A Unique Child: Inclusion - Better off?

From teeth-brushing sessions in nurseries and revamped parks where children can learn how food gets to their plate, to systematic reviews of health visiting services and the development of a whole new workforce, changes are taking place across the country, powered by the Big Lottery Fund’s A Better Start programme.

The Big Lottery Fund is investing £215m between 2015 and 2025 to improve outcomes for children in specific parts of Blackpool, Bradford, Southend, Nottingham and the London Borough of Lambeth, focusing on those below the age of five.

It aims to encourage a shift in culture and spending towards prevention work, and the development of more joined-up, needs-led services, as well as services that work with the whole family to improve outcomes for children. Described as a ‘test and learn’ programme, evidence-based work is key, as is robust evaluation of every project.

‘By investing in a child’s development during pregnancy and their earliest years, we want to help families support their children to reach their full potential, reducing the likelihood of vulnerability throughout this period,’ says Sarah Gibbs, head of funding at the Big Lottery Fund.

PARTNERSHIP WORKING

A Better Start aims to improve outcomes for children in three key areas: social and emotional development, communication and language development and diet and nutrition. While in each area work is led by a voluntary sector organisation, such as the Preschool Learning Alliance in Southend, partnerships lie at the heart of the programme. This includes not only multi-agency working, involving local authorities, Primary Care Trusts, voluntary sector organisations, academics and more, but also involving parents in the development and delivery of projects.

‘Parental involvement is crucial at all stages,’ says Laura McFarlane, project director at Lambeth Early Action Partnership (LEAP). ‘Forty per cent of votes on our board go to parent champions,’ adds Luke Murray, deputy programme manager at Small Steps, Big Changes, Nottingham’s Better Start partnership.

Services may be based on ideas that have worked elsewhere, or developed based on the latest research, or driven by creative new ideas.

Existing evidence-based programmes, such as Raising Early Achievement in Literacy (REAL), Fathers Reading Every Day (FRED) and childhood obesity prevention initiative Health Exercise and Nutrition for the Really Young (HENRY), can be tweaked to make sure that they meet the specific needs of the local community.

‘Our antenatal programme, Baby Steps, focuses on relationship-building,’ says Annette Algie, business manager at Blackpool Better Start. ‘It was originally developed in conjunction with the NSPCC as a targeted programme, but we felt it could be adapted as a universal programme across the Better Start wards.

‘We make contact earlier than with standard antenatal programmes, and also make contact after the baby is born, as we know peer support in those early few months is vital.’ The scheme has been so successful there are plans to roll it out across the whole of Blackpool.

In Bradford, two-year-olds receive an additional language assessment on top of the Integrated Review for two-year-olds, with those deemed at risk of delay receiving a six-week in-home intervention, made up of activities proven to develop language.

‘It has become apparent that the level of need is much greater than we anticipated, and the six weeks that had been sufficient in other communities in which the project was run was not enough,’ says Michaela Howell, programme director of Better Start Bradford.

COMMUNITY FUND

The partnerships are also passing funding over to the community. Nottingham’s Innovation Fund, for example, makes grants of between £1,000 and £5,000 available for those with ideas for projects or activities that could improve child development.

The fund is open to the existing workforce, including early years practitioners, as well as community groups. ‘Funding decisions are made by community partners and parents,’ says Mr Murray.

Blackpool has a similar fund, with parent forums at children’s centres allocated specific amounts for people to bid for. ‘There have been more than 200 activities and events, including a science lab, family picnics and balance bike activities,’ says Sharon Mather, community development manager. Having gained confidence, parents have now taken control of a budget of £1.6m to improve local parks.

The programmes are also funding new roles in the community. In Blackpool, 10 part-time Community Connectors have just started a 12-week training programme, at the end of which they will work to connect families to resources, perhaps accompanying a nervous mother to a stay-and-play session for the first time. Lambeth is training Parent Champions to support other parents with their child’s communication and language, diet and nutrition and relationships and well-being, while in Nottingham, family mentors provide support (see below).

