1. Greater Manchester Public Service Reform Early Years New Delivery Model Update June 2014 Pat McKelvey Early Years Lead

2. What are we doing in Greater Manchester? 10 Local Authorities 175 Children’s Centres 12 CCG’s 855 primary schools 7 Maternity Providers 1214 Daycare providers 6 HV Provider Trusts 777.5 Health Visitors (in 2015) 37500 babies per annum

3. 3 GM Consistent principles of reform 1. Interventions chosen on strength of evidence base 2. Integrated, co-ordinated and sequenced – bespoke packages of support at the right time, in the right order 3. Family based approach to changing behaviour, not just focus on individual 4.Methodology: -Define the cohort, and how they are identified -Co-design new delivery models with partners based on these three principles -Cost-benefit analysis based on modelled assumptions vs business as usual -Test examples of reform, obtain evidence -Replace modelled assumptions with actuals -Use as basis for securing investment from partners into scaling up -Decommission reactive services no longer required as we reduce demand, reinvest some of the savings

4. To increase the number of children who are ready for school by making the best use of resources to improve outcomes for all children in their early years and close the gap in performance for the Early Years Foundation Stage Profile (EYFSP) between all children and the bottom 20%. Early Years New Delivery Model Business Case Oct 2012 Early Years Overall Objective

5. No silver bullet, most families will need a sequenced package of support, some over two years and others even longer Holistic approach taking the whole child within the whole family Integrated across sectors - health, local govt, daycare providers, voluntary providers Early identification of need and risk factors through timely assessments points Evidence-based approach to assessment and intervention Ensuring maximum VFM for the taxpayer Emphasis throughout on work and skills for both children and parents (linking with Universal Credit) Evaluation to inform planning and policy making New Delivery Model Principles

6. New Delivery Model Components 1. A shared outcomes framework, 2. A common assessment pathway across GM 3. Evidence-based assessment tools 4. A suite of evidence-based interventions 5. Ensuring better use of daycare 6. A new workforce approach, to drive a shift in culture 7. Better data systems 8. Long-term evaluation

7. Outcomes - Population Children ready to learn Improved family Health & well-being Improved economic and well being Improved parenting skills Children achieving a good level of development - at age 2 to 2 ½ (ASQ3/SE) - Early Years Foundation Stage Profile Breastfeeding rate 6 to 8 weeks Hospital emergency admissions caused by unintentional and deliberate injuries to children Referrals to Children’s Social Care Secure attachment/Social and Emotional Development KPI Children accessing high quality Childcare Home Learning Environment Index Children living in poverty KPI Disclosures of Domestic Abuse

8. Outcomes - impact School Readiness (incl. cognitive dev) Behavioural/ emotional dev. Population earnings Population unemployment Truancy Exclusion ASB Crime Maternal supportiveness Early cognitive stimulation Early development Short term direct parental impacts: e.g. employment, smoking Short term direct child impacts: e.g. use of health services Intervention Mental health

9. Outcomes - Child

10. The 8 Stage Assessment Stage 2 New Birth Visit 10 – 14 days Health Visitor Newborn Behavioural Observation Stage 3 2 months Health Visitor (EPDS, ASQ3) Stage 4 9 months Health Visitor (ASQ3 & ASQSE if in use) Stage 4b Targeted 18 months Children’s Centre or HV team To identify need and promote uptake of 2 year old Early Learning Offer (ASQ3 & ASQ SE if in use) Stage 5 24 months HV & EY provider Integrated Review/Information to be shared (ASQ3 and EYFS, ASQSE if in use) Stage 6 On entry to Nursery (universal 3/4 year old provision) EY Provider/School (ASQ3 and EYFS, ASQSE if in use) Stage 7On entry to Reception in school EY Provider and receiving school (ASQ3 and EYFS, ASQSE if in use) Stage 8 Early Years Foundation Stage Profile Optional ASQ3 &/ SE (up to 5 ½ yrs of age) Undertaken by school within the last term before the child's 5th birthday (by30/6) Stage 1 Pre Birth Under Review All points are already part of Healthy Child Programme or Early Years Foundation Stage apart from Stage 4b, which is a targeted assessment for children identified with needs at stages 2 to 4 Assessments at Stages 2, 3 and 4 to be undertaken within the family home wherever possible The engagement points will be expected to be undertaken in line with the appropriate ASQ3 tool ASQ3 is parent led, standardised, retest reliable, and has been selected as the National measure of childhood development at 2/2 ½. EYSF is used throughout within early learning settings to measure progress.

