Re designing Ealing Early Years Service: Challenges and Rewards

1. Re designing Ealing Early Years Service: Challenges and Rewards • Background: • Ealing • Drivers for Change • New Service • Outcomes Creating a great place for every child and young person to grow up

2. EALING Rising 0 – 4 age group Population: 305,000 1991 18,703 2100 24,405 Socio- economic 23% FSm Poor health standards, low household incomes English Additional Language 55% pupils do not speak English as a first language Ethnicity 79% pupils ethnic minority (21% nationally) ,

3. Ealing Service for Childrenwith Additional Needs

4. Who are we?

5. DRIVERS FOR CHANGE LOCAL Pressures on existing service • Increasing numbers of referrals • Increasing complexity of referrals • Inequalities of waiting times across borough • Inequality of universal service • Increase in administration and paperwork • Hard to reach families • Better partnership working

6. DRIVERS FOR CHANGE NATIONAL • Bercow Report (2008) • Better Communication (2009) • ECAT • Every Child Matters (2009) • EYFS (2007)

7. COMMON THEMES • Early identification and intervention • Training for the wider workforce • Reducing inequalities and outcomes across, health, education and employment opportunities • Integrated local services • Greater multi agency working

8. Previous Model Referral received and triaged Sure start internal referrals PSSN/ DOMS Children's centres X3 CLINICS x7 Sure start Ax Initial AX Therapy package Initial Ax Initial Ax Therapy package Therapy package Therapy package

9. OUTCOMES The redesigned services aimed to: • Reduce waiting times for assessment • Reduce waiting times for therapy • Engage better with hard to reach families • Provide equal access across the borough • Improve support and advice for families • Prevention • Increase skills of Early Years Practitioners • Reduce DNA • Clear pathway

10. OUTCOMES CONTINUED • Better partnership working across : -PCT -LA -Sure Start -Children’s Centres -Early Identification -Support ECAS sustainability programme

11. Universal groups (see separate information) Drop-in for ALL under 5s Home/nursery/group visit for hard to reach families or further assessment (see separate policy) Language group – low level -Children from 3;0 to 5;6yrs -Parent/Carer has attended PCI or would not benefit - group may focus on attn & list, turn-taking, joint attention, Makaton as appropriate PCI group -Preverbal or 1-2 word level -Parent/carer likely to benefit from interaction support Attention and Listening Group -Attn and list predominant difficulty -group may focus on turn-taking, joint attention, Makaton as appropriate Language group – medium and high levels -language predominant difficulty SLT/OT group -child known to SLT & OT -sensory issues -social communication difficulties PECS sessions -3 sessions -review Dysfluencypackage of care 1:1 speech sessions Up to 6 sessions - Look annd listen groups children with SCD 1:1 voice sessions -fortnightly sessions 1:1 dyspraxia sessions -fortnightly sessions Feeding -tailored to needs of child and family • Groups will run for up to 5 weeks with the 6th week for report-writing (e.g. may be 4 weeks if annual leave/meeting/training). Groups will be run by 2 therapists/assistant/volunteer. Therapists will be expected to run groups alone if necessary. • A report will be written for each child following the group. Children should have a gap for consolidation, and therefore should • not be invited to 2 consecutive groups. All targetted groups and L & L group have a parent session at beginning of group. Individual sessions will run for up to 6 weeks with the exception of children with feeding difficulties which will be left to the discretion of the therapist. A report will be written at the end of each block of therapy or as appropriate.

12. Ealing Early Years Service

13. Strategy for Change Meetings with: • Commissioners • Local authority managers • PCT managers • Speech and Language Therapists • Children’s Centre managers • Local support networks, ie Libraries, Voluntary Organisations • SEN • Pre school Learning Alliance • Parents Marketing campaign and launch

14. Challenges • Space in children’s centres • Logistics of timetabling • Therapists’ attitudes to change • Professionals’ attitudes to change • Time restraints • Organising meetings with local authority managers • Re-writing policies, procedures, leaflets • Appointing new assistants

15. OUTCOMES • Waiting times • Parent Questionnaire • DNA rates • Accessibility/Equality • Cost • Reduced administration • Effectiveness of therapy

16. Type of therapy September 2009 January 2010 PCI Groups 28 7 Language Groups 20 10 Speech Sound Therapy 28 12 140 120 100 80 No of children waiting more than 6 weeks for initial assessment 60 40 20 0 May June July Aug Sept Oct Nov Longest wait in weeks for therapy Longest wait in weeks for initial assessment Outcomes – waiting times 35 30 25 20 15 10 5 0 May June July Aug Sept Oct Nov

17. Outcomes The new service has increased productivity through: • increasing the numbers of children it is possible to see for initial assessment in a certain timeframe. • This has financial implications too. To see 3 children for initial assessment in the old clinic service would cost £309. However, to see 3 children through Play and Talk costs half of this, at £154.50. • reducing the administration tasks for therapists • the use of assistants to support running groups and completing administration tasks

18. Access • Increasing numbers of “drop ins” • 85% drop ins have identified seen DNA rates decreased from 21% to 10%

19. Accessibility Northolt Ealing Southall Acton

20. PARENTAL VIEWS Questions Results • Length of wait 100% seen within 6 wks • Information prior to appointment 98% clear and helpful • Location 98% convenient • Friendliness 100% greeted and made to feel welcome • Advice given 100% useful “Your guidance is very important thanks”. “I will take all this information of board and use it”. “I know how to help my child with his speech and how simple language will help him”.

21. Effectiveness of therapy

22. Next Steps • Workforce development : ICAN 0-3 Early Talk Pilot Project • Prevention / awareness raising • Communication friendly environments • Promoting parent / carer understanding of their role in supporting communication • Key messages campaign • Joint working: library groups , Coram