Flying Start Update for 2010

Flying Start update for 2010

Summer 2011

INTRODUCTION

Number of FS settings-8

FLYING START UPDATE ON PROGRESS AND EVALUATION

CITY & COUNTY OF SWANSEA

Cap number of children -1430

It is good news that funding for the Flying Start Programme has been extended for a further three years, until 2014, and we are on track in Swansea to become fully operational this year, pending CSSIW registration and successful recruitment of staff.

Rather than a narrative report, as in previous years, this update will concentrate predominantly on a number of evaluation reports undertaken by the service providers. There are plans to develop a more robust evaluation framework this year that will be in line with the Results Based Accountability (RBA) model that the Welsh Government is adopting nationally for Flying Start, and revised Service Level Agreements with service providers will reflect this.

Main points of interest This has been another busy year in terms of completing the building work in the Flying Start schools and we are pleased to say this has now been done. The Portmead Flying Start setting opened last autumn and the child care is managed by Faith in Families. The Pentrechwyth Flying Start setting was finished in August and the school governing body was successful in their application to manage the child care provision in the school. The child care manager and team have been recruited and plan to begin inviting families into the setting for a variety of activities in the summer term, prior to being in a position to offer the child care entitlement in full from September.

Work to extend the facilities in Swansea Children’s Centre has also been completed. Child care provision was provided in the hall in Clwyd School for several months during the building process and we are grateful to the school for helping to make this happen. The extended facilities will double the capacity for FS childcare provision in the centre and Faith in Families will also manage this.

Plantos Bach has relocated to the FS setting in Waun Wen and offers Welsh childcare provision 5 afternoons a week. The location is not convenient for all families wishing to access this child care option and close monitoring of this arrangement will be ongoing.

Statistics

STATISTICS

The following tables give an idea of the activity undertaken delivering the entitlements of the FS programme this year, and it is this information that is submitted to the WAG each quarter: Health Team Separate contacts with FS children and/or parent Health Visitors

4590

Community nursery nurses

889

Midwife(teenage parents)

390

Link Worker(Bengali)

69

Speech and language therapist and therapy support worker 257 Child care Total number of FS child care sessions attended in the FS settings

14466

Parenting support Number of groups

44

Average number of attendees

282

Number of sessions in the home 311

EVALUATION - a national perspective An interim national evaluation of Flying Start was published on behalf of the Welsh Government by SQW in 2010. It drew on the work of the consortium delivering the national evaluation of Cymorth and Flying Start, comprising: Ipsos MORI; CRG Research; University of West of England, Bristol and Karl Ashworth. The pilot nature of the programme meant that its effectiveness and cost effectiveness had to be evaluated with respect to those children and their parents who were eligible for the Flying Start entitlements and took them up, rather than in terms of its impact on improving the life chances of children in need as a whole. All the evidence indicates that early years’ interventions need to become embedded operationally, culturally and consistently before they can have an effect that is discernible.

Despite its qualitative nature, the various research strands have revealed a substantive body of evidence from across the 22 Partnerships which points consistently in the same direction suggesting that improvements have been secured in: • The emotional and social development of Flying Start children • Their language and cognitive development (to a lesser degree) • Parental confidence and engagement Across the programme it is apparent that there are generally high levels of satisfaction and strong demand for the services delivered. The story that is being told strongly and consistently suggests that the programme is on the right positive trajectory to achieve its immediate outcomes around child development and family/parental development, as well as contributing more widely to service improvement.

EVALUATION IN SWANSEA To date, apart from the national evaluation of FS as described earlier, each of the 22 Flying Start areas throughout Wales have evaluated their own projects in different ways and several examples of good practice from Swansea are in the national evaluation report. The Welsh Government is planning to roll out the Results Based Accountability (RBA) evaluation model within the next year to be used throughout the programme. This will involve a considerable amount of training and awareness raising for practitioners and this process has already begun.

Meanwhile, below are some snapshots of evaluated work undertaken by service providers in Swansea. Full reports are available on request.

SPEECH AND LANGUAGE THERAPY Speech and language therapist and therapy support worker

This evaluation covers the time period from July 2010-March 2011. The full time speech and language therapy post holder was on maternity leave during this period and cover provided by a speech and language therapist from the generic service in the Health Board was for only 5 hours a week.

There was an excellent uptake of initial appointments-all home visits-with low rates of failed visits at initial assessment (only two failed visits over the time period). A waiting list has built up due to the lack of resource this year.

Evaluation Questionnaires were completed pre and post intervention, and were originally devised to capture parents’ perceptions of their child’s speech, language and communication skills as a quantitative measure of service effectiveness.

Qualitative information was also obtained from a record of verbal comments made by parents. The questionnaire contains a total of 11 questions, but this

report focuses on the most salient information captured, in order to give an overall picture of the parents’ views.

1. How concerned are you regarding your child’s speech and language?

Average self rating on a scale of one to ten (1-not concerned, 10-very concerned) 6 5 4 3 2 1 0 pre intervention

post intervention

The majority of families reported a decrease in concern post intervention, which is a positive result. However, three families reported an increase in concern. These families tended to be those who were initially unconcerned as they did not appear aware that their child was encountering any difficulties.

Following intervention from the service, they became more aware that their child was not communicating as he/she should have been, and their level of concern was then justifiably raised by the end of the intervention.

2. How would you rate your child’s speech and language?

Average ratings on a scale of 1-10 (1- Poor, 10 excellent) 7 6 5 4 3 2 1 0 Pre intervention

Post intervention

This shows a positive increase from an average of 4.1 to 6.1 post intervention.

This is a desired result as parental perception is an important marker in how they feel their child has improved.

Do you feel able to help develop your child’s speech and language?

Rating on a scale of 1-10 (1not at all, 10 - totally) 7.5 7.45 7.4 7.35 7.3

Pre intervention Post intervention

7.25 7.2

This was a rather disappointing result, with only a small increase. Perhaps parents are a little reluctant to admit on an initial assessment that they don’t actually know the best ways to encourage their child’s speech and language.