EARLY YEARS INVOLVEMENT

‘We are identifying touchpoints through the system where mothers’ and babies’ journeys touch services, and working on how to ensure each service recognises their contribution to the bigger picture,’ says Michael Freeston, director of A Better Start, Southend, and the PLA’s director of quality improvement.

In Nottingham, a growing number of projects are delivered in partnership with nurseries, as the Better Start cohort gets older. ‘Our family mentors support families to access the two-year-old offer,’ says Mr Murray. ‘Nurseries are going to be key for us moving forwards, helping to evaluate whether what we’ve been doing is having an effect in the long term.’

In Lambeth, says Ms McFarlane, ‘We are keeping an eye on childcare settings’ quality improvement journey, and can offer extra support if they are not doing well in particular areas. After a very long journey, Lambeth has now reached the national average (71 per cent) for achieving a good level of development at age five.’

The attainment gap between disadvantaged children and their peers at age five currently stands at -3.6 in Lambeth, according to the Closing the Gap report published earlier this year, compared with the national average of -4.3.

FREE TRAINING

Free training is available as part of the journey to quality improvement. Southend, for example, launched a Mobile Crèche project in January to give childcare professionals the healthy eating and lifestyle skills training already being offered to parents. This means that childcare staff use the same language and approach that the children’s parents do.

The early years workforce in Lambeth can access training including Brief Encounters, a course designed to give practitioners the practical tools, skills and information to be able to offer timely and effective support to parents.

In Blackpool, where oral health is a major issue, 34 childminders and four nurseries have signed up to a supervised teeth-brushing programme involving 323 children, ensuring they are exposed to fluoride at least once a day.

‘We introduced twilight training to ensure we pick up more of the early years workforce, and we run an annual conference, bringing experts to Blackpool, which is free for all Blackpool early years staff,’ says Ms Algie.

MEETING CHALLENGES

As a ‘test and learn’ programme, it is important for projects to keep a close eye on data, to find out what, if any, impact they are having. ‘Getting appropriate benchmark data can be a challenge – we are trying to bring science and research where it hasn’t been before,’ says Mr Freeston.

Another issue is access, states Mr Murray. ‘We are limited to working across the specified areas, but a child might live in one area and attend nursery in another, or vice versa, so how we square that circle for service providers is a bit challenging.’

Multi-agency working brings its own challenges. ‘As a partnership of service providers, the community and researchers, we have an unusual richness,’ says Ms Howell. ‘However, with that comes a tension, because if you are living or working in a community with a really great need, you see such hardship and crisis that you want to change things right now, while researchers may take a longer-term view, prioritising gathering evidence before acting.’

EVALUATION

The programme as a whole is subject to a national evaluation from a consortium of universities and research organisations led by the University of Warwick. Families from the Better Start areas will be tracked and their outcomes compared to a group of similar families living in comparison areas. Meanwhile, the London School of Economics is evaluating the economic impact of the programme.

Each local partnership has its own evaluation team, helping them to understand which programmes to implement more widely or how to change what they are doing.

‘Everyone is hungry to know what works and what we could do differently, but because a lot of what we do is starting from birth, we have to wait to see the impact,’ says Mr Murray.

Some projects are starting to show green shoots, however – Lambeth, for example, has reduced the number of babies with high birth weight, which can lead to complications for mother and child (see box).

In the public sector, change is the only constant. ‘In Nottingham, we are using this as an incredible opportunity to really look at what works, testing new things,’ says Mr Murray. ‘If they evaluate well, we will look at scaling up what works. It’s important to keep refreshing and reviewing the programme, because things never stand still.’

BETTER START, BRADFORD

Lead organisation: Bradford Trident

Awarded: £48,969,270

Active in: Bowling & Barkerend, Bradford Moor and Little Horton

Bradford is currently delivering some 22 different projects aiming to give children in its Better Start areas the best start in life, but it is the underlying partnership which is key, says Michaela Howell, programme director. ‘Our mantra is voice, choice, power – everyone needs to feel they have had an opportunity to contribute,’ she explains.

As an example, the board faced a difficult decision when recently published research cast doubt on the effectiveness of intervention scheme the Family Nurse Partnership (FNP).

‘Researchers round the table were unsure about going ahead with commissioning as planned, but on the other hand, the service providers were seeing a need which the FNP could meet,’ explains Ms Howell.

