Leeds integrated early start offer

Introduction

During July 2010 – May 2011, a universal review took place between NHS Leeds, NHS Leeds Community Healthcare Trust and Leeds City Council. The review focused on the needs of local families from pregnancy to five years using the Organisational Development Service population centric approach.

The findings highlighted various issues including areas of duplication eg. health visitors and children’s centre family service practitioners were both undertaking new birth visits and there was a lack of clarity about the support available to families.

The outcome of the review was to establish the early start service in 2012; this is an integrated service offer for pregnancy to five that supports children and their families to have the best possible start in life to achieve health, well-being, and a readiness for learning.

Across Leeds, there are 56 children’s centres of which 24 sites have Little Owls nurseries based within them. The children’s centre and health visiting workforce have integrated to form 26 early start teams which are aligned to the geographical clusters in Leeds.

Early start service

The early start team:

  • provide all families with a clear point of contact, clear communications and realistic choices
  • work with communities to improve health and education outcomes
  • do all they can to keep families safe
  • provide additional services for those in greatest need
  • identify children and families who will benefit from time limited additional support
  • plan packages of family support in partnership with other services where ongoing additional help is required.

The early start service is a combination of children’s centres and health visiting practitioners working together in fully integrated teams. The teams comprise children’s centre managers, family outreach workers, senior family outreach workers, health visitors & school nurses. The workforce is drawn from health, education & care routes.

Early start teams work closely together with children’s centre ‘Little Owls’ nurseries, GPs, midwives, schools, nurseries, community nurses and youth service in cluster areas.

The teams deliver services such as health, childcare, play, early learning and development to meet the needs of children and families from pregnancy up to the child’s fifth birthday, to provide the right services in the right place at the right time.

The early start service comprises of:

  • an agreed universal pathway
  • a four-tiered service model
  • shared vision set out in the integrated service specification
  • agreed joint framework for workforce skills, knowledge and competency
  • a workforce plan
  • family offer pathways
  • information sharing agreement

The family offer provides all families with a programme of support tailored to meet their needs. The four tiers of service provision support the wide range of family needs from pregnancy to five years:

  • Community

    Developing an understanding of the needs of families with children under five in a defined area, building capacity and using that capacity to improve health and education outcomes in local area.

  • Universal

    The provision of a planned programme of contacts and services for all families to ensure their wellbeing, optimum development, and safety. Initially, working with midwives to build strong relationships in pregnancy and early              weeks.

  • Universal plus

    Additional services from the early start team that a family might need for a specific length of time; intervening early to prevent problems developing or worsening, for example care packages for maternal mood, parenting support, breast feeding, behaviour or disability.

  • Universal partnership plus services

    Additional services for vulnerable families requiring ongoing additional support for a range of special needs, for example families at social disadvantage, adults with mental health or substance use issues, families where there are safeguarding, and child protection concerns or children with a disability and/or complex health need.

Each early start team holds a weekly early start allocation meeting to consider all requests for support and to determine who, within that team, has the best skill set to deliver the package of support that is needed. The support would then be delivered in line with the relevant family offer pathway. In addition, there are elements of service delivery which are co-delivered by a children’s centre family services practitioner and a health visitor i.e. preparation for birth & beyond ante-natal parenting programme.

Workforce development

A workforce training and development plan was developed, which included details of development activities available to practitioners and managers, to support safe delivery of the early start service and in line with the competency and skills triangle. The competency and skills triangle uses information from the early start career framework developed as part of the universal service review process. The workforce development and training plan is based on the following assumptions:

  • practitioners will continue to access their organisations statutory and mandatory training
  • practitioners will have an annual appraisal and role review where training and development needs are identified
  • teams will complete a training needs analysis based on the learning needs identified for delivering the family offer.

In addition, there are various joint workforce development opportunities i.e. helping hands, ‘babies, brains and bonding’ training, safe sleep training etc.

An early start safeguarding supervision standards was developed which supported, but did not replace child protection supervision policies, helping early start practitioners to safely deliver the family offer. The standards are audited annually which will inform any required revision.

We have commissioned the infant mental health service to deliver training and to provide restorative case discussion (RCD) sessions to the multi-agency teams.

The impact of the early start approach is continually monitored through parent and partner agency evaluations, case studies, feedback, staff surveys and the early start monitoring dashboard.

How challenges were overcome

  • Information sharing

    As each organisation within the integrated teams had their own recording systems, a significant amount of work went into developing an Information Sharing Agreement to ensure the safe sharing of data across the different sectors.

  • Retaining professional identity

    Ensuring a shared understanding of roles, skill sets, knowledge was embedded into the roll out programme and by developing the allocation meetings, professional discussions continually take place to determine who is best placed to offer particular packages of support.

  • Developing awareness of different organizational culture

    The roll out programme was vital to bring the workforces together and this is continued to enhance this further through co-location, touchdown and co-delivery spaces in children’s centres.

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