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									 SURE START
 Background to Sure Start
 About Blossom Sure Start
 Marmot Objective A
 Sure Start service delivery – how it fits
 with Marmot
 Lessons from Sure Start
What is Sure Start
 Sure Start is a key plank in the Government
 Strategy to give children a better start in life.
 It plays a key role because it supports the
 whole child and the family by addressing a
 range of needs. It looks at health, learning
 and social development in an integrated way,
 because they all reinforce each other. It
 works with parents as well as children,
 communities as well as families”.

    (Angela Smith, Minister for Health Dec. 2004)
 Labour Government Strategy to address
 social exclusion and poverty
 Based on extensive research on what works
 Universal service in identified areas of need
 Extensive development of Sure Start projects
 Shift in England to Children’s Centre – target
 of 3,500 Children’s Centres.
Sure Start England
 Investment in Sure Start represented
 significant focus on Early Years following
 years of neglect
 Based on importance of early intervention
 and prevention in addressing social issues
 Commitment to retain Sure Start (England) in
 cuts announced last week
  Work undertaken by Centre for Social Justice
 on Early Intervention – Cross Party Early
 Intervention Report
Sure Start NI
 First projects in NI 1999-2000
 Currently 32 projects across NI –
 Urban/rural mix
 Top 20 most deprived Wards, new
 Wards identified as statistics evolve
 Approx. 30,000 pre-school children in
 NI within Sure Start catchment
Southern CCP Area
7 projects currently
Portadown; Dungannon; Newry; South
Armagh; Clogher Valley; Lurgan/Brownlow;
Oldest NI projects now around 10 years old –
represents considerable resources into Sure
Start NI to date
Blossom Sure Start budget £640K
Eligibility – live in Sure Start area and have
pre-school child
                     Department of Education
                     (Policy responsibility for Early

                            Regional Health
    Lead Body                   Board                   Accountable Body
Southern HSC Trust      (financial accountability)      Southern HSC Trust


Local Management
 Partnership arrangements bringing together
 community, voluntary and statutory organisations
 Within Southern Area projects these are
 un-constituted partnerships
 Some areas (e.g. Eastern) projects are set up as
 Limited Companies
 Lead and Accountable bodies – mixture of voluntary
 and statutory bodies
 SHSCT is both Lead and Accountable Body for
 Blossom Sure Start
 Management Committees responsible for strategic
 development and delivery
Blossom Sure Start Management
 Southern Area Health Trust (3) – Health
 Visiting/Speech and Language/Social Services
 DELTA Parenting Partnership/SHSCT
 Early Years – the Organisation for Young Children
 Drumcree Community Trust (CD organisation)
 PLACE (CD organisation)
 Cots and Tots Day Nursery (community daycare)
 Ashgrove Playgroup
 Corcrain Parent and Toddlers Group
Blossom Sure Start
 Originally (2001) one Ward and two parts Wards of
 urban Portadown – mainly Catholic Drumcree area
 Corcrain Ward ranked among highest in terms of
 economic and social deprivation
 Divided interface area at a difficult time –
 considerable challenge re location of building/delivery
 of services/duplication
 Original catchment of 432 pre-school children-
 compact urban area
 10 staff
 No Migrant Worker families
Blossom Sure Start
 Significant expansion over 9 year period
 Covers 6 full Wards – approx. 2/3 of urban
 Catchment of 1080 pre-school children – close to
 100% registered
 Area remains segregated but clear evidence of
 integration within Sure Start project
 Nearly 20% of families are Migrant families – mainly
 Portuguese and Polish, some Lithuanian
 Staff team of 31 – extensive range of services
 Only project in Southern Board with Children’s Centre
                    BLOSSOM SURE START TEAM

                                                Project Manager

Health Visitors                             Administrators              Early Years Support
      X3                                     2 x 37.5 hrs                     Worker

                                       Occupational Therapist            Early Years Leader
  Speech & Language
  Therapists x 2
                                     Childminding & Training                Early Years
                                          Co-ordinator                     Assistants x7

                    Family Support       Home Start Organiser/          Creative Arts & Play
                      Workers              Incusion Officer                   Worker

Bilingual Family Support      Parenting Worker        Creche Leader   Parenting Support
        Workers                                                        Worker for Men
NI Aims and Objectives

