Section 2: What we know from policy and research
For many years research has helped us understand that intervening early in the lives of young children can have a positive influence on their lives as they live and grow. The rationale behind this focus is well documented and equally well accepted as the best way to proceed to enhance the lives of young children. The important difference now is that what happens to a young child, and the subsequent impact on their family, is formally being acknowledged in the Act. There is a wide range of evidence indicating the potential benefits of high quality, funded early learning and childcare. For example, we know that:
- While all social groups benefit from high quality ELCC, children from the poorest families gain most from universal provision.
- The benefits of high quality ELCC provision continue at age 14, with particular benefit for children whose families had a poor early years home learning environment.
- Among 5 year olds, non-parental ELCC in the early years is generally beneficial to cognitive development and a child's vocabulary.
- Long-lasting effects from ELCC lead to better cognitive scores at age 7 and 16.
- The more cognitive stimulation a child gets around the age of 4, the more developed the parts of their brains dedicated to language and cognition will be in the decades ahead.
In Scotland, many innovative projects have taken root and grown into stable successful situations where the needs of young children are well met. The difficulty that has been faced is that the previous provision of funded places has been by necessity directed to 3 and 4 year olds and this is now insufficient to address a growing number of families who need to have extended hours to help support working parents or to meet the needs of younger children aged 0-3 years. The Act seeks to address these anomalies to benefit children and families in a much more cohesive way. As a first step, increasing hours and flexibility of funded places for 3 and 4 year olds; and, including some 2 year olds is a significant move forward.
2.2 Getting it Right for Every Child
The delivery of ELCC is underpinned by the central elements and values of Getting it Right for Every Child (GIRFEC) which is the national approach to improving the wellbeing of children and young people. Through policy and the delivery of services at both national and local level, the GIRFEC approach:
- Puts the best interests of the child at the heart of decision making.
- Takes a holistic approach to the wellbeing of a child.
- Works with children, young people and their families on ways to improve wellbeing.
- Advocates preventative work and early intervention to support children, young people and their families.
- Believes professionals must work together in the best interests of the child.
The GIRFEC approach is designed to be flexible enough to support all children and families whatever their need, whenever they need it. It is about responding in a meaningful, supportive way, working with parents wherever possible. It takes into account that everyone involved with the family has an important part to play and puts the wellbeing of children and families at the heart of any support. To do this eight indicators of wellbeing are used: safe, healthy, achieving, nurtured, active, respected, responsible and included. These are often referred to using the acronym "SHANARRI". These indicators represent the basic requirements that all children need to grow and develop. They are used in the planning process for any child in need to ensure the best possible outcomes for children to improve their life chances and wellbeing.
The importance of the contribution that ELCC can make to this process cannot be underestimated in this context. We know that intervening early for those children and families who need it most makes a positive difference. There are strong connections and links between the SHANARRI wellbeing indicators and the principles of Pre-Birth to Three, Rights of the Child, Relationships, Responsive Care and Respect. These in turn link to the four capacities of Curriculum for Excellence: Successful Leaners, Responsible Citizens, Confident Individuals and Effective Contributors.
2.2.1 What is the role of the named person?
When the GIRFEC duties within the Act are commenced (expected to be August 2016), this will include a named person for every child, from birth, until they reach 18, or later if they remain in school. In the meantime practitioners should make reference to the current GIRFEC national practice model.
For children from birth, to the point of starting primary school the named person service will be provided by the Health Board. The named person is likely to be a midwife from birth until the child is about 10 days old, and then the child's health visitor. The named person in health will provide consistent, knowledgeable and skilled contact for families, working alongside staff in early years settings and other practitioners who work with young children.
The GIRFEC approach makes it clear that most children get all the support they need from their parents or carers. So, in most cases, the named person will not have to do anything more than they normally do in the course of their day to day work. The major difference will be that they use the National Practice Model as a starting point for considering and recording information about a child or young person's wellbeing and also for when they have particular concerns.
Once the named person has identified a concern, or a concern has been brought to their attention, the named person - who will be the first point of contact for the child and their family - needs to consider how they can best promote, support and safeguard the child's wellbeing. In some cases that will mean taking action, offering help, or arranging for the right help from others.
