Themed Breakout HEALTHY - 27/30 Month Assessment

1. Themed Breakout HEALTHY - 27/30 Month Assessment

3. Introduction and overview John O’Dowd Consultant in Public Health Medicine (Child Health) NHS Greater Glasgow and Clyde

4. Themed breakout Day 1 Topic HEALTHY - 27/30 Month Assessment Stretch aim to which topic relates To ensure that 85% of all children within each Community Planning Partnership have reached all of the expected developmental milestones at the time of the child’s 27-30 month, child health review, by end-2016

5. Sandra MacInnes, Programme Manager, Best Possible Start, University of West Scotland Topic: Implementation of the 27-30 month Child Health Review across NHS Lanarkshire Stretch Aim to which Topic relates: 85% of all children within each CPP have reached all of the expected developmental milestones at the time of the child’s 27-30 month child health review by end 2016

6. Presentation Outline • Overview of NHS Lanarkshire Guidance • Emerging learning from Practice • Key Successes • Issues/Challenges • Future Actions

7. Best Possible Start Programme A joint collaborative programme between NHS Lanarkshire and the University of the West of Scotland to implement a suite of national policy documents aimed at improving maternal, infant and child health outcomes in the early years to ensure Lanarkshire’s children have the best start in life.

8. Best Possible Start Policy Drivers PRE-CONCEPTION – 8 YEARS Overall Aim: “Strengthen contribution maternity care makes to improving maternal and infant health outcomes and reducing inequalities Overall Aim: “To improve the capacity of Antenatal services to reach higher risk groups and identify and manage risks during pregnancy” Overall Aim: “Improve the nutrition of women of childbearing age, pregnant women, and young children, particularly in disadvantaged areas’’ Overall Aim: “Strengthen Health for all Children (2005) to ensure best quality care and support is delivered to children and families in the vital early years” Launched by Scottish Government 2011

9. Circulated to NHS Boards December 2012 Implementation by April 2013

10. NHS Lanarkshire Guidance • Specialist Community Public Health Nurse - HV Lead • Named Person : GIRFEC Practice Model : SHANNARI Wellbeing Framework • Clinic Venue : Home Outreach Model • Toolkit SGSII : Equipment Standards : Mary Sheridan! • Local Guidance Document : RAG ‘Request For Assistance’ Pathways • NHS Health Scotland Early Years Information Pathway • PHN Team additional capacity : Administrative Support

11. Specialist Community Public Health Nurse ‘Assessment is a complex task that requires a high level of professional knowledge and skill’. (National Guidance Document ,2012) However, assessing and responding to different levels of complexity requires substantial professional skills. It also means that assessment of very specific parameters such as language development can be seen as a lens through which to consider various issues such as parenting and the home learning environment, autism risk, and hearing.’

12. NHS Lanarkshire Guidance • Specialist Community Public Health Nurse - HV Lead • Named Person : GIRFEC Practice Model : SHANNARI Wellbeing Framework • Clinic Venue : Home Outreach Model • Toolkit SGSII : Equipment Standards : Mary Sheridan! • Local Guidance Document : RAG ‘Request For Assistance’ Pathways • NHS Health Scotland Early Years Information Pathway • PHN Team additional capacity : Administrative Support

13. SGS II Toolkit

14. SGS ll Toolkit Optional cognitive profile Examines 7 Developmental Skill areas Locomotor Manipulative Visual Hearing and Language Speech and Language Interactive Social Self-Care Social

15. NHS Lanarkshire Guidance • Specialist Community Public Health Nurse - HV Lead • Named Person : GIRFEC Practice Model : SHANNARI Wellbeing Framework • Clinic Venue : Home Outreach Model • Toolkit SGSII : Equipment Standards : Mary Sheridan! • Local Guidance Document : RAG ‘Request For Assistance’ Pathways • NHS Health Scotland Early Years Information Pathway • PHN Team additional capacity : Administrative Support

16. Preparatory Training Needs Analysis

17. Preparatory Training Needs Analysis

18. Tiered Training Programme Large Group awareness raising 211 SCPHN’s: Introduction to the Review/Process/Toolkit Master class SGSII : Training the Trainer approach (GL Assessment) Locality/Team Practice Development roll out programme Evaluation positive

19. Testing the process......

20. Act Plan Study Do PDSA Cycle Sets goals based on patient/service needs PLAN Do Implement Analyse what happened STUDY Make sure improvement is permanent ACT

21. PLAN D S A Objective of first test Test the time required to complete an assessment clinic and associated documentation in preparation for the implementation of 27-30 month child health review What did you predict? Public Health Nurse unable to complete all areas within the timeframe PHN’s confidence of using SGSII toolkit would improve Parents/carers may require time spent on anticipatory guidance to support parenting role Onward request for assistance or PHN follow up may be required Parents would have increased understanding of importance of CHSP and be more inclined to attend What’s the plan? Recruit 2 volunteer Public Health Nurses - 1 North CHP, 1 South CHP Provide staff training on the SGSII toolkit /CHSP Form/Wellbeing form Ensure availability of suitable rooms and equipment Arrange 2 clinics inviting 5 CORE children each within the age group Call the parent/carer to offer an appointment and explanation of the assessment Initial appointment time allocated 1 hour per child Create a data capture form to support clinical activity and timing evidence

22. PLAN D S A What measures do you plan to use to assess the success of this test? • Time spent for each child in minutes on the following activities: • SGS assessment and SGS forms completion including parent feedback • Completion of CHSP form including height and weight • Provision of anticipatory guidance and gathering wellbeing information • Completion of wellbeing documentation • RFA documentation • How many children required further support: • Signposting • Follow up by PHN or by support staff within team • RFA to another agency or discipline