 “To work with parents and children to
 promote the physical, intellectual and social
 development of pre-school children,
 particularly those who are disadvantaged, to
 ensure they are ready to thrive when they
 get to school”
 Improving health and well-being
 Improving social and emotional
 Improving ability to learn
 Engaging and strengthening families
 and communities
6 High Level Outcomes
 Being Healthy
 Living in Safety and with Stability
 Enjoying, Learning and Achieving
 Contributing positively to community
 and society
 Economic and Environmental Well-Being
 Living in a Society that Respects Rights
 Core elements of Sure Start
Support for families and parents,
befriending, parenting information
Support good quality play, learning and
childcare for children
Outreach and home visiting
Primary and community healthcare and
advice about child health and development
Support for those with special needs,
including signposting to specialist services
Service delivery
 Early intervention and prevention through
 integrated range of services
 Dependent on and responsive to local needs
 – variation across projects
 Universal and targeted services –
 proportionate/progressive universalism
 Additionality – building on existing services –
 statutory/voluntary/community services
 Home-based, group-based and joint services
Integration and reinforcing
key messages
 Majority of services cut across a number of the
 themes identified in Marmot Objective A
 Social model addressing wider context of health
 issues – holistic approach
 Multidisciplinary staffing arrangements-everyone
 working to same agenda, out of same building- focus
 on best outcomes for the child
 Reinforcing key messages across range of staff – e.g.
 ‘time’ for your child’; breastfeeding; bonding;
 emotional health; obesity; physical activity;
 importance of play
Marmot Policy Objective A
 Reduce Inequalities in the early
 development of physical and
 emotional health, and cognitive,
 linguistic and social skills
Health Visiting model with
Blossom Sure Start
 Significant number of HV hours in project – 80 hours
 Only project in NI to have a HV model with core and
 additionality – HV carry caseload for 1st year for 1st
 time parents (with core costs paid by SHSCT)
 Facilitates the delivery of additional services –
 primarily a home-based CDP programme by the same
 Health Visitor
 Enhances the development of trustful relationship
 between HV and family
 Establishes link between family and Sure Start
 services and promotes take-up of other services
Physical and emotional health
 3 very experienced HV’s deliver the Early Child
 Development Programme
 Home-based 12 month programme – monthly visits –
 adapt elements of programme
 Universal for 1st time parents in Blossom Sure Start
 Focus on understanding child development/needs
 and supporting parents to child is 1 year old
 Includes ante-natal visit to est. contact
 Over 600 CDP visits April 09-March 2010
Physical and Emotional Health - Early
Child Development Programme
 While focus is on outcomes for child CDP supports
 well being of whole family
 Key themes:
 bonding and attachment;
 Routines, security and stability
 Promotion of breastfeeding/weaning/healthy
 diet/establishing eating patterns for life
 Physical development – importance of
 immunisations/medical needs/physical activity-
 Stimulation - Talking, reading, rhymes – early
 language skills
 Learning through play
 Home safety
Attachment and Bonding
 “According to attachment theory, from early infancy the
 capacity of parents to respond in a sensitive way to their child’s
 overtures and needs is crucial…The child ‘internalises’ his/her
 experiences …and forms a model of him/herself as lovable, and
 as others as loving and reliable…are associated with growing
 child’s ability to make other relationship, such as with friends,
 and, later, intimate love relationship. Children who display all
 insecure attachment patterns also show more emotionally
 dysregulated, disruptive behaviour and those with disorganised
 attachment show especially high rates of aggression”
                                    DeKlyen and Speltz, 2001
Physical and Emotional Health - Early
Child Development Programme
 CDP important in linking 1st time parents with Sure Start
 Audits of CDP demonstrates:
 Mothers very receptive – increasingly fathers taking part in CDP
 visits and attending other services e.g baby massage
 Relationship building/trust developed through continuity is a key
 element of success of Programme
 Information and materials from CDP is shared with
 partners/grandparents/friends/neighbours – spreading
 important messages to wider audience
 Mothers use information for the CDP with subsequent children
 Revised Healthy Child, Healthy Futures Programme for Health
 Visiting acknowledges the importance of increasing home visits
Physical and emotional
Also delivered by HVs
  Baby Massage – now also by Parenting
  Support Worker for Men
  Post-natal yoga
  Bi-weekly breast feeding support group (in
  rotation with midwife)
  Weekly baby clinic
  Input to other groups –e.g. parent
  groups/programme for 2 year olds
Physical and emotional health
– other home-based support
 Home based support to families under stress
 delivered by Family Support Workers and Home-Start
 volunteers – targeted service
 Home based support recognised as key way to
 support families most in need and engage them in
 Primarily referral service but can self-refer
 Emotional health of mothers and mental health issues
 in majority of referrals – over half of referrals
 Enhancing parenting skills and build resilience in
Physical and emotional health
– home based support
 Recent external evaluation of home-based support undertaken
 Staff/volunteers parents and referrers consulted
 126 families supported over 3 year period
 Benefits to parents highlighted by evaluation:
 Reduced anxiety and stress in their role as parents;
 More self confidence and self esteem as individuals;
 Greater self confidence as parents;
 Wider social networks;
 Recognising and managing stress levels in themselves and their
 children and the importance to taking ‘time out’.
Physical and emotional health
– home based support
 Benefits for children
 The establishment of routines and practices for
 children regarding quiet times, bedtimes and
 The practice of a positive parenting approach which
 rewarded children for good behaviours;
 The establishment of clear boundaries and effective
 management of discipline …without resorting to
 physical punishment
Physical and emotional health
–home based support
 Comment from Health Visitor
 “By using Sure Start you know you are giving
 a family every chance for success. Family
 Support Workers and Volunteers can
 reinforce the messages we are giving parents
 and also provide opportunities for parents to