11. Assessment and Outcomes tools Universal Newborn Behaviour Observation Edinburgh PND QuestionnaireEarly Years Foundation StageAges and Stages 3 (ASQ-3) Home Learning Environment Index Ages & Stages (Social Emotional) Targeted Neo-natal Behaviour Assessment Scale (NBAS) CAFBeck Anxiety / Depression Achenbach Child Behaviour Checklist or Eyberg Child Behaviour inventory Karitane Parenting Confidence Scale Parenting Stress IndexWellComm Screening Tool

12. The Child The Child In Context The Family The Community The Child in the Family Assessments to cover:- Learning and development Evidence based tools incl. ASQ3

13. Core Pathways Parent Infant Attachment / Parental Mental Health Communication and LanguageSocial, emotional and behaviouralEmployment and skills Vulnerable Families (Complex Dependency) Young parentsSpecial needs and disabilityMaternal health in pregnancy

14. EIF evidence standard: criteria and ratings

15. Suite of Evidence Based Interventions Universal Baby Express Healthy Child Programme Newborn Behaviour Observation Children's Centres Solihull Approach Every Child A Talker 3-4 yrs olds Childcare Early Years Foundation Stage Targeted Family Nurse Partnership Neo-natal Behaviour Assessment Scale (NBAS) Incredible Years Parenting Programme Triple P parenting programme Parent Child Communication and Language Group Targeted 2s daycare

16. 1.Project Team and worksgroups continue to develop details to support implementation, notably re sustainable effective workforce 2.Localities are establishing Early Adopters aiming to test the model in a ward/s 3.Exploring funding options for staged implementation of the full model, including conversations with Public Health, Schools and CCG’s re joint investment 4.High Needs Family Pathway; Pre-conception to Reception integrated pathway for families in the social care system 5.ESRC funded Baby Express Randomised Control Trial Current Priorities

17. High Needs Family Pathway – Integrated Early Years, Complex Dependency, Children’s Social Care from pregnancy to school – amalgamation of best current practice140827 Lead worker in place – responsible for ensuring coordinated provision, child and family meetings and plan or Child In Need or Child protection plan Named Health Visitor at Universal Plus level – using Solihull or Family Partnership Model Family Nurse Partnership – assertive engagement to promote uptake for all first time young mothers with high needs Social Care at 20wks – Pre- Birth Assessment Midwifery Health and Social Care/ Booking Assessment identified highly Complex Social Factors e.g. ACE - Early referral to Children’s Social Care and Health Visiting As Required – working together as multi-agency team around the family Specialist Mental Health Primary Care MH & IAPT Parent Infant MH Service VIG CAMHS GP Domestic Abuse intervention Drug & Alcohol Services Debt adviceVoluntary sector services Probation Housing Police Pregnancy Pregnancy Birth 1 year old 2 years 3 years School 12 weeks to 20 weeks old old old 19 weeks onwards School Nursing Intensive midwifery – specialist or named midwife1:1 antenatal education as Preparing for Pregnancy, Birth and Beyond 2,3 and 4 years early learning School transition plan M/A referral hub Work and skills within whole family Sequence of evidence based parenting programmes promoting attunement, attachment, social, emotional, behavioural development Perinatal parent education eg PEEP 1:1/Group Incredible Years Baby Incredible Years Preschool Basic NBAS Evidence based intensive family support model (TF) Statutory Child in Need/Child Protection Plan Children’s Centre targeted groups and community connections Attachment focussed parent education eg Perinatal PEEP or Solihull baby 1:1/Group