Qualitative comments made by parents perhaps offer a more personal insight into the value of the service: ‘I can see how he’s trying to communicate more now; I think I was missing stuff before’ ‘I didn’t think about getting the toy tea set out for him before but he loves it and we play picnics with his toys’ ‘He loves it when I play with him now’ ‘She’s trying to say more now ‘cos I leave her say it herself and not say it for her’ ‘I’m grateful for those ideas, I can have a go myself now’ ‘I’ve been really trying to get rid of her dummy’ Speech and Language groups in the Flying Start child care settings Group activities had been devised by the Flying Start speech and language therapist prior to her maternity leave and have been continued by the therapy support worker who has been visiting each Flying Start child care setting in turn, providing them with a block of four sessions over four weeks. The size of the groups has varied from four to eight children and a total of 65 children have been seen. Each group session consists of activities designed to focus on attention and listening; turn taking; eye contact; receptive language; vocabulary development and oro motor skills.

The group sessions have been evaluated via staff questionnaires, and also by recording any staff/child comments. Constructive criticism regarding group dynamics has resulted in positive change, and the use of an interpreter in some of the settings has helped children access the service, enhanced their understanding and has broken down language barriers.

Group evaluation How happy were you with the input provided to your setting?

Average rating – 2 (1-very happy, 5 - not happy) How effective do you think the input was in meeting the needs of the children?

Average rating – 2 (1 – very effective, 5 - not effective) Do you feel Speech and Language input has made a positive impact to your setting?

Average rating – 2 (1 – very positive, 5 – not positive) Group feedback has therefore been positive on the whole, and constructive criticism has been used to improve future group sessions.

Some qualitative comments made by staff members after the group sessions ‘Blow painting was real success and the children really enjoyed this’ ‘We have now developed our own fishing game with the same philosophy; it works very well in groups.

‘X has become much more confident since attending the groups.

CHILD CARE Each child is entitled to 2.5 hours a day, 5 days a week, and 42 weeks a year

As part of the Evaluation of the Flying Start childcare service in Swansea, the developmental records of three children from each Flying Start setting were analysed, and data collected. The children were selected at random and were given the titles Child 1, Child 2 or Child 3 in each setting. Using selected individual records based on the Foundation Phase Developmental Profile, two sets of data were collected from each of the seven areas of development – an Entry score and an Exit score. The areas of development are as follows: Personal development (Pd on graph) Social development (Sd) Emotional development (Ed) Language development and Communication skills (L&Cd) Cognitive development (Cd) Physical development – Fine motor (PdF) Physical development – Gross motor (PdG) A cumulative score for each setting was then produced for entry and exit, using Child 1, 2 and 3’s scores for each area of development. Graphs for each Flying Start setting were produced, representing this cumulative data.

Total number of targets achieved

Flying Start Townhill Cumulative scores for Child 1,2,3, across 7 areas of development 50 40 30 20 10 0 Pd

Sd

Ed

L&Cd

Cd

PdF

PdG

Key:

Within each colour set of two columns, the first column represents the cumulative entry scores and the second column represents the cumulative exit scores

Flying Start Seaview Cumulative scores for Child 1,2,3,across 7 areas of development

Total number of targets achieved

50 40 30 20 10 0 Pd

Sd

Ed

L&Cd

Total number of targets achieved

Flying Start Portmead Cumulative scores for Child 1,2,3, across 7 areas of development 50 40 30 20 10 0 Pd

Sd

Ed

L&Cd

Cd

PdF

PdG

Cd

Pd F

PdG

These graphs clearly show a significant difference between the developmental skills these children entered the setting with, and the skills they had gained by the time they were leaving their Flying Start setting and entering Foundation Phase.

Without exception, this data shows that the high quality Flying Start childcare has contributed to a positive impact on the development of the sample of children randomly selected.

Flying Start Hafod Cumulativ e score s for Child 1,2,3, across 7 areas of de v elopment

40 achieved

Total number of targets

50

30 20 10 0 Pd

Sd

Ed

L&Cd

Cd

PdF

PdG

Total number of targets achieved

Flying Start Arfryn/Clwyd Cumulative scores for Child 1,2,3 across 7 areas of development 50 40 30 20 10 0 Pd

Sd

Ed

L&Cd

Cd

PdF

PdG

Flying Start Waun Wen Cumulative scores for Child 1,2,3 across 7 areas of development

Total number of targets achieved

50 40 30 20 10 0 Pd

Sd

Ed

L&Cd

Cd

PdF

PdG

Flying Start Plantos bach Cumulative scores for Child 1,2,3 across 7 areas of development including Welsh language development

Total number of targets achieved

50 40 30 20 10 0 Pd

Sd

Ed

WL&Cd

Cd

PdF

PdG

Key:

WL&Cd – Welsh Language and Communication development

Flying Start Plantos Bach Cumulative scores across 7 areas of development including English Development and Communication skills

40 achieved

Total number of targets

50

30 20 10 0 Pd

Sd

Ed

L&Cd

Cd

PdF

PdG

Total number of targets achieved

Flying Start Blaenymaes Cumulative scores for Child 1,2,3,across 7 areas of development 50 40 30 20 10 0 Pd

Sd

Ed

L&Cd

Cd

PdF

PdG

In the graph above that represents the cumulative scores from the Blaenymaes Flying Start setting, it is noted that the range between the entry scores and the exit scores for each area of development, is generally smaller that in the graphs from other settings. The reason for this is the data collected from Child 2, is not typical of children in the area. This can be clearly seen in the graph below showing Child 2’s entry and exit data across the seven areas of development.

As seen in the graph below, Blaenymaes Child 2 has particularly high entry scores across all seven areas of development; consequently, unlike most of the sample group, this child’s entry and exit scores are very similar. This example supports the practice of extending the Developmental Progress Tracker further along the continuum for some children, to ensure that each child is given opportunities to extend their developmental skills which are then accurately assessed and recorded.

achieved

Total number of targets

Flying Start Blae nymae s Child 2 Cumulativ e score s across 7 are as of de v e lopme nt 90 80 70 60 50 40 30 20 10 0 1

2 Entry cum ulative score (1) Exit cum ulative s core (2)

Cumulative scores across 7 areas of development in child care settings Setting

Pd

Pd

Sd

Sd

Ed

Ed

L/cd

L/cd

Cd

Cd

Entry

Exit

Entry

Exit

Entry

Exit

Entry

Exit

Entry

Exit

Fine motor

Fine Motor

Gross motor

Gross Motor

Entry

Exit

Entry

Exit

Townhill

21

38

15

29

12

24

21

40

10

31

8

28

8

20

Sea View

21

40

21

31

12

30

26

39

13

32

15

28

10

22

Portmead

14

42

11

32

8

33

10

41

10

39

5

32

10

24

Hafod

18

42

15

31

9

26

19

38

10

38

15

32

11

28

Arfryn/Clwyd

25

42

18

31

18

32

22

38

15

32

10

29

10

22

Waun Wen

16

46

11

31

12

32

19

45

9

39

10

32

8

28

Plantos Bach(Welsh)

18

40

12

30

16

32

6

30

4

32

6

31

2

21

Plantos Bach(English)

18

40

12

30

16

32

18

41

4

32

6

31

2

21

Blaenymaes

30

40

24

29

22

29

31

34

18

29

16

30

16

24

It is clear to see, as illustrated on the above table, that children travelled a considerable distance and made progress in all areas during their Flying Start child care experiences.

