Early YearsThe Collaborative Approach

Why does Early Years matter?

The Evidence

The Evidence Base Brains Are Built from the Bottom Up: Skills Beget Skills

The Evidence Base Toxic Stress Damages Developing Brain Architecture

Typical neuron: many connections Neuron damaged by toxic stress: fewer connections

Some key facts:

• By 2 years of age, brain is 80% of adult size

• >50% of the incidence of depression and suicide attempts could be attributed to adverse childhood experiences

• Boys assessed as “at risk” at age 3 had 2.5 times as many criminal convictions at age 21 than those “not at risk”

Early years change activity

• Early Years Framework (2008)- Winning Hearts and Minds but very broad in scope

• Early Years emphasis in 2011 Manifesto commitments • Development of Early Years Taskforce & Change Fund• Now need to focus on priorities (like SOA discussion) • Get joint clarity about what needs to be done to achieve

those priorities (Taskforce vision and priorities) • Use CPPs, the statement of ambition and the review of

SOAs to achieve maximum impact• Apply Improvement methodology to effect change and

improvement via CPPs

Scotland is the best place in the world to grow up and the best place in the world to bring up children

Scottish Government Champions the importance of the early Years and gives out consistent messages about what is needed to make this happen.

Others champion and lead the Early Years agenda at a national and local level

Parents, Families and Communities understand the importance of the early years and behave in a way that supports improvement

The Early Years Collaborative meets stated aims

Workforce have the capacity and capability to deliver improvement

Clear measurement and real-time data is available and acted upon

•Ministers•Officials •Children’s Bill

•EYTF & Subgroups•Leadership walkarounds•SOAs and CPPs prioritise EY

•Play Talk Read Campaign•Early Years Alliances •Parenting Strategy

•Collaborative in place•Workstreams meet their aims•EYTF support the work•Public strand works

•EYTF Workforce group•Practice Development Team •Improvement Support •Learning sessions and CPD provided

•Improvement Advisor•Early Years Indicators•Health ISD will provide data

What is the process of the Early Years Collaborative?

IHI Breakthrough Series Collaborative

Select Topic

(develop mission)

Planning Group

Develop Framework & Changes

Participants (10-100 teams)

Prework

LS 1

P

S

A D

P

S

A D

LS 3LS 2

Supports

Email (listserv) Phone Conferences

Visits Assessments

Monthly Team Reports

A D

P

SExpert

Meetings

AP1 AP2 AP3

LS – Learning Session

AP – Action Period

Holding the Gains

We are here

What is the Model for Improvement?

What are we trying toaccomplish?

How will we know that a change is an improvement?

What change can we make that will result in improvement?

Model for Improvement

Act Plan

Study Do

Langley, et al.

Appropriate Scope for a PDSA CycleCurrent Situation Resistant Indifferent Ready

Low Confidence that change idea will lead to Improvement

Cost of failure large

Very Small Scale Test

Very Small Scale Test

Very Small Scale Test

Cost of failure small

Very Small Scale Test

Very Small Scale Test

Small Scale Test

High Confidence that change idea will lead to Improvement

Cost of failure large

Very Small Scale Test

Small Scale Test

Large Scale Test

Cost of failure small

Small Scale Test

Large Scale Test Implement

Staff Readiness to Make Change

Improvement Guide, 2009

Does this ImprovementModel Work?

The Evidence

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1981/8

2

1982/8

3

1983/8

4

1984/8

5

1985/8

6

1986/8

7

1987/8

8

1988/8

9

1989/9

0

1990/9

1

1991/9

2

1992/9

3

1993/9

4

1994/9

5

1995/9

6

1996/9

7

1997/9

8

1998/9

9

1999/0

0

2000/0

1

2001/0

2

2002/0

3

2003/0

4

2004/0

5

2005/0

6

2006/0

7

2007/0

8

2008/0

9*

2009/1

0*

2010/1

1*

2011/1

2*,

p

Year of discharge

% M

ort

ali

ty o

n D

isch

arg

e

Surgical Mortality

35%

0.51%

0.78%

What are the aims of theEarly Years Collaborative?