23. P DO S A What actually happened? • Public Health Nurses were trained in the use of SGSII toolkit and associated documentation by Community Paediatrician and Best Possible Start PHN • Both clinics were coordinated by the PHN’s : booking rooms, equipment standard and contacting clients for the clinic - each inviting 5 children for 1 hour appointments • Both clinics went ahead as planned • A total of 8 children attended – 4 for each PHN with 2 cancellations • All 8 children received a SOGS II assessment and parents were provided with feedback/discussion of child’s progress • All 8 CHSP forms were completed. • PHN’s completed their recording forms to reflect time taken • Reflective meeting was held to provide PHN’s with the opportunity to feed back qualitative information

24. P D STUDY A What were the results of the test, and how did they compare to the prediction? • 4 of the 8 accompanying adults required a greater degree of anticipatory guidance – mainly toileting/behaviour strategies • 1 issue required extra support and a follow up home visit was arranged – this had implications for future clinical time • 1 child required a RFA to SALT – this took longer again as it created additional documentation • Neither PHN was able to complete the wellbeing with any of the clients in the time frame • PHN’s reported their confidence in the use of the tool increased by the end of the clinic and they found they could complete the SGS II assessment slightly quicker • Both found the new lay out CHSP form difficult to complete in the time but did persevere (a copy was unavailable for parents at this time)

25. P D S ACT Based on what you learned, what did we do next? • Conclusion to recommend 1 hour appointments for all children • Clinic destination was recommended as a suitable venue for most children • Training for all staff on the use of the SGS II toolkit and accompanying documentation was commenced using the learning from the test • Wellbeing documentation/analysis best completed out with the assessment process • Where there was a cancellation/FTA, this created an hour long gap – this could be used by practitioners to complete other clinical documentation/work if able to do so

26. Data Support Triggers Emerging ‘Failed to attend’ Reports • PDSA Action Response • Public Poster/personalised appointment letter • Telephone contact to parent prior to 2nd FTA appointment • PDSA Access tests (day/time) • PDSA Base Tests (location) • Monitoring Improvements

27. Local Poster

28. % Clinic Attendance Data (NHSL) *Locality range 67-78% August

29. Data Support Triggers Emerging ‘Meaningful Review’ Reports • PDSA Action Response • Recall of 231 national forms from Child Health Department • Minor misunderstanding/coding : issues with National CHS Form • Proactive return of forms to staff via senior nursing professional structures/practice development to apply ‘teach back’ technique

30. % ‘Meaningful Review’ Data (NHSL) *Locality range 80- 92% Sept

31. Key Successes • Implemented June 2013! • Quality and GIRFEC based approach to Implementation consistent with national guidance • Identification of children requiring additional support • Public Health Nurse ‘buy in’ – universal approach as an essential contemporary practice model • Use of SGSII as a popular toolkit within practice • Parental involvement and ownership of the review - a developing public confidence in the local child health service? • Quality of information transfer opportunity to early years establishments

32. Issues /Challenges • Increase in workload for SCPHN staff • Administrative support inconsistent • 30 month implementation – timescale of ‘breach’ definition • Emerging ‘reviews’ within system and workload implications • CHS National Form – user group action? • Cultures and Language • Scanning National Form/SGSII into electronic record • Pre - review communication to SCPHN : access to GP summary records • GP participation/role in preventative child health programme

33. Future Actions • Addressing our issues/challenges! • Electronic version of SGSII/Mobile MiDIS test • Staff user group to review progress and coordinate improvements • Children on SNS – ‘wellbeing review’ standard • Service Impacts • Process of data transfer to Early Years establishments • Test 15-18 month review : North/South Lanarkshire • Research : local and national

34. Monthly reports Monthly summary and locality level reports are in development

35. Sina Currie Clinical Team Leader Early Years, Children and Families Community Nursing Service NHS Ayrshire & Arran

36. Overview of NHS Ayrshire & Arran Guidance 27 month assessment introduced April 2013 Universal Home Visit by Health Visitor Parental Involvement : ASQ & ASQ ( SE) Holistic GIRFEC Practice Model assessment Pathway development to meet stretch aim

37. Review of Emerging Learning from Practice Staff focus group identified

38. What are we doing well? • Child focused approach • Strength based working • Parents as Partners • Standardised approach to professional practice • Supportive of GIRFEC and Named Person role • Improving access to services through the development of pathways

39. What can we improve on? Completion of ASQ’s prior to assessment in some areas Language barriers Increase parental knowledge of assessment process Administration processes

40. How are we going to carry out these improvements and future actions? Small tests of change to identified areas Staff working group and action plan Parent focus group Develop leaflet/promotional materials Continue to involve our partners

41. Key successes to date Devlin’s Story..........

42. Questions?........ Contacts sandra.macinnes@lanarkshire.scot.nhs.uk scott.purdie@lanarkshire.scot.nhs.uk liz.kearney@lanarkshire.scot.nhs.uk fiona.gray2@lanarkshire.scot.nhs.uk margaret.clark@lanarkshire.scot.nhs.uk

43. Table Discussion Who are the individuals and/or teams currently working on this area? Are they currently using Quality Improvement methods/tests of change to guide their learning? What evidence based practice is being used? What learning can be shared between CPP areas?

44. Feedback One/ two “headline” per table

45. Alsh (Ground Floor) National Partners Boisdale (Ground Floor) Falkirk East Dunbartonshire West Dunbartonshire Stirling

46. Dochart (First Floor) East Ayrshire West Ayrshire North Ayrshire South Ayrshire Carron (First Floor) Glasgow