A Unique Child: Integrated Review - As I see it


The Integrated Review has the potential to make us better understand individual children by combining perspectives, says Dr Kay Mathieson

Working in early years provision increasingly means engaging with a range of people who have different perspectives on the children that we work with in our setting. This can feel like a great advantage at some times and at others a source of frustration.

As a general rule of thumb, when others agree with us, we are pleased to have their input, but if they challenge our views we can be defensive and irritated. This defensiveness is one of the major barriers to mobilising advice and support for children and their families. It is not a response that is particular to early years professionals either! Adults being able to share different perspectives is one of the most positive opportunities for constructive reflection on a child’s progress and the most effective way to identify and organise support.

The Integrated Review is one of the more formal times when different perspectives are brought together. The first step to making this a useful experience is to recognise the reality of each person’s view and experience of the child. For example, parents and practitioners will, of course, have a different view of a child and their skills and abilities. This is related to the contrasting contexts in which we experience the children. Home is, by its nature, very different from the setting. In addition, a child is unlikely to feel as at ease or have the same opportunities in both contexts. Further, just considering the different amount of time parent or practitioner spends with the child across their life span begins to uncover the complexity of the situation.

Of course, it is not just about amounts of time, but also the specialist knowledge and understanding that we bring to the table. A parent has insights about their child, built up over time and in a range of different contexts that cannot be replicated by professionals from any agency. So, the contrasting perspectives are informed first, by amount of time spent with the child; secondly, by the nature of our involvement with the child; thirdly, by our own knowledge and training; and finally by the purpose and guiding principles of our employment organisations. Let’s think through the impact of this thinking on our real professional experience.

CASE STUDY: CHARLIE

Charlie is making great progress with his physical development but seems to be struggling with progress in language and social areas. He has just had his fourth birthday. His key person (Mandy) was involved in the initial admission discussions with the manager to welcome the family and begin to learn about Charlie, Anusha (mum), Rudy (dad), other family members and his life outside the setting.

At the end of each session, Mandy would talk briefly with either Anusha or Rudy about something she had noticed about Charlie’s development. For example, ‘Charlie really enjoyed playing hide and seek outside and for the first time it was he who started the game with me.’ Anusha shared ideas and interest in the way Charlie played hide and seek at home, including thinking about ways to use this favourite game to encourage him to engage with another child.

Parents’ perspective

Children are different in the setting than at home, in the same way that we are different at home and at work. While parents are skilled in noticing and watching their children, they seldom have detailed knowledge of child development in the way that early years practitioners do. They are also not in a position to be closely involved with several children of similar ages.

The comparative view that practitioners’ develop – seeing how several children develop at different rates but in broadly similar ways – changes their perspective on what raises a concern. This will highlight what practitioners feel confident are typical patterns of development but may seem to cause more anxiety for parents. By sharing daily child development observations and listening to home experiences, the parents and practitioners contribute to a shared understanding of progress.

Health visitor perspective

Charlie’s two-year health check took place before the Integrated Review was considered effective practice, so there was no information from childcare. At that time, his parents were able to understand what Charlie was communicating and talked to him a lot. He was walking independently in the room, holding and passing toys to the adults. His parents reported that he was showing interest in using the potty. The health visitor, in the context of the 20-minute appointment, saw nothing that gave her cause for concern about his progress.

The Integrated Review is now an opportunity to bring together health, early years and parents’ perspectives of the information available about Charlie. This inevitably gives a more holistic view of his progress, well-being and shared learning about how best to support him in the future. Evidence can be shared showing similarities and differences between his responses at home and in the setting.

At home, this will be different because:

there are fewer children to compete with

his ‘special people’ who inevitably are more involved with him across his life span are present.

At the setting, there would be difference in the:

  • numbers of children to interact with
  • competition for toys/equipment
  • routines
  • wider range of opportunities and resources.

Similarities may include language use, engagement in interactions with adults and characteristics of effective learning.

The health practitioners, as well as their own professional health perspective, are able to use the Ages and Stages Questionnaire as a standardised tool. This provides indicators of how Charlie’s response compares with a much larger population of similarly aged children. So the Integrated Review gives us the opportunity to see Charlie and his responses in three distinct contexts:

At home with his family, where comparisons may be made with siblings’ development or parental expectations gathered from extended family, the media, etc.

In a childcare setting, where comparison may be made with unrelated children of similar age but also with guidance from information about typical development; for example, Mary Sheridan’s From Birth to Five Years: Children’s Developmental Progress, as well as Development Matters or Early Years Outcomes.

Through the health review, where comparisons can be made with wider typical population data and health-related family background.

It is important to recognise that these different contexts can often lead to adults having different perspectives on a child’s progress. What seems a concern in the home – for example, a child’s disturbed sleep pattern – can often confidently be seen by an experienced early years practitioner as a temporary behaviour related to brain development/activity as early language takes leaps forward. The same disturbed sleep pattern could justifiably be viewed by the health practitioner as an opportunity to explore more deeply the routines, nutrition and current family pressures. None of these perspectives is wrong, but they are different, so they need to be discussed and evidence shared to ensure that progress is monitored and triggers for further action are not missed.

Key questions

It is right that professionals should bring to the Integrated Review their views about a child, informed by their specialist knowledge and training. Each perspective articulated in the Integrated Review provides a chance to share and reflect on evidence that either supports or challenges a judgement or assessment.

If we can create a context in the meeting where everyone listens attentively and carefully considers another’s view, this can deepen and refine everyone’s understanding of the child’s whole experience. This is also an important tool in really understanding more about the child’s own perspective. Key clarification questions and prompts include:

  • Tell me more about when you have seen Charlie respond in that way.
  • Can you talk me through what you have seen that leads you to think that?
  • What would happen if…?
  • How might we make it more likely that Charlie will respond in that way?
  • I’m wondering if Charlie would find it easier if we…

The Integrated Review has the potential to be a powerful tool within our toolbox to clarify, understand more deeply and be proactive in helping and supporting individual children and their families. It is for the professionals to find ways to engage with each other, as well as with parents, so creating the most positive tone in the Integrated Review information sharing process.

It is not an expectation that everyone will agree, but that the differences of opinion and perspective will be a catalyst for improving the shared understanding of the child as an individual, ensuring that all appropriate support is mobilised.

MORE INFORMATION

Department of Education (2014). Statutory Framework for the Early Years Foundation Stage

Digman, C and Soan, S (2008). Working with Parents. Sage

Early Education (2012). Development Matters. Early Education supported by Department for Education

Mathieson, K (2015). Inclusion in the EYFS. Open University Press, McGraw-Hill Education

National Children's Bureau (2015). Integrated Review (available from ncb.org.uk)

www.foundationyears.org.uk – further information about Healthy Child Programme and Integrated Review

Sharma, A and Cockerill, H (2014). Mary Sheridan’s From Birth to Five Years. Routledge

Woodhead, M and Oates, J (eds) (2010). Supporting Parenting. Early Childhood in Focus, 5. Open University Press (available from www.bernardvanleer.org)

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