Greater Manchester Public Service Reform Early Years New Delivery Model Update June 2014

1. Greater Manchester Public Service Reform Early YearsNew 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. GM Consistent principles of reform • Interventions chosen on strength of evidence base • Integrated, co-ordinated and sequenced – bespoke packages of support at the right time, in the right order • Family based approach to changing behaviour, not just focus on individual • 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. Early Years Overall Objective 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

5. New Delivery Model Principles • 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

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

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

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

9. Outcomes - Child

10. The 8 Stage Assessment Stage 1 Pre Birth Under Review 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 2 New Birth Visit 10 – 14 days Health Visitor Newborn Behavioural Observation Stage 5 24 months HV & EY provider Integrated Review/Information to be shared (ASQ3 and EYFS, ASQSE if in use) Stage 3 2 months Health Visitor (EPDS, ASQ3) Stage 6 On entry to Nursery (universal 3/4 year old provision) EY Provider/School (ASQ3 and EYFS, ASQSE if in use) Stage 4 9 months Health Visitor (ASQ3 & ASQSE if in use) Stage 7 On entry to Reception in school EY Provider and receiving school (ASQ3 and EYFS, ASQSE if in use) • 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. 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)

11. Assessment and Outcomes tools

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

13. Core Pathways

14. EIF evidence standard: criteria and ratings

15. Suite of Evidence Based Interventions

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

17. High Needs Family Pathway – Integrated Early Years, Complex Dependency, Children’s Social Care from pregnancy to school – amalgamation of best current practice 140827 Pregnancy Pregnancy Birth 1 year old 2 years 3 years School 12 weeks to 20 weeks old old old 19 weeks onwards Lead worker in place – responsible for ensuring coordinated provision, child and family meetings and plan or Child In Need or Child protection plan Family Nurse Partnership – assertive engagement to promote uptake for all first time young mothers with high needs Intensive midwifery – specialist or named midwife1:1 antenatal education as Preparing for Pregnancy, Birth and Beyond 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 M/A referral hub Social Care at 20wks – Pre-Birth Assessment Statutory Child in Need/Child Protection Plan Evidence based intensive family support model (TF) 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 advice Voluntary sector services Probation Housing Police Sequence of evidence based parenting programmes promoting attunement, attachment, social, emotional, behavioural development NBAS Attachment focussed parent education eg Perinatal PEEP or Solihull baby 1:1/Group Perinatal parent education eg PEEP 1:1/Group Incredible Years Baby Incredible Years Preschool Basic Named Health Visitor at Universal Plus level – using Solihull or Family Partnership Model School Nursing Children’s Centre targeted groups and community connections 2,3 and 4 years early learning School transition plan Work and skills within whole family