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School readiness

School readiness

What: A 2 year pilot within North Warwickshire to improve School Readiness within the county.

Who: Hayley Norman, Project Lead School Readiness, Warwickshire School Health and Wellbeing Service

What is the initiative and or project you are involved in?

School readiness remains an area of concern across the country and has been highlighted recently by Amanda Spielman (Chief Inspector, OFSTED) at the Pre-school Learning Alliance Annual Conference. All the evidence indicates that if a child is not ready for school they are immediately disadvantage and the impact on their social and emotional development and their learning can be significant. Warwickshire School Health and Wellbeing Service (WSHWBS) has been commissioned via Public Health Warwickshire to undertake a 2 year pilot within North Warwickshire to improve School Readiness within the county. The pilot commenced April 2017 and the outcomes will be fully understood by March 2019 following evaluation.

What prompted you to do this work? 

The Warwickshire Smart Start Strategy 2016-2020 focuses on children 0-5 years and aims to ensure that Warwickshire children have the best possible start in life. A major consideration within this strategy is to improve school readiness in Warwickshire. Warwickshire Public Health data from 2016 indicates that 71% of children do achieve a Good level of Development (GLD - is used to measure school readiness) in Warwickshire, however in boroughs of North Warwickshire, children achieved lower levels with approximately 1 in 3 children not reaching a GLD at the end of reception year and this is raised to nearly half within the male cohort.

The final mandated contact that children and families have with Health Visiting is 2¼. Consequently any health issues or concerns that emerge following this may not be addressed until children reach school age and their health is reviewed at school entry. The pilot aims to close the gap for children between the last Health Visiting contact and them starting school, facilitating their access to services and shaping public health interventions.

How did you initiate the work?

WSHWBS currently uses a health needs assessment tool (HAPI – Lancaster model) to collect school entry data (Healthy Child Programme) and produce a public health plan which facilitates partnership working with schools. The health needs assessment is in the form of an online questionnaire and is offered universally to all parents who access the questionnaire through a secure portal. The school age questionnaire was adapted to meet the needs of the pre-school child with regard to school readiness from an individual child and public health perspective.

During the first year of the pilot WSHWBS worked with 22 Early Years settings including Childrens Centres. Our aim was to work collaboratively with them, using their established communication processes, to offer their parents the opportunity to complete the online health needs assessment questionnaire. In order to facilitate the rollout of the questionnaire, we held focus groups with the Early Years professionals to understand the barriers and challenges that could present. The Early Years settings were keen to be involved with the pilot and assisted us by distributing to parents an explanatory letter, which included the link for parents to access and complete the health needs assessment online, and were pivotal in its promotion.  

What have the challenges to implementing the service/intervention been? And what has enabled the implementation of the service/intervention?

The Early Years settings raised concerns that the pilot would increase their workload and add pressure to an already stretched workforce. We met with all the settings individually and listened to their concerns and adopted an approach that was not prescriptive but allowed for flexibility of delivery depending on the individual settings circumstances. 

Has the initiative or project made a difference to patients/service users and or staff?

WSHWBS reviewed the completed questionnaires and contacted parents where a concern had been indicated.  So far only anecdotal evidence is available, however parents are reporting that the response from WSHWBS was timely and that they have received the extra help required. 

A number of children were identified as requiring extra support regarding behaviour, toileting and eating issues and these were referred back to the Health Visiting Service. We identified a number of children who were not attending dentists or having eye tests and these parents were given information regarding the importance of engaging with these services for their child and how to access them. Early indicators are that a number of parents have accessed these services and further analysis of this data will be undertaken following parents completing the school entry questionnaire.