Additional information about the Flying Start child care provision •

Individual evaluations on children receiving 1-2 days of their child care entitlement in Stepping Stones, based on different assessment criteria, show progress in all their areas of development

•

Pentrechwyth, Portmead and the Plantos Bach Welsh provision are currently going through the process for CSSIW registration prior to operating at full capacity

•

Current child care capacity is not meeting the demand in all the settings and there are plans to address this by applying for additional capital funding from WAG this year

EDUCATIONAL PSYCHOLOGIST A new addition to the FS team this year, providing one day a week support The educational psychologist (Alison Griffiths) took up her role within Flying Start from April 2010. The educational psychologist has aimed to work within a consultation framework with parents, health visitors and childcare setting staff to address issues of concern, the health visitor being the key worker/link person. Consultations lead to agreed actions being carried out, such as observation of the child in the childcare setting, assessment of the child, home visits to consider behavioural issues at home, and working with the people most concerned on strategies to improve the situation. Consultations are generally focused on behaviour, aspects of the child’s development or working with a particular disability.

In addition to consultations about individuals, informal discussions are also available for any members of FS staff to discuss general issues such as behaviour management or child development issues. Informal discussions are also sometimes had prior to initiating a sole consultation.

The educational psychologist has also offered training sessions focusing on particular subject areas, chosen by the Flying Start team, which have involved parents and staff working together. The aim has been to develop good working relationships with every Flying Start setting and to offer a number of planned sessions each term, as well as some additional sessions on request.

General Evaluation The role has developed well over the year, following an initial period of awareness raising with the FS team and establishing referral criteria and processes. The feedback has been very positive, and some settings have already explored many aspects of what is on offer, whereas others are using the time more informally.

Third Quarter (January, February and March 2011) During the above period there were ten setting visits. Seven children were worked with, some on more than one occasion. There have been two training sessions with families and staff.

So far Hafod, Waun Wen (Welsh medium and English medium) Townhill, Clwyd, Sea View, Blaenymaes and Stepping Stones have all had input.

Portmead and Pentrechwyth will be offered input from the Summer Term.

Evaluation of work undertaken during the third quarter Six evaluation sheets were returned from setting staff and families over this term and the outcome was: •

83% stated that their confidence in dealing with the issue had increased following input from the educational psychologist.

•

100 % rated the educational psychologist as eight out of ten or above in helping them to clarify issues.

•

100 % rated the educational psychologist as eight out of ten or above for helping them to implement appropriate strategies.

Comments on the evaluation sheets included the following: •

“The assessment was extremely worthwhile and staff were able to consider strategies to aid development,”

•

“The feedback was invaluable”

•

“I was pleased with the record of consultation and I am going to try to use the ideas to help my child develop his language skills.”

Evaluation from the two training sessions •

87 % stated the course content was good or very good.

•

75 % stated the content was good or very good regarding its relevance.

•

100 % stated the training was very good or good at providing the information clearly.

•

87 % stated the training pack was good or very good.

MOBILE TOY LIBRARY

The evaluation is based on, and adapted from, the Baby Effective Early Learning Programme by Bertram & Pascall.

Rationale •

A sample of 8 children was taken to reflect a snapshot of play sessions carried out during visits on the Mobile Toy Library bus.

• • • • • •

Observations were taken between September 2010 and March 2011.

3 children aged 0-1 years and 5 children aged 1-2years.

3 girls and 5 boys.

6 observations were taken of each child totalling 48 observations.

Observations were amalgamated in each analysis and presented as bar charts showing the cumulative tally for each level.

The Levels of Child Engagement and Child/Adult Engagement range from non-engaging Qualities at Level 1 through to fully engaging qualities at Level 5.

1. Care, Learning and Development Experiences The play activities offered during sessions on the Mobile Toy Library bus are geared to meet the needs of the child and aimed at promoting a child’s; Creative Development Communication, language & literacy Knowledge & understanding of the world Problem solving, reasoning & numeracy Personal, social & emotional development Physical development Key Findings The data analysis showed that of the learning experiences offered, results showed high scores for most areas of development with the highest score being for Communication, Language & Literacy.

This showed that the aim of the project was being realized in promoting holistic child development especially speech and language skills. The low score for knowledge and understanding of the world reflected the age and development of the sample group.

2. Child Engagement Child Engagement demonstrates the way a child engages in the process of learning through play and is split into 3 categories: Connectedness reflects emotional security and well-being, confidence.

Exploration reflects motivation to discover.

Meaning Making reflects a child’s ability to make sense of their experiences.

Key Findings The data analysis showed the highest score of Connectedness was Level 3.

For 60% of experiences a child is beginning to take initiative and beginning to make choices, is growing in independence but still seeks much support.

The lowest score was at Level 1 which reflects over-dependence, lacking in confidence, is easily anxious or withdrawn and unresponsive.

The highest score of Exploration is Level 3. For 44% of experiences a child is often distracted, cautious when faced with new situations and is developing the ability to concentrate. However a close score of 42% is evident for Level 4 which suggests a child is working towards looking attentively or intensely, listening attentively or intensely, exploring objects in various ways and delights in new things. The lowest score is at Level 1 where a child lacks interest, is vacant, mistrustful of environment or is attention seeking.

The highest score of Meaning Making is Level 3. For 56% of experiences a child shows some interest in the environment, makes limited choices, has moments of engrossment and is more purposeful. .

The lowest score is for Level 1 where a child is reluctant or wary of interacting, reluctant to manipulate and unable to make choices.