The named person will plan for the child who needs extra help from within universal services, or through seeking assistance from more specialist services. They will ensure there is effective and proportionate sharing of information about the child's wellbeing, within the terms of the Data Protection Act 1998 and the duties within the Act, when so required to support the child. For example, this is likely to happen when the named person responsibility transfers to another service, such as when a child is starting primary school, when the new named person is most likely to be the headteacher.
When two or more agencies need to work together to help a child or young person and family, there will be a lead professional to coordinate that help and manage the child's plan.
2.2.2 What is the role of a lead professional?
There are some circumstances where a child's needs require two or more agencies to work together to deliver services (targeted interventions) to the child and family. Where this happens, a lead professional will be identified. The lead professional becomes the person within the network of practitioners who are supporting the child and family who will make sure that the different agencies act as a team and the help they are all offering fits together to provide appropriate support for the child and family. The lead professional will have a significant role in working with other agencies to coordinate a multi-agency child's plan. The lead professional will not do all the work with the child and family; neither does he or she replace other practitioners who have specific roles or who are carrying out direct work or specialist assessments. The lead professional's primary task is to make sure that all the support provided is working well, links with involvement of other practitioners and agencies, and is achieving the outcomes specified in the child's plan.
The lead professional will be the professional who is best placed to carry out the coordinating role and work with the family to improve outcomes for the child. The named person will work with the lead professional and will always be involved in the decision to initiate a child's plan.
2.2.3 What does this mean in practice in an ELCC setting?
As the child's keyworker, everything you do for young children should promote, support and safeguard their wellbeing. You will have the day to day knowledge of how a child is settling in and progressing. You may also be a first line of contact for the parent or carer. The key to success for the child and family is building professional caring relationships. Your unique role in engaging and involving the child and family is important. Where there are wellbeing concerns it will be crucial that there is a good link between the ELCC staff and the named person in health. Where these wellbeing concerns lead to the development of a child's plan, the ELCC practitioner may be a partner to the plan. In some cases, it will be appropriate for the ELCC practitioner to take on the lead professional role. It is also important that key staff in the ELCC setting understand their roles in relation to the named person and the child's plan and feel confident in contributing and talking about the child's wellbeing needs.
2.2.4 Case Study: Baby Emma
Illustration of duty to record alternative arrangements in a child's plan for looked after 2 year olds.
Baby Emma, born to a parent with a history of unsettled family life, health and social issues.
- Midwife noting concerns and providing support to Emma's mother pre-birth.
- Health visitor alerted and engaged pre-birth.
- Health visitor becomes named person within few days of birth and Emma is categorised as having additional needs in terms of the health visitor's engagement. As a result Emma and her family have additional contact and support offered by the health visitor.
- Parent engages well with the health visitor and due to on-going concerns about wellbeing, the health visitor arranges for specialist assessment/support from paediatric services and targeted parenting support. With the parent's agreement these targeted interventions are coordinated within a single agency child's plan, managed by the health visitor.
- When Emma is 18 months old concerns are heightened by community events involving the family and reports of domestic abuse, so Social Work services become involved on a voluntary basis. The child's plan is reviewed and updated as a multi-agency plan in partnership with the parent, and the social worker becomes the lead professional. One of the concerns highlighted is the lack of appropriate stimulation at home for Emma so the plan includes three sessions per week in the local family centre for Emma and the parent, where Emma can receive input through play, and the parent can be supported by staff.
- The lead professional is made aware that the parent is finding the sessions very stressful and has started to miss sessions, blaming Emma's health. Emma can also be distressed and shows behavioural issues during the sessions.
- A review of the plan leads to a referral to the Children's Reporter and a decision by the Children's Panel that Emma should be on a Home Supervision Order. The sessions at the family centre are put on hold and Emma instead receives time with a childminder, and one session per week at home with the childminder and parent. The parent is more engaged with this arrangement.
- When Emma is 2 years old, the child's plan is reviewed to consider progress and whether taking up her entitlement to 600 hours of early learning and childcare would meet her wellbeing needs. Multi-agency assessment, taking account of the views of the parent, indicates that a standard placement at the family centre would not be the most appropriate support for Emma at that point. However, due to some progress in achieving the outcomes in the plan, including the parent's confidence to play and interact with Emma, as well as Emma's engagement in play and an improvement in Emma's general health, it is agreed that a mixed package of support, including continued input from the childminder and short sessions in the family centre, should be put in place. The family centre becomes a partner to the plan, and the sessions in the centre are recorded as a targeted intervention within the plan.