 put into practice the advice and guidance we
 are offering” (generic Health Visitor,
 Portadown HV Team)
Physical and emotional health
 Recent external evaluation of HBS services quoted
 one parent who had been supported with her
 struggle with PND:
 “I hope this service can continue long into the
 future and help others who fall into that dark
 bottomless pit of despair at what should be
 such a memorable point in their lives, and help
 them realise that everyone has potential and
 can reach their goals in life if they have the
 right support network in place”
Physical and emotional health
– home based support
 Home-based support needs to be available at the time of stress
 – waiting lists not appropriate – support must be timely
 Quality of relationships with staff are very important – trust/non
 judgemental approach
 Tea and sympathy doesn’t provide answers – challenge function
 Often difficult to time-limit but must have a focus – many
 families are starting from very low base – focus must be on
 outcomes for the child/ren
 Need to reinforce messages – work collaboratively with other
 staff – e.g. HV/SLT
 Signposting to other services – health/housing/social
 Marmot policy recommendations include outreach support –
 outreach very important for engaging hard to reach families
Cognitive, linguistic and Social
 Speech and Language Therapist/s
 Occupational Therapist
 Creative Arts Play Worker
 Early Years Team/Creche Leader/
 Programme for Two Year Olds
Cognitive, linguistic and social
skills – SLT
 Nursery and primary schools had identified language and
 communication as key difficulty/barrier for children’s learning
 One full-time equivalent post (job share) – specialist SLT post
 Primarily group work with children, parents and Early Years
 Work with children in universal and targeted groups
 1-1 assessment of children
 Intervention with children who fail to access core service –
 ensures children access some support
 Additional support for children with Special Needs
SLT continued
 Feedback from nurseries and primary schools very
 positive in relation to SLT
 Statistical evidence from SLT service demonstrating
 fall in referrals to core service
 Capacity building with Sure Start staff/other Early
 Years staff and parents in early identification of
 problems and support for children
 Early identification of children and appropriate
 intervention leads to better outcomes – increasing
 opportunities to identify e.g 2 Year Old Programme
 Works closely with OT on delivery of services
Cognitive development –
Occupational Therapist
 OT employed approx. 1 year – now 16 hours per
 Primarily groups – with children, parents and Early
 Years Providers
 Some 1-1 support with children
 Additional support for children with special needs
 Capacity building - Support and training for Sure
 Start staff/local Early Years providers
 Works closely with SLT/s
 Greatly enhanced integrated services
Cognitive, linguistic and Social
 Creative Arts Play Worker
 In post since inception of project
 Modelling to other staff/local Early Years Providers
 and parents importance of choice and creativity for
 children’s development
 Activities include story telling; themed activities;
 outdoor play and exploration; summer programmes
 Emphasis on importance of time spent with child and
 use of everyday use materials
Marmot Policy Objective A
 Ensure high quality maternity services,
 parenting programmes, childcare and
 early years education to meet need
 across the social gradient
Maternity Services
 Midwifery input – limited 6 hours per week
 Focus on additional support for vulnerable antenatal
 and early postnatal mothers – e.g. teenage mothers
 – home-based support to those who does not access
 Physical and emotional health during pregnancy and
 in post-natal period –
 smoking/alcohol/breastfeeding/preparation for
 Group based and 1-1
 Input in breast-feeding group and targeted groups
 Close liaison with generic M/W and HV’s
Parenting Programmes
 Range of support for parents – through 1-1; groups;
 evidence based programmes
 DELTA – Parenting Officer
 Incredible Years – 12 week programme with focus on
 managing behaviour – targeted
 Parent Workshops for Programme for Two Years Olds
 Range of other staff input to parenting programmes
 – e.g. SLT/HV/CAPW
 Works closely with Parenting Support Worker for Men
 in engaging fathers
Childcare and Early Years
 Creche – Creche is a gateway for children to group
 based activity – dedicated creche room
 Creche Leader undertakes home visits to hard to
 reach families – in conjunction with other staff, as
 Creche activities are particularly important for
 children who have limited opportunity for separation
 for their parents e.g. Migrant children
 Creche Leader has undertaken role of Transitions
 Importance of good transitions for children
 increasingly recognised for good outcomes
Childcare and Early Years
 Programme for Two Years Olds
 Focus on children’s physical, social, emotional and cognitive
 development with a focus on age appropriate play-based
 learning and enjoyment;
 Creating a learning and development strategy for staff in
 relation to the needs of children and how practitioners can
 support their development;
 Supporting a partnership with parents that builds on knowledge
 and skills in relation to their own children …positive play and
 learning, SLT, behaviour management, child development,
 emotional well being and dispositions for learning
 Universal but targets children who will benefit most from
Childcare and Early Years
 Children in their pre-preschool year
 7.5 hours per week – 12 children per group
 Blossom currently has 5 groups – 60 children
 High demand – 90 applications for 2010-11
 Groups run September-June
 Home visits incorporated to programme
 Development of transitions programmes has been
 key element of programme – from home-
 programme-preschool – positive feedback from local
 pre-school facilities on benefits of the programme
Childcare and Early Years
   Evaluation of 9 projects undertaken by ETI Nov. 09 – report
   June 2010 – available on ETI website
Comments on provision for learning (integration)
“In the majority of the centres the quality of integrated specialised
   support ranged from good to outstanding. In the best practice
   observed, there was evidence of a well established and
   effective, integrated partnership between the HSCT and the
   SureStart team in targeting early identification. The multi-
   agency approach, when effective, provides prompt and
   individualised support, empowering the parents to develop a
   resilience, and greater confidence to overcome difficult
   circumstances and provide a better start for their child”
Marmot Policy Objective A
 Build the resilence and well being of
 young children across the social
Resilience and Well Being