3. Child/Adult Engagement BEEL suggests that the quality of adult intervention is a critical factor in the quality of learning which is experienced by the child. Based on this, the Adult Engagement in this evaluation is based on the involvement of the child’s parent/carer in their child’s play experiences. It is split into 3 categories.

Stimulation: How the parent/carer intervenes in the learning process Sensitivity: The sensitivity of the parent/carer to the child’s feelings and wellbeing.

Autonomy: The degree of freedom the parent/carer provides for the child to experiment and make judgements.

NB. Not all parents of the children observed stayed on the bus for the play sessions Key Findings The highest score for Stimulation is Level 4. 50% of parent interventions showed mainly engaging qualities but some evidence of non-engaging qualities. They were working towards their intervention presenting activities as enjoyable and motivating, encouraging their child to use their senses and sharing in their child’s interests. The lowest score is Level 2, mainly nonengaging qualities but some evidence of engaging qualities. Mostly does not motivate their child and does not accommodate or share in child’s interests.

The highest score for Sensitivity is Level 4. 56% of parents almost always showed warmth and affection, praised effort and achievement and empathized with the child’s needs and concerns.

However it is worth noting that 33% of parents scored at level 5 for Sensitivity which demonstrates totally engaging qualities of the above.

The lowest score is level 3 which reflects neither engaging nor non-engaging qualities predominate.

The highest score for Autonomy is Level 4. 64% of observations showed the parent was mainly enabling their child to experiment, choose and supported child-initiated ideas. The lowest score is Level 1 for Autonomy 3% of observations showed the parent was dominant or, the other extreme, laissez-faire or gave the child no room for choice or experimentation.

BOOKSTART- statistical data

Number of children attending Bookstart Activities

2375

Number of Parents in early Literacy Sessions-modelling

956

Number of Library Information Packs given out

685

Number of Library Sign up’s (by Bookstart Co-ordinator)

205

Number of Children completing Bookstart Bookcrawl at Libraries serving Flying Start Areas

Brynhyfyd 83,Fforestfach 31,Penlan 42,SwanseaCentral 72,Townhill 30

Number of Bookstart Packs gifted by Bookstart via Health Visitors

Baby Packs (gifted at6- 9 months) 2288

National Bookstart Day (June 2010)

250+ children and 200+ adults attended 22 different events in Libraries/ Flying Start childcare and playgroups. Working with Flying Start, LAP, Sure Start, and other basic skills voluntary and statutory organisations.

Art and Story Project

Artist Led Project in 2 Flying Start Settings: Seaview and Stepping Stones. 50+ Children

Early Years packs (gifted at approx 2 years old) 3190

World Book day (March 2011) Week of visits to all Flying Start Settings 193 children attended.

Bookstart Storytime Box(March 2011)

All Flying Start Settings, including Stepping Stones (special needs provision) 400+ Bilingual Books gifted,190 Children visited ,96

parents in early literacy modelling sessions Flying Start Post code library Registration 2010-2011

Pentrechwyth 3,Arfryn,Blaenymaes 19,Clwyd16,Hafod17 Seaview 51,Townhill 56,Waun Wen 27

Rhyme Time Challenge

422 children and 245 Parents took part in the challenge which was organised by Booktrust and aimed at pre-school and reception age children, to encourage a love of rhymes and early poetry and to increase family involvement by encouraging the learning and use of rhymes at home. The project, led by the Bookstart co-ordinator, was supported by Libraries, Flying Start early years Foundation Teacher and a speech and language therapist.10 Libraries, 6 Flying Start settings and two schools took part.

Qualitative information: Lots of activities and promotions have taken place, along with the gifting of the Bookstart packs. It has also been a year where poor literacy levels throughout Wales have been highlighted by Leighton Andrews the Assembly Minister for Children, Education and Lifelong Learning.

Raising literacy levels and levels of attainment in Wales is one of the Assembly’s key objectives and research has shown that schemes like Bookstart help support children with that first step into reading and help kickstart their learning journey through life.

Quotes from childcare staff: “A fantastic sensory experience” “Great to see parents and children especially dads enjoying singing with their children” “It’s great to work on an Arts and Project Story. The children get so involved in their art they hardly notice you, which is ideal to capture those spontaneous images that come out of this creative environment."

HEALTH VISITING

Recruitment of Health Visitors in Swansea remains problematic and is mirrored across the ABMU health board as a whole. This has an impact on the amount of additional support that can be offered to families that is above the core service and recommended in the WAG Flying Start Guidance for this

part of the Flying Start entitlement. Priority is given to new births, children with additional needs and those where safeguarding and or child protection is an issue.

Focus on assessment of children and their progression The Flying Start guidance requires the health visitors to assess each child involved in the programme using the Schedule of Growing Skills (SOGS) assessment tool at the age of 2 years and 3 years. This is a developmental screening procedure, based around the well known and well respected developmental sequences designed by Dr Mary Sheridan (From Birth to Five, Sheridan, 1985). The main purpose is to provide an accurate and reliable method of developmental screening and SOGS can be used as part of child health surveillance programmes to both monitor and measure child health and development. It is able to provide information on how a child is developing, what progress they are making, whether there are any areas of potential delay, and whether there is a need for a referral for more detailed assessment or therapy. Although it is not an in-depth diagnostic tool, it does provide diagnostic pointers to the nature of a child’s problem.

We have begun to analyse the data for 22 children who have been involved in the Flying Start Programme long enough to have had a 2 year and 3 year SOGS assessment completed.

The table below outlines the findings so far. We have noted a significant improvement in the cognitive skills domain in particular and would like to think that this can be attributed in some part to the Flying Start programme.

The next stage of the analysis, during 2011-2012, will be to map the individual children who have also received their FS childcare entitlement and compare their SOGS results to children who have not.

It is hoped it may also be possible to include other interventions the programme has offered to parents for themselves and/or their child as part of this ongoing evaluation process.

The table below outlines the individual cognitive skills scores from the SOGS assessment of 22 children. They relate to the following abilities:Manipulative skills; visual comprehension; interactive social skills; social behaviour and play.

MIDWIFERY

Over the last twelve months significant progress has been made in service provision for pregnant teenagers and teenage parents and their children within the Swansea locality. Teen Start was launched in October 2009 and initially Flying Start clients were supported by the Flying Start midwife and teenagers from the rest of Swansea were supported by the Teen Start Health visitor. Support was offered on a 1-2-1 group basis.