- The lead professional continues to monitor the effectiveness of the child's plan and set review dates as appropriate to Emma's needs and the requirement to review the supervision order.
Putting the guidance into practice
- What do you see are the benefits in working in this way for the child and family?
- When Emma is being cared for by the childminder, what impact do you think there may be in relation to wellbeing indictors for Emma?
- What type of support is there or could be developed in your own setting, for you to play your part in a situation as described above?
- What are the areas in which you could contribute really well and which are the ones where you and your team needs a bit of support?
Find out more:
Getting it Right for Every Child: http://www.scotland.gov.uk/Topics/People/Young-People/gettingitright/background
2.3 Growing up in Scotland (GUS)
Growing Up in Scotland (GUS) is a large-scale longitudinal research project aimed at tracking the lives of several cohorts of Scottish children from the early years, through childhood and beyond. GUS is a holistic study, concerned with all aspects of the child's life, including health, development, family circumstances, neighbourhood, education, friends and leisure activities.
The GUS information is helpful to us as practitioners to have a better understanding of the lives of young children and what we can do to help. For example, the GUS paper Changes in child cognitive ability in the pre-school years it highlights potential factors to how young children achieve in specific areas such as communication and language and problem solving.
Find out more:
Growing Up in Scotland: http://www.scotland.gov.uk/Publications/2014/02/8789
2.4 The Early Years Collaborative
In recent years, the Scottish Government has reflected and supported the commitment to developing a universal approach to prevention and early intervention in tackling the significant inequalities in Scottish society.
Research describes well how the early years' experience can make a significant difference to life chances. Shonkoff describes how exposure to multiple risk factors (such as poverty, neglect, abuse, drug and alcohol misuse, domestic violence etc.) in early life gives children a 90-100% chance of developmental delays. We also know that this can impact physiologically on conditions such as heart disease in adulthood.
The Early Years Collaborative (EYC) attempts to address these social challenges by developing a quality improvement partnership of Community Planning Partners (CPPs), including social services, health, education, police and third sector professionals.
It is the world's first national multi-agency quality improvement programme delivered across the country through each of the 32 CPPs.
A CPP comprises all relevant public, private, voluntary and community bodies in its area and sets out a joint vision with agreed objectives for the area in the form of a Community Plan, through setting out challenging outcomes, identifying resources, monitoring and evaluating.
All CPPs are committed to making Scotland the best place in the world to grow up.
The EYC uses the Institute of Healthcare Improvement (IHI) model for improvement which asks:
- What are we trying to accomplish? - What is our aim?
- How will we know that a change is an improvement? - How will we measure this? - where is the data?
- What change can we make that will result in an improvement? - How will we implement this?
Crucially, the model works on a cycle of small scale tests of change using the Plan, Do, Study, Act, cycle.
The GIRFEC framework ensures that anyone providing support puts the child or young person - and their family - at the centre. What has been missing until now is a method to implement these ideas reliably for every child every time. The EYC provides a single improvement method to do just that.
The Collaborative has been established with four workstreams:
- Conception to 1 year.
- 1 year to 30 months.
- 30 months to primary school.
- Primary school to age 8 years.
With an ambition to make Scotland the best place in the world to grow up, by improving outcomes and reducing inequalities for all babies, children, mothers, fathers and families across Scotland, each workstream of the EYC is underpinned by a stretch aim (i.e. an aim which cannot be reached by just working harder and doing more of the same):
- To ensure that women experience positive pregnancies which result in the birth of more healthy babies as evidenced by a reduction of 15% in the rates of stillbirths (from 4.9 per 1,000 births in 2010 to 4.3 per 1,000 births in 2015) and infant mortality (from 3.7 per 1,000 live births in 2010 to 3.1 per 1,000 live births in 2015).
- 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.
- 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.
- To ensure that 90% of all children within each Community Planning Partnership area will have reached all of the expected developmental milestones and learning outcomes by the end of Primary 4, by end 2021.
In addition to the above there is a leadership strand to the EYC.
Following the Learning Sessions, where teams from each CPP area have been introduced to the methodological approach and taught the Model for Improvement , teams return to their local working environment and start to undertake small scale tests of change to services for children and families that they know need to be improved. Teams have engaged with families and others to build on the positive community assets that exist and are seeking to implement agreed improvements using the methodology in their own areas.
