4. 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

5. 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”

6. 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.

7. 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.

8. 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

9. 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.

10. 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

11. 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

12. 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

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

14.
Video
ABCD in the Early Years Collaborative

15. Angela Glassford – Head Teacher
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

16. 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

17. Growing health and wellbeing
Delivering!
Salutogenesis
Growing health and wellbeing

18. 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

19. 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!

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

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

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

23. 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

24.
Driver Diagrams

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

26. 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

27. 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…?

28. 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

30. Project Driver Diagramdo
study
act
plan

31. 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

32. 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

33. 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

34. So can we use this approach today?
So can we use this approach today?
Table time to develop your own aim – 5 minutes

35.
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

36. 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

37. 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

38. 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?

39. Group your change ideas at your table
feedback

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

41.
SUMMARY
Next steps
What are you going to do by next Tuesday?