Themed Breakout: Understanding the Emergent

Learning around the 27-30 month child health check

John O’Dowdjohnodowd@nhs.net

Early Years Collaborative Learning Session TwoDay 2

Stretch Aim 2

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.

Stretch Aim 3

To ensure that 90% of all children within each Community Planning Partnership have reached all of the expected developmental milestones at the time the child starts primary school, by end-2017.

Ready to Learn pilot

•Started in August 2011

•Covers NE and NW Glasgow, East Dunbartonshire and Renfrewshire

•Approximately 600 children per month

•Builds on previous work done in West Glasgow around a 12 and a 30 month universal contact

Evaluation & Research

•NHSGGC: – John O’Dowd– Michelle Affleck– Lucy Thompson

•Glasgow University: – Phil Wilson– Fiona Sim

•Newcastle University: – James Law

Ready to Learn pilot•Focus on developmental readiness of universal nursery provision•Create progressive universalism•Built on local needs assessment around the prevalence of communication needs and known links between behavioural problems and risk of future conduct problems/disorder•Pathways to early intervention • Second element still underway:

– validation of tools

Ready to Learn - tools•Strengths and Difficulties Questionnaire (SDQ)

– 5 domains: emotional symptoms, conduct, hyperactivity, peer relationships, and prosocial domains

•Sure Start Language Measure (SSLM-R)– 50 common words– Below 20 suggests significant delay– Below 50 provides stimulus to promote

language (but no normative need)

Findings- reachGlasgow NE & NW Pilot: Percentage of

Assessments completed per month (improper median)

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

1 2 3 4 5 6 7 8 9 10 11 12

Month

% C

om

ple

ted

Findings- reach

•80% uptake across all quintiles in first month

•Dropped off with time and competing demands

•Rally with feedback through managers

•Positive reaction from staff and parents

•Learning from exceptions

Findings- communication

Communication category by SSLMR

Percentage of completed checks

50 words 28%

21-49 words 62%

20 words or less 10%

Findings- behaviour

Behaviour Percentage of completed checks

No needs

(normal range)

73.4%

Possible needs (Borderline range)

12.7%

Probable needs

(Abnormal range)

13.9%

Findings- behaviour and communication

SDQ

No needs

SDQ

Poss needs

SDQ

Prob needs

Total

SSLMR 50 23% 2.7% 2% 28%

SSLMR

21-49

43.4% 8.2% 10.4% 62%

SSLMR ≤ 20

6.7% 1.7% 1.4% 10%

Total 73.4% 12.7% 13.9% 100%

Pathways to interventionRTL contact

Behaviour +/or communication needs

Behaviour Needs

Promote communication Intervene in communication

Triple P Parenting Intervention

Behaviour and comm needs

Communication Needs Only

Multiagency planning group and

intervention

Request assistance

Needs Resolve

d

Needs Unresolv

ed

Needs Resolved

Needs Unresolv

ed

Needs Resolved

Needs Unresolv

ed

Reformulate or escalate

Needs Resolved

Needs Unresolv

ed

Emergent learning• Reach:

– capacity– engagement : positive framing using developmental readiness

• Learning from errors: epistemology of practice• Working together – interdisciplinary before interagency!• Capacity

– cumulative intervention– concerns about reduced time for targeted work

• Capability and developmental assessment• Capability, capacity and new interventions• Individualised solutions versus organisational pathways

Acknowledgements

• Parents and children in the 4 pilot areas

• Staff in the pilot areas

• Early Years Collaborators

• One Glasgow

• Research collaborators

• Healthy Children Programme Board and operational team