In January 2011, additional midwifery hours were secured and service delivery reorganised so that the midwives now support the antenatal clients and the health visitor and nursery nurse support the new parents. Both professionals now work Swansea wide.

The additional support provided by the service for pregnant teenagers and teenage parents aims to:1.

2.

3.

4.

5.

6.

7.

Improve the uptake and continuation of breast feeding, Reduce subsequent unplanned pregnancies Reduce the incidence of anaemia Increase uptake of MMR, HPV & school leaving vaccine Improve engagement with core services Support those that choose to live independently to do this effectively Reduce the incidence of smoking

Work has commenced in evaluating parts of the service and results so far are as follows in respect of clients supported this year: 1. 36 Flying Start clients who were transferred to the Flying Start Health Visitor between 01.04.10-31.03.11

2. 31 Flying Start clients referred to the Flying Start Midwife for Teenagers between 01.04.10- 31.03.11 Gravida status at time of referral: (Gravidity is defined as the number of times that a woman has been pregnant. For example, a woman who is described as ‘gravida 2’ has had 2 pregnancies).

At time of referral 14 % were multigravida.

Of these 6% had an older child, and 8% had not proceeded with the first pregnancy either through miscarriage or termination.

86% were first pregnancies or primagravida.

Gravida G2P0 8%

G2P1 6%

P 86%

Uptake of contraception at time of discharge: 18% had not accessed contraception.

82% stated they had accessed contraception or had a plan of what method of contraception they intended to access at point of discharge from the Flying Start Midwife.

Contraception Nil 18%

Pill 15% Condom 9%

Depo 9%

Coil 15%

Imp 34%

Involvement with social services at time of discharge: 35% had some involvement with social services during their pregnancies.

This varied from referral to the initial assessment team to legal proceedings for a full core assessment (foster care & mother and baby units).

Social Service Involvement Social Services 35%

Nil 65%

The data for the last 12 months revealed a larger percentage of Gravida 2 were involved with social services than primigravidas.

Method of Feeding at birth identified from the Flying Start Midwife’s evaluation at discharge.

Initiation of breast feeding increased slightly from the previous annual review to 52%. This could have been due to the distribution of breast pumps and promotion of breast milk expression. Further audit and support needs to be implemented to assess and support the continuation of breast feeding.

Group Attendance evaluated at discharge from Flying Start midwife Of the 36 Flying Start clients discharged 50% accessed groups and 50% declined groups

Groups

Bumps & Babies 17% DADS 22% Attended Multiple Groups 11%

YM2B 50%

Of the 4 Groups accessed: 50% Flying Start Clients accessed Young Mums 2B 22% Flying Start Clients accessed the Monthly Dads group 17% accessed Bumps & Babies for older babies 11% accessed a combination of groups

Service Evaluation of those Flying Start clients discharged from the flying Start Teenage Pregnancy Midwife between 01.04.10-31.03.11

PARENTING

The following report is a summary of the evaluation feedback that is done with parents who receive both one to one and group support from the parenting team, which sits in the Early Years Development Team (Child and Family Services) and includes input from Barbados Children Matter. Questionnaires are completed both at the beginning of the service and at the end and show the parent’s perception of the positive change they feel they have made.

Three key areas are measured; 1. Self confidence and self esteem 2. Parenting skills 3. Child’s behaviour 1. Self confidence and self esteem The following table demonstrates the clients’ perceived distance travelled in relation to the first research question about self-esteem and self-confidence.

Table 1: Parents’ average scores confidence and self esteem What difference has the project made to your Self Confidence and Self Esteem?

4.79

5.35

6.86

The average score for the questions relating to self-confidence and selfesteem given by parents completing the structured questionnaire at the start of the service was 4.79, rising 5.35 at review, with a further increase to 6.86 at the end of the service. This represents 20.7% increase in the overall score for self-confidence and self esteem (see table 1).

Parents identified the greatest confidence to ask for support’; that having support officers that main influence on that change.

Start setting stated;

area of change in this section was in ‘the it was commonly stated in the focus groups offered a non-judgemental approach was the One mum in a group run in the Hafod Flying

“Coming here is great. You can say what you need to and nobody will judge you, we will look at how we could have handled situations differently but you’re not being judged”.

Mum ‘A’ also attended a parenting group, which she says helped her to build on her confidence. She acknowledges that the benefits of attending group, in regard of her self esteem, are “untold”. She also stated that: “understanding that there are no perfect parents and that most of her problems were common to other families, I am not alone, at times we all make mistakes and learn by them was important”.

2. Parenting skills The following table demonstrates the clients’ perceived distance travelled in relation to the second research question about parenting skills Table 2: Parents’ average scores Parenting Skills What difference has the project made to your Parenting Skills?

6.0

6.6

8.6

The average score for the questions relating to parenting skills given by parents completing the structured questionnaire at the start of the service was 6.0, while at the end of the service this score had risen to 8.6. This represents a 26% increase in the overall score for parenting skills (see table 2).

It was commonly stated that understanding the need to be consistent and clear when setting boundaries was important and had the greatest impact on the ability to manage their children’s behaviour. However this was not where we saw the greatest area of change. The areas where parents reported most change were:

• •

Ability to manage children’s behaviour Difficulty being a parent

Parents generally recognised that consistency and clarity were the key skills in achieving both.

Mum ‘L’ stated “What I’ve learnt is to look at things from my child’s view and not just from my view” ‘L’ went on to report that she felt that not only was being a parent less difficult but that life in general was. She later stated:

“I was at the end of my tether when I first came to this group, I was shouting all the time, now I stop. They were only playing but I was stressed, the shouting was about me and not about them being naughty, they are just boys being boys. Coming to the group has looked at what is happening for me and to stop before I act and not react” Parents generally reported that using tools from the ‘Parentline plus/working with parents’ programmes has helped with understanding what is happening.

Generally it was recognised that having the visual prompts that were given out as handouts helped them implement what they were discussing in group. A few parents said that they had explained the models to the family and reported that partners or children were now using the models and language.

An example given by one mother is that her 8 year old child had come home and explained how she had used the “traffic lights” and had stopped to think before she got angry.

‘T’ (dad who received both one to one and group support and has been involved with the service for over 2 years) stated that: “We now play more games or go out for walks; we also give individual time to the children. It’s not easy and it doesn’t always work out but when we do things we are happier, it’s nice to take them out and not shout, we go to the park, play football we have a kite. They’re still naughty at times but when I tell them they need to stop they know I mean what I say and generally they listen – not all the time mind but it is easier” The question was asked about how they saw improved parenting skills as impacting on them being able to return to work, or at least thinking about it.