Workstream 1- -9months to 1 month Workstream 2 - 1 month to 3 years Workstream 3 - 3 years to 5 years

Early Years Collaborative- Scotland the Best Place in the World to grow up

How will improvement be achieved? Supporting strong attachment Improving child and maternal mental health Improving nutrition / breastfeeding Stimulating brain development Improving and promoting physical activity and Play Additional Support for the most vulnerable Better planning and decision making for LAC

How will improvement be achieved? Supporting development of positive relationships Improving child and maternal mental health Improving nutrition Improving and promoting physical activity and Play Stimulating brain development Better planning and decision making for LAC

What do we want to improve? Improve AGA Weight for all children from x% to

x% by 2017 Reduce avoidable stillbirth rate by x% by 2017 Reduce avoidable neonatal death by x% by 2017 Reduce avoidable injury/harm to children by x%

by 2017 Increase stability/attachment for all LAC by yyyy

Who will support improvement? CPPs are the microsystem Primarily Public Health Nurses, GPs, Social

Work, Speech & Language and Educators Parents, Families & Communities

Who will support improvement? CPPs are the microsystem Primarily Public Health Nurses, GPs, Social Work,

Speech & Language and Educators Parents, Families & Communities

Who will support the improvement? CPPs are the microsystem Primarily Maternity Services, GPs, Public

Health Nurses, Social Work Parents, Families & Communities

What do we want to improve? Reduce % of children starting school with difficulties in: Early

Language and Communication, Social & Emotional Behaviours, Mobility & Coordination Skills and Creativity/Enquiry skills by x% by yyyy

Reduce % of children experiencing avoidable harm/injury by x % by yyyy

Increase stability/attachment for all children by yyyy

How will improvement be achieved? Increase Smoking Cessation pre-/during

pregnancy Reducing Substance misuse pre-/during

pregnancy Improving Nutrition pre-/during pregnancy Better planning and decision making for LAC

What do we want to improve? Reduce avoidable infant mortality rates by x% by 2025 Reduce avoidable injury/harm to children by x% by

yyyy Reduce % of children (at age 24 months) with

difficulties in: Early Language and Communication, Social & Emotional and Fine/Gross Motor Skills by x% by yyyy

Increase stability/attachment for all children by yyyy

How will we know if improvement has been achieved? Improved AGA Weight Statistics Reduction in avoidable stillbirths rates Reduction in avoidable neonatal deaths rates Reduction in avoidable injuries/harm Number of LAC Placements reduces and

permanence achieved within x months

How will we know if improvement has been achieved? Needs recorded and addressed at the 24-30 month

review: language, communication, social, emotional, obesity, etc.

Reduction in avoidable infant mortality rates Increase in breastfeeding rates Number of LAC Placements reduces and permanence

achieved within x months

How will we know if improvement has been achieved? Children have the skills they need to continue

their learning journey as successful learners, confident individuals, effective contributors & responsible citizens. Measured at Primary 1.

Number of LAC Placements reduces

All underpinned by support from: Addictions Services, Adult Public Health, Criminal Justice Social Work, Police & Third Sector

Led By: CPP Chairs, Local politicians, Local Authority CEx, NHS CEx , Directors of Finance, Chief Constables, Third Sector leaders

EY Collaborative – progress & next steps

• Launched on 1 October –Ministers, CMO, COSLA, Senior Civil Servants

• Expert groups – September and November to scope out each workstreams.

• Engagement with CPPs to encourage participation with the programme and learning sessions in November/December

• CPPs identify leaders and virtual teams to lead each workstream at a local level

• Final draft Aims to Early Years Taskforce for sign off in December

• 1st learning event 24/25 January with further events in May and October 2013.