Within the EYC approach there are many examples of ways that practitioners in ELCC settings are trying out and testing approaches to engage parents and improve, for example, children's communication and language.
2.4.2 Case Study: "Our Literacy Journeys"
In 2014 two South Lanarkshire nurseries agreed to run a project that encouraged their children to learn about literacy, within their own immediate area. In the second year this will be extended to meeting people from different areas. The nurseries knew that the approach had helped the children's literacy skills - but they wanted to see if their hunch that it also had wider benefits for the children was correct. To do this they used the improvement approach promoted by the EYC to test how they might measure how being involved in the our literacy journeys programme benefited the children.
The programme had a bear as its central character, and involved the children thinking about journeys - the bear went on a journey between the two nurseries, and the children also visited each other. Facetime was used for the first time to great effect in helping the children to feel at ease with each other before they actually met. The programme ended with a trip to the Build a Bear Workshop in Glasgow where the children chose a new outfit for their bear.
The aim of this test of change was: To track improvements in the overall wellbeing for the 32 children who were involved in the eight week Our Literacy Journeys programme. The SHANARRI wellbeing web was used, and a scale of 0 (low) - 6 (high) was used to place the children on the wheel - with existing resources from the GIRFEC programme being used to guide staff use of the tool.
There was a lot of valuable learning from this test:
- The programme leads were able to track impact on the children who took part in the programme. The way the information on each child's progress was presented on a web was very visual and gave staff an instant overview of each child. This was very valuable in initiating conversations about the children.
- Facetime was a useful way of making contact across the different establishments and would definitely be used again.
- This was the first time the staff had used the EYC improvement method and the SHANARRI wellbeing indicators in this way. Staff set out to test whether the programme had an impact on the children beyond that around improved literacy. Both used the GIRFEC wellbeing web and looked at the data that came back. Using the data and graphs will enable staff to further test this tool to enhance their understanding and ability to support the children in the participating nurseries more generally.
Putting the guidance into practice
- Is there something that you feel could be improved in your setting? Can you see a natural link to the four workstreams described in the text?
- How could you use improvement methodology to make a difference?
- Is there an area you would like to improve to help children meet their developmental milestones? If so, what changes as a team could you consider?
Find out more:
About the above case study and the Early Years Collaborative: http://www.scotland.gov.uk/Topics/People/Young-People/early-years/early-years-collaborative
The Scottish Child Health Programme: Guidance on the 27-30 month child health review: http://www.scotland.gov.uk/Publications/2012/12/1478/downloads#res410922
2.5 Review of the workforce
The ELCC sector in Scotland is unique in many ways. ELCC is delivered by an enthusiastic and dedicated workforce in a variety of settings ranging from local authority, private and voluntary provision and childminders. The range and variety of different qualifications are complex and at times difficult to unravel.
There has never been a time where the policy commitments to increasing and improving ELCC have been greater. The Act will deliver an increase in the funded entitlement to a minimum of 600 hours per year for 3 and 4 year olds, and introducing the entitlement to 15% of 2 year olds from August 2014 and 27% from August 2015. The Act is also setting the stage for further expansion to meet the Scottish Government's wider ambitions to develop a high quality, flexible system of early learning and childcare that meets the needs of all children, parents and families.
In order to ensure that Scotland builds on its capabilities within the ELCC workforce, an independent review of the ELCC workforce was established in February 2014, by the Scottish Government under Professor Iram Siraj.
The Minister for Children and Young People in announcing the review stated:
"I'm delighted that Professor Iram Siraj has agreed to lead an expert review to ensure the development of the workforce matches the scale of our ambition. By boosting skills, ensuring high quality and recognising the value of those we entrust to give our children the best start in life, we will attract the brightest and best to deliver the transformation in childcare. And by pursuing a shared vision we can secure the foundations for Scotland's future as the best place to grow up."
The workforce review will examine a range of issues including skills and qualifications, career progression, recruitment and retention, and workforce planning to ensure that all those working in ELCC settings have the right skills and experience to deliver high quality ELCC across the country.
The review will consider and collate views from a wide range of stakeholders, and include visits to establishments and draw on the expertise of a Core Reference Group who represent the range of interests on the ELCC workforce in Scotland.
A final report setting out recommendations on all aspects of the review will be published in Spring 2015.