Frequently feedback reflected that having fewer difficulties with the children allowed parents to have more time and energy to focus on other things. One parent stated: “As I explained before, when I came here, I was at the end of my tether but everything’s calmer in the house. I had to give up work because of the children as I didn’t have time to work, but now I am thinking I would like to go back to college, I don’t always want to be only mum. I don’t think I am ready yet I want to do that STEPS programme.”

3. Children’s behaviour The following table demonstrates the clients’ perceived distance travelled in relation to the third research question about children’s behaviour.

Table 3 Parents’ average scores in Children’s Behaviour

Overall average for section

5.7

6.7

7.8

There has been a significant positive increase in children’s behaviour between the start and end of the service.

The average score for the questions relating to parenting skills given by parents completing the structured questionnaire at the start of the service was 5.7., while at the end of the service this score had risen to 7.8 This represents a 21% increase in the overall score for children’s behaviour (see table 3).

It was interesting to note that the majority of those who participated in the structured interviews commonly said that they felt that their children’s behaviour has not only changed in the home but that reports from school were also more positive. However it was also recognised that, where parents had been confident to liaise with school staff, the impact on the child’s behaviour was more positive.

Mum ‘B’ said that: “I never felt good about going into school to discuss X’s behaviour, I always felt as if it was my fault, but we discussed this in group and I realise that it is not about who’s to blame it’s about finding a way forward and working together with the school. I now know what the school is doing and I can then make sure I back them up. It’s working and X is listening and not getting into trouble” She went on to reiterate that having the confidence to speak to professionals had helped her make positive changes in the family, which was a common theme identified by parents.

The majority of men identified group support as making a major contribution to bringing about the changes they identified in all 3 areas. They commonly identify that being given an opportunity to problem solve within the group enabled them to develop skills that they were able to use in day to day life.

For example, ‘R’ stated that: “Being able to work things out for myself and being able to trust my own judgment is good. Sometimes you know the answers but being able to talk them through is all you need.”

Being able to develop a network of support outside the service was an important aspect of creating independence. Many men stated that they had

little to no support outside the group and that ‘being able to meet other dads in the same situation is helpful’. It was commonly stated that: “Being able to talk about your kids and chat about the problems you have with them helped make sense about what you were doing. It also helps to know you’re not the only one who has problems”.

The majority of parents identified the benefits of attending group and that developing peer support was important. The majority stated that Group support was an important part of being able to move on but the benefits of having access to long term support to enable the participant to take a journey that enables sustainable change is essential.

The benefits of the service to parents were summed up by Child ‘C’ who said “It’s nice living in our house now, we laugh and cuddle and mum doesn’t need to shout. It’s fun”

OBSERVATIONS FROM SOME OF THE FLYING START SCHOOLS

Sea View Primary school •

Excellent transition arrangements for all children

•

Opportunities for information sharing about children before they start in the school setting – this gives at least a half term head start for staff to get to know children

•

Better working relationships

•

Shared Understanding

•

Joined up working with staff and parents

•

More confident children who embrace their learning opportunities

•

Increased opportunities to share practices and improve CPD

•

Joined up thinking across all agencies working with children and families in the community

•

Increased opportunities for help and support in a variety of areas (e.g. family support at home to benefit children in school)

•

Working as a team with families in crisis

Waun Wen primary school •

Improved transition to school. Children have attended FS child care and are familiar with the setting and school staff.

•

Flying Start staff are able to support the children in their transition to school by encouraging and reassuring them in the FS child care setting.

•

Flying Start children also attend weekly park visits the term before they begin nursery in order to become familiar with the park setting and routine.

•

A member of nursery staff attends Flying Start once a month to carry out a short activity in their setting. These routines ensure that there is less distress on entry to nursery, and Flying Start children have far less difficulty with the transition to school than those coming from home.

•

Children are used to routines from Flying Start setting, for example, rhyme time, story time etc, and this helps when they attend nursery as they are already aware of class routines.

•

Additional needs have often been identified whilst the child is in FS child care and appropriate referrals for support made. The nursery staff continue to have links with the agencies involved.

•

Parental Involvement begins early, and an annual trip is run jointly with the Foundation Phase and Flying Start. Parents attend this trip with their child and have the opportunity to meet with school staff. Some will also have previously attended school playgroup.

•

Nursery staff operate an open door policy where parents are invited into the classroom to settle children and talk to staff.

•

Parents are encouraged to be involved with their children by attending Language and Play courses and special fundraising days. This philosophy is continued in the reception year with the Family Learning course.

•

Children who have attended Flying Start show more awareness of others in their play and have more confidence in areas within the nursery setting.

•

Joint planning is undertaken between departments and the nursery teacher and Flying Start manager meet weekly, promoting continuity and seamless progression between departments.

Hafod primary school This year we have observed the same benefits as previous years, qualitative evidence in the main but significant outcomes. The Flying Start provision is undoubtedly making a decisive difference to the life chances of our children and their families in Hafod. The services provided have had a huge impact on both children—primarily through, but not limited to, improvements in emotional and social development—and their parents—through increased confidence and self-esteem. The relationships formed between staff and parents through Flying Start have been tremendous, giving parents an insight into school life and the positive support the school can offer the family. Many of our parents did not have positive experiences themselves in the school system.

Flying start is not, and has never been, a quick fix but time has seen it become embedded operationally in our school.

There have been improved outcomes for our children in all of the following areas • • • • •

Language development Cognitive development Social and emotional development Physical health and physical development And early identification of needs

Some examples of what our SENCO and early year’s staff have observed as the “Flying Start” children enter and move through the infant department: • • • • • • • • • • • •

Happy, settled, confident. Smooth transition into the Nursery class.

Sits and listens to adults and other children for longer periods of time Familiar with class routines, staff and structure Is able to share, play with others Can hold a pencil/crayon/paintbrush—makes marks with control/paints pictures Some can match colours and can name some Generally more sensible, controlled behaviours Asks more questions Interested in story books Knows and can recite nursery rhymes/songs Interested in stories More skilled physically—gross motor and fine motor skills developed

Structure and processes.