The partnership decided to commission the FNP, particularly as the research had focused on outcomes for the mother rather than the child, but keep a close eye on its impact.

Better Start’s work is beginning to be replicated. ‘We are doing a pilot with the midwifery service, giving mothers-to-be longer appointments and a named midwife, as well as a buddy in case the named midwife is away,’ says Ms Howell. ‘Other midwifery teams are starting to take on some of the practice.’

SMALL STEPS, BIG CHANGES (SSBC), NOTTINGHAM

Lead organisation: Nottingham Citycare Partnership

Awarded: £44,991,807

Active in: Bulwell, Aspley, Arboretum and St Ann’s

In 2009, Nottingham billed itself as the UK’s first Early Intervention City, and Small Start, Big Changes is building on that early intervention background, going further than before with a more universal, preventative approach.

The city still has a wide gap between the attainment of disadvantaged children and their peers at secondary school level, but the Better Start work aims to impact on future outcomes by working with children from birth.

The parents of every child born in SSBC areas are offered one-to-one support in the form of family mentors - locally recruited, trained peer supporters. ‘They are recruited based on values, not necessarily qualifications – they have the lived experience of bringing up children in these areas,’ says Luke Murray, deputy programme manager.

Family mentors have so far worked with 800 families, delivering Small Steps at Home, a structured programme of home visits during which they share activities and tips.

‘They are not there to replace health visitors or children’s centres, they reinforce and support what they are doing,’ says Mr Murray. ‘Parents are coming to us and saying we initially turned you down but now we see others with a family mentor – can we have one?’

The Family Mentors scheme is just one of a plethora of projects and activities run by SSBC, with groups including Bump, Birth and Babies, delivered by health visitors, and Cook and Play, delivered by family mentors. The partnership is investing £1.3m over 10 years, providing children with a free book every month.

More than 2,600 families have benefited from SSBC projects so far. ‘We want as many children and families as possible to benefit from as many different elements of the programme as possible,’ says Mr Murray.

LEAP, LAMBETH

Lead organisation: National Children’s Bureau

Awarded: £36,035,060

Active in: Coldharbour, Stockwell, Tulse Hill and Vassall

One of Lambeth’s flagship projects is the Community-based Activity and Nutrition (CAN) programme, supporting women with high BMI in pregnancy to make behaviour changes.

‘During the design process, we made a number of changes led by parents,’ explains Laura McFarlane, project director. ‘We lowered the BMI at which parents were eligible to take part, built in a translation element to the one-to-one meetings as there are around 130 languages spoken in Lambeth, and made changes to resources to represent food families in local communities actually eat. Now we are seeing even better results, and the uptake from BME groups in particular is quite high.’

Early data is showing a reduction in the number of larger babies in the LEAP areas. ‘Part of the offer is a glucose intolerance test and we are also starting to pick up gestational diabetes very early on,’ says Ms McFarlane.

Early years practitioners are critical to the delivery of the Better Start programme in Lambeth. ‘We are about to kick off an oral health programme across early years settings, including childminders,’ she says. ‘We are training practitioners to offer supervised teeth brushing as part of the daily routine.’

Oher projects offered by LEAP include Chattertime, an open access stay-and-play focused on early intervention. ‘We are now delivering to a younger cohort, and through PVI settings, which we have not done before,’ says Ms McFarlane. ‘Part of that involves building up the skills and knowledge of early years educators in the PVI sector around early intervention.’

MORE INFORMATION

Better Start Bradford, https://betterstartbradford.org.uk

Small Steps, Big Changes, www.smallstepsbigchanges.org.uk

LEAP, www.leaplambeth.org.uk

Blackpool Better Start, www.blackpoolbetterstart.org.uk

A Better Start Southend, http://abetterstartsouthend.co.uk

A Better Start: information about learning from the programme, www.abetterstart.org.uk

Closing the Gap? Trends in Educational Attainment and Disadvantage by Jon Andrews, David Robinson and Jo Hutchinson. Education Policy Institute, August 2017, https://epi.org.uk/wp-content/uploads/2017/07/closing-the-gap-web.pdf

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