SURE START BLOSSOM SURE START STRUCTURE OF PRESENTATION 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) Background 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; Armagh 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 Years) Regional Health Lead Body Board Accountable Body Southern HSC Trust (financial accountability) Southern HSC Trust SCCP Management Committee 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 Committee Southern Area Health Trust (3) – Health Visiting/Speech and Language/Social Services DELTA Parenting Partnership/SHSCT Early Years – the Organisation for Young Children Home-Start NICMA 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 Portadown 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 status 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 x2 Therapists x 2 Childminding & Training Early Years Midwife 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 Portuguese Polish Lithuanian NI Aims and Objectives Aim “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” Objectives Improving health and well-being Improving social and emotional development 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 area 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- obesity 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 development 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 services 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 families 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 mealtimes; 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 Skills 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 Providers 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 week 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 Skills 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 services Physical and emotional health during pregnancy and in post-natal period – smoking/alcohol/breastfeeding/preparation for parenthood 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 Education 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 appropriate 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 Education 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 programme Childcare and Early Years Education 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 Education 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 gradient 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 children 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 carers 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 outcomes 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 school Outreach – disadvantaged families Evaluated models to meet quality standards Finally 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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