 Cross cutting theme across range of services
 Importance of love, time and attention reinforced
 across the range of programmes
 Protective factors – routines, security and stability
 Promoting healthy development
 Promoting learning through play
 Enhancing opportunity for parents and children for
 social engagement
 Focusing on the whole child
Building resilence of young
 Inclusion work with hard to reach families –
 dedicated role of Inclusion Officer, targeting families
 who do not use services – important in reaching most
 disadvantaged families
 Bilingual Family Support – Portuguese, Polish and
 Lithuanian speaking workers
 Parenting Support Worker for Men – dedicated
 worker to focus on engagement of father and male
 Support for childminding – quality of provision
Concluding remarks
 In the current climate it is critical we harness the best of
 everything to ensure best outcomes for children
 Clear fit of Sure Start with Marmot Objective A
 Health – with a holistic focus on the child and the outcomes for
 the child – supporting family and community
 Recognise the significant resources allocated to Sure Start and
 outcomes achieved
 Considerable work undertaken at project level of measuring
 Need for data tracking – within Southern Area the Sure Start
 Database provides valuable information for project management
 DE has proposal for evaluation of Sure Start NI – strategic
 approach to evaluation will be welcomed by projects
Concluding remarks
 There is a wide range of policy documents that has
 relevance to Sure Start – e.g. Family Support; Mental
 Health – danger that Sure Start doesn’t seek to have
 all the answers/need to keep focus on good
 parenting and outcomes for children
 DE has policy lead for Early Years – Draft 0-6
 Strategy out to consultation – welcome that Sure
 Start is incorporated in major policy document
 Response from Sure Start in Southern Area will
 highlight holistic view of child and importance in
 health related outcomes
Concluding remarks

 New Healthy Child, Healthy Futures – A Framework
 for the Universal Child Health Promotion Programme
 in NI – emphasises importance of integrated
 children’s services in partnership with key
 stakeholders including Sure Start to improve
 outcomes for children
Concluding remarks
 Marmot policy recommendations on Objective
 A have specific relevance to Sure Start in
 relation to:
 Focus on Early Years
 Focus on families and on child development
 Good quality EY education and childcare
 Developing programmes for the transition to
 Outreach – disadvantaged families
 Evaluated models to meet quality standards
 Thanks on behalf of Blossom Sure Start
 for opportunity to overview project and
 relevance to Marmot – this has been a
 very timely opportunity to look at the
 relevance of our work to health
 objectives and be able to share that
 with you.

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