Over the course of the three years an identifiable programme has developed, more so in the past 18 months, and partnerships are making impressive progress at Hafod.

•

A health visitor is on site and works alongside the flying start staff with secure knowledge of the children and their families, which is readily shared.

• • •

• • • • •

Effective relationships are being built with our families including those that have been traditionally hard to reach.

Parents are becoming more interested and engaged in the lives of their children.

Needs are being identified earlier and concerns shared with an education psychologist linked to the flying start settings. Our school SENCO and school education psychologist pick up Flying Start referrals and reports as the children move into Nursery ensuring no delays in processes.

More effective referral routes to other agencies are now in place eg TAF An effective multi-agency approach is being developed.

Regular meetings with a wide group of professionals take place to better meet the needs of our community Significant, excellent quality investment in staff development and training.

Flying start is achieving high levels of satisfaction and there is strong demand for the services at Hafod.

Baseline analysis Reception total score is 547 30 children assessed Average score =18.23 Year 1 total score is 661 30 children assessed at baseline Average score = 22 Year 2 total score is 436 26 children assessed at baseline Average score =16.76 Both year 1 and reception’s average scores are higher than year 2 There are a number of children in reception identified in flying start / nursery as having speech and language difficulties and, consequently, receiving speech therapy. They benefitted by being identified early and, although their scores are low, pulling down the average scores for the class, the average score is still not as low as the average score of year 2 who did not go to Flying Start.

baseline scores

Language scores 20 15

Year 1

10

year 2

5

Rec

0 1

5

9 13 17 21 25 29 children

Average scores in language In year 2 the average score is 10.73 In year 1 the average score is considerably higher at 13.23 In reception the average score is 10.75 highlighting the number of children identified with speech and language difficulties.

Clwyd Community Primary School Flying Start has been based at Swansea Children’s Centre since 2006.

During the past two years the school has begun look at the progress of those children who have entered nursery from the Flying Start placement.

The school has adopted the Flying Start Developmental Profile to bench mark children and observations have indicated that: •

• •

•

In general on entry to nursery N1 there is no observable difference between those children who have experienced the Flying Start setting and those who have not.

The more able children come from supportive home environments and this is reflected in their scores.

On the Flying Start Profile the majority of children score significantly below their chronological age in the key areas of Cognitive and Language Development.

The majority of children entering nursery N2 score significantly below their chronological age in all areas of the Flying Start Profile

(Benchmarking for the N2 cohort is carried out in September, as the children start at different times according to their 3rd birthday when N1.)

• •

By Reception there continues to be no observable difference between children having had the Flying Start input and those who have not.

The enhanced Health Visiting service has proved very successful as it has led to the early identification of several children with special educational needs. The children and their families now have the involvement of the appropriate agencies and this enables the school to focus more clearly on ensuring the appropriate provision is put in place to meet their needs. The school has found the Flying Start Health visitors most help in giving information and advice.

These findings do not mirror what is reported by the other schools and the children’s progress, as described earlier in the analysis in the child care section, also shows relative progress for children in the Clwyd Flying Start setting. There has been a turnover of child care management staff in the setting which has had an adverse effect on maintaining the all important continuity for the children and the child care team in the setting that is stressed in the WAG Flying Start Guidance. This is essential for the positive outcomes of the children and for the stability of the staff team and the issue is being closely monitored.

Blaenymaes Primary school •

Parents were asked to complete evaluation forms in Nov 2010 and in Feb 2011 and their comments were extremely positive.

•

The evaluations with parents showed that, on both occasions, 100% of parents asked were happy with the activities on offer, felt that their child’s development had improved, were happy with the snacks on offer, felt staff had been helpful and supportive and felt that the sessions had helped prepare their children for school.

•

Children at Blaenymaes Butterflies Flying Start settle in quickly and build in confidence within a few weeks. They form positive relationships with staff and their peers.

Foundation Phase feedback •

All children who have attended Flying Start child care in the school are much better equipped when they start nursery in comparison to those children who have not received Flying start input.

•

The children settle quicker into routines

•

The children are more exploratory in their play skills.

Townhill community school The partnership with Flying Start continued to thrive and the school started to build bridges with the new Health Visiting team, with on going good professional working relations with the child care team.

What works well for the school:

Flying Start children and staff visit the nursery to begin that familiarity with the setting as part of their transition to the Foundation Phase.

Having some trips and visits together or sharing common visitors such as Bookstart readers.

Identification of early needs that may require social service intervention or additional learning needs requiring referral to the appropriate agencies.

Speech and language intervention programmes set up before the children start in nursery. (We notice the difference in children who do not attend Flying Start prior to starting nursery) Parental links are very positive having begun in Flying Start.

Common approaches in health care such as the Designed to Smile programme.

Children who have been to Flying Start have better developed social interaction skills Joint working on a common Baseline tool with shared professional outcomes.

Next steps for us as a school To aim to give more time to school staff to link with the Flying Start setting in order to meet and greet children and do activities in their familiar surroundings

OTHER RESEARCH ACTIVITIES

There are two examples of activities that were undertaken using a joint service delivery approach, showing the positive impact that professionals working together can have on children and their families.

1. Making the most of music: The value of early intervention This project brought together Flying Start practitioners, the West Glamorgan Music Service and the Centre for Child Research, Swansea University. The project involved running a series of music sessions with a skilled musician and Flying Start parents and children. It was hoped that, by evaluating the effectiveness of this small scale project, a model for good practice could be established which might then be extended to other families throughout Swansea and other Flying Start areas in Wales.

The specific objectives of the project were: 1. to promote parent-child interaction through music 2. to share expertise between skilled musicians and Flying Start practitioners

3. to increase parents confidence in their integration of music into every day interactions with their child 4. to increase the opportunities available for children to have musical experiences 5. to equip parents and children with early music making and singing skills 6. to enhance the child’s attention and listening skills METHOD The Flying Start setting in Swansea Children’s Centre was selected as the sample site for the intervention. Fourteen parent-child dyads were invited to participate. The children in the group were aged between 9 months and 3 years of age.

The music sessions ran weekly over a period of 6 weeks. The sessions were 50 minutes long. Each session was carefully planned to be as interactive as possible – using puppets, props and instruments. The sessions built on and developed key skills over the six week period. All parents and children received a music pack to enjoy and extend activities at home.

A variety of different techniques were used to collect data in relation to the objectives and included: video analysis; pre and post questionnaires and interviews and parental diaries.