The data gathered from the individual questionnaires was anonymised, collated and shared by WSHWBS with the Early Years settings. Facilitated and supported by WSHWBS, the Early Years settings reviewed the data and 3 public health initiatives have been devised to reflect the findings within specific geographical locations. Each initiative considers different aspects of school readiness and are fully supported by Warwickshire Public Health. The initiatives, which all impact on elements of school readiness, include:

Bottle swop – Health Needs Assessment Data indicated concerns in the areas of speech and language, accessing dental services and diet. Early Years professionals were concerned regarding the number of children using bottles within the age range of 1-4 years. WSHWBS approached public health to request funding to buy 1000 freeflow beakers/cups for the children within the locality, with the aim of supporting parents to swop from using feeding bottles to age appropriate drinking cups. The bottle swop will enable a face to face contact between a key professional and parent and support a discussion regarding the circumstances that the bottle is used and the advantages to health for changing from a bottle. Public Health messages will be given to parents which are linked to school readiness and parents will receive continued support in order to sustain the change. 

Adult Mental Health – Health Needs Assessment data indicated that within the cohort that completed the questionnaire approximately 1:5 adults reported a history of anxiety or depression. Using the data collected and collated by WSHWBS a comparison was made with the School Entry data which showed that this figure increased to approximately 1:3 adults within the school entry cohort during the same academic year. This was shared with Early Years professionals and following discussions it was noted that generally adult mental health is not addressed within the Early Years settings and the training that is received is limited. Early Years settings had informed us during the focus groups that they find it difficult to identify and access robust training and therefore within this area, the decision was made to focus on upskilling the early years workforce by providing an Adult Mental Health workshops. The training will include promoting positive adult mental health, recognising signs of deteriorating adult mental health, starting difficult conversations and signposting to relevant services. Stakeholders representing commissioning, adult and child mental health agencies, voluntary and third sector organisations have been approached and training workshops are now planned for the autumn.  

School Readiness – After reviewing the data the settings decided to focus on the skills that children require to be school ready, particularly physical skills and language skills. A decision was made to initially survey the local reception teachers from their feeder schools to determine the priority skills they would like to see improved with regard to school readiness. Using this information and knowledge from within the settings the plan is to develop a series of activities that, can be supported at home, to ensure that the children acquire the necessary competencies. 

It is too early in the pilot to determine what changes have been made and sustained within the 3 initiatives as the plan is to launch all 3 initiatives within the academic year 2018-19. 

The pilot identified the need for a countywide school readiness policy and this was fed back to Warwickshire Public Health. A broad working party has been established, with representatives from health, education and local authority, to co-produce a policy which will be available to all interested parties including parents. The aim will be to ensure a consistent approach to the expectations of children regarding school readiness.  

What are the long-term aims for the work?

Year 1 of the pilot was successful and will be extended and replicated to cover a larger part of the county during the second year. 96 settings have been invited to be included within Year 2 with the potential of reaching 2300 children. The anticipated outcomes are that there will be improved contact with services from families with children between the age of 3 and 5 years and that there will be more cohesive working between Health and Early Years professionals. Intelligence that is gathered from the health needs assessment questionnaire will be useful to inform any redesigning of services in a way that is evidenced and targeted to local needs.

Engaging with and working closely with the Early Years settings has proven to be pivotal to accessing parents of pre-school children due to the unique relationships that they build with parents. The settings also appreciated the extra support that they received from health and that there was a forum for them to discuss their issues regarding children’s health and development and their challenges accessing services.

Parental completion rate of the questionnaire overall was 39%. Parents have been surveyed to gain their views of the questionnaire and to understand their motivation for completion or non-completion. Recommendations have been made from this for year 2 of the pilot in an attempt to improve completion rates. This includes altering some processes and offering extra support to parents within the settings to complete the questionnaire. 

All outcomes of the pilot are shared with Warwickshire Public Health and are being measured by Coventry University. Following analysis of the pilot, Warwickshire Public Health will make any decisions regarding taking the initiative forward. 

Nurses 4 public health

Nurses 4 public health

The RCN has been working with members on a series of case studies which help showcase the variety of ways nurses are currently working to improve public health. 

If you would like to submit a case study, please complete this template and email it to helen.donovan@rcn.org.uk. To fill out the template, you will need Adobe Acrobat Reader, which you can download here