OBJECTIVES AND FINDINGS Objective

Findings

(1) to promote parentchild interaction through music

There was an increase in the frequency of both physical and verbal interaction between parents and children over the course of the sessions

(2) to share expertise between skilled musicians and Flying Start practitioners

The programme appeared to have a positive impact on the practice of the Flying Start staff. Staff referred to how they had developed their knowledge and understanding to promote music with children in their centre. They gained the confidence to set up and run a regular Monday afternoon parent and child music session without the musician.

(3) to increase parental confidence in their integration of music into every day interactions with their child

There was a notable increase in parents reporting that they enjoyed doing music with their children following the intervention. The sessions also appeared to impact positively on how comfortable parents felt doing musical things.

(4) to increase the opportunities available for children to have musical experiences

At the start of the intervention, the majority of parents reported that they rarely did musical things with their children. Following the intervention all of the parents reported doing musical things with their children either often or very often. Parents reporting

that their children enjoyment music also increased.

(5) to equip parents and children with early music making and singing skills

At the start of the intervention, observations showed that the musical skills of both parents and children were limited. Analysis of later observations showed that these skills developed through the project culminating in parents and children displaying a good knowledge of simple songs, good vocal control and an ability to play instruments to the pulse of songs.

(6) to enhance the child’s attention and listening skills

Observation revealed that children’s involvement and engagement was substantially higher in weeks 5 & 6 when compared to weeks 1 & 2.

The music pack

Overall the packs were well received by parents and their children, with most feeling that the pack was a good use of money and resources. All of the participants found the items in the pack of some use and the majority felt it was important to receive it. This suggests that the use of a take home pack was successful. The music CD was particularly popular. Other contents may need to be reviewed.

CONCLUSION The overall aims of the project were met and the analysis demonstrates some positive outcomes for parents, children and practitioners; in particular the increase in musical activity in the home; confidence of parents and child’s enjoyment of music and the child’s holistic development The project has given the practitioners the confidence; understanding and relevant skills to continue similar sessions with the childcare settings; offering other children the opportunity to develop.

Overall the project has been successful; even with the low level attendance noticeable outcomes have been achieved. The findings support further use of this type of music intervention and also provide guidance in relation to improvements that might be made to enhance future projects.

2.

Talk to Baby DVD

The ‘Talk 2 Baby’ DVD, launched in July 2010, was a joint initiative between the Flying Start specialist speech and language therapist, Flying Start specialist midwife and community nursery nurse working with pregnant teenagers in the Flying Start areas in Swansea.

The main impetus for the project came during a joint home visit undertaken by the speech and language therapist and midwife when a young mum asked: “Do I need to talk to my baby? What is the point he can’t understand?”

‘Talk 2 Baby’ aims to demonstrate the importance of early bonding in the ante-natal and immediate post-natal periods; emphasise the importance of talking to babies from very early on in pregnancy; and highlight the importance of effective parent-child interactions as a basis for a positive lifelong relationship.

A variety of activities were used throughout the production of the DVD to promote and encourage early language and communication development in children. The teenage parents carried out the activities with their babies to enhance their ability to subsequently use them in their own homes.

The DVD format was chosen because the team became increasingly aware of the poor literacy skills that seemed to be a common theme in this client group.

A visual format appeared to be a far more acceptable, user-friendly health promotion tool for this client group, in comparison to the copious quantities of leaflets handed to expectant teenage parents.

To formally evaluate the project the nine teenage parents involved in the DVD’s production were asked to complete a questionnaire before becoming involved and issued the same questionnaire after they had viewed the completed film. An 89% response rate was received for the pre-DVD questionnaire and 78% for the post questionnaire. There was a significant difference between the pre- and post- mean scores (4.6 versus 8.8 out of a total of 10). All nine teenage parents said they were willing to engage in future similar projects.

A small qualitative focus group with the teenage parents following their initial viewing of the completed product was also conducted and positive comments were obtained.

The most positive outcome however was the teenagers’ engagement in the whole process. They demonstrated an ability to apply the interactive games and techniques with their babies outside the specific filming scenarios. They also showed dedication and commitment to the project, engaging proactively from start to finish. This was an outstanding achievement given their vulnerable circumstances.

There has been no incidence of post-natal depression in any of the girls taking part in the project to date and there was clear evidence of enhanced bonding, attachment and communication with their babies after the DVD was shown to them.

It is hoped that there will be a reduction in the number of referrals to the speech and language service and a decrease in post natal midwifery involvement with this client group as they are enabled to identify the needs of their children in the areas highlighted in the DVD. This was an innovative project and there have been over 300 copies of the DVD sold nationwide to date and positive comments from the viewers. Of course the positive response from the teenage parents is one of the most meaningful outcomes of the process.

The DVD has been shortlisted in the Annual NHS Wales award, which rewards innovation and good practice which helps to transform patient care, in

the category of promoting better health and avoiding disease. The winner will be announced in Cardiff on July 6th.

MAIN PRIORITIES FOR THIS YEAR The Flying Start programme in Swansea is making steady progress in respect of delivering the entitlements as stated in the WAG Flying Start Guidance and the evidence to date, as highlighted inn this report, suggests that this is resulting in positive outcomes for children and their families. The model of co location of staff in the Flying Start settings is resulting in a more integrated approach to service delivery that includes the Flying Start team and other agencies in the wider community. The focus this year will be to ensure that the Flying Start Programme in Swansea continues to meet the requirements on a national level and to compliment the local Strategic Plan for Children and Young People 2011-2014.

The main priorities for the year will include: •

Securing the capital funding from the Welsh Government and subsequently increasing the capacity for child care provision in FS areas as required

•

Reviewing the service provision to ensure the entitlements are being delivered effectively, ensuring strategies are in place in respect of families that are difficult to engage

•

Registering current child care provision with CSSIW in the shortest time frame possible

•

Developing and implementing the RBA model of evaluation and drawing on the necessary resources and/or expertise that may be necessary to do that

•

Further developing the FS data set on the PARIS IT system used by different agencies in Swansea in order to capture and share the relevant information within the appropriate legislation and guidelines.

I hope you have found this report interesting and informative.

Chris Koukos June 2011 To make comments or request further information on Flying Start please contact: Chris Koukos, Flying Start Manager.

Chris.koukos@swansea.gov.uk 01792 635400