A Unique Child: Integrated Review - Out of concern

The idea of an Integrated Review, with health and early years practitioners working closely together and sharing information about the child’s development and progress, is still quite new in most local authorities. Many pilot programmes and trial approaches have highlighted both the challenges and advantages of integrated working. My sense, as I meet with colleagues around England, is that closer working between health and early years is increasingly a very positive experience with major gains for children and their families.

In the pilot areas, memories fade quickly about any initial struggles to really understand each other’s perspective and finding a common understanding of children’s progress. Practice generally moves quickly, as practitioners get to know each other, from focusing on the problems to creating solutions. Innovative ways of responding to parental needs and concerns are explored, including flexibility with timings and different venues for review meetings.

Once there is clarity about the actual numbers of review meetings required and the timescale in which they need to happen, it is easier to identify any barriers to be overcome – for example, making meetings accessible for both parents and practitioners by using early mornings, evenings or Saturdays.

Making such local decisions has been made easier when strategic leaders, from health and early years, contribute to creative thinking and remove specific barriers. This also offers an important opportunity for identifying and sharing effective practice.

COCKTAIL OF EMOTIONS

For practitioners, review meetings will vary, each offering its own challenges and delights. Approaching an Integrated Review where there are emerging or increasing concerns about a child’s progress, though, may feel very different than when development seems to be as expected. In addition, if there are conflicting opinions between practitioners and parents, there can be growing frustrations for both parties. This cocktail of emotions and concerns could make the review meeting a tense experience for everyone.

In early years settings, concerns are usually highlighted through our observations and tracking progress systems. Alternatively, parents or carers may share worries, leading to joint concerns about a child’s progress. Our tools for building a shared understanding of a child’s progress and development with parents include our:

• admission process
• daily, weekly, fortnightly, monthly, half-termly/termly, annual conversations
• observations
• tracking progress systems
• learning journals
• Progress Check at Two.

If we are to engage parents in a meaningful way with the significant aspects of child development that are relevant to their child, there must be coherence between these different forms of communication. Using both the Development Matters (Early Education 2012) and What to Expect, When? (4Children 2015) documents to inform our discussions can really help to make explicit what we are seeing and how we are supporting a child’s progress.

Where concerns persist, our early years response is to seek further advice beyond the setting. The Integrated Review is an ideal opportunity to do this alongside parents and carers. Given the different perspectives of parents, health and early years practitioners, communicating clearly and factually about any concerns is essential.

Parents and practitioners inevitably see different aspects of a child’s development. They see children in different contexts, with various children and adults; they also develop expectations based on their own experiences. Discussions prior to the review can be a valuable time to deepening our understanding of another’s perspective.

CASE STUDY: JOSH’S STORY

Josh has been attending his day nursery for three months. He has just had his second birthday and his Integrated Review is due soon. Josh is an only child; his mum (Alicia) and dad (Peter) both work full-time, with Peter working away from home at least four days a week.

Recently, Josh’s key person, Myra, raised concerns about his progress in communication and language. Alicia and Peter have no concerns, as they can understand what Josh says and means. In order to help Josh’s language development, Myra has observed carefully and noted:

• where, when and with whom he is most motivated to use his language
• key words that he says clearly.

Alicia and Peter enjoy singing and playing action rhymes with Josh, so Myra makes sure she knows his favourites and uses the same words and actions in the setting.

In preparation for Josh’s Integrated Review, Myra explains to Alicia about:

• completing the Progress Check at Two, summarising their observations and discussions about Josh’s development in communication and language; personal, social and emotional development; his physical development; and his Characteristics of Effective Learning
• using the Ages and Stages Questionnaire (ASQ) to record the progress Alicia and Peter feel Josh has made
• making contact with the health visiting team to arrange a suitable time and place for the review.

Myra contacts the health visiting team to agree dates and times available for reviews. Parents are able to choose or negotiate alternatives. In the days leading up to Josh’s review, Myra collected specific examples of his speech from home and in the setting. It became increasingly clear that Alicia and Peter did not agree with each other about completing the ASQ section on communication. One morning, Alicia was very anxious and shared their worry that the health visitor would think that they had not done the best for Josh, and that his speech was not developing as it should. Alicia also shared that they had had an argument about what might happen if Josh was found to have special educational needs and not be able to continue at the setting.

As the concerns tumbled out, Myra realised that she had been focusing on getting Alicia and Peter to share her understanding that Josh’s speech was not as clear or comprehensible as it should be but had not recognised what this may mean for them. She reassured Alicia that the first step was to be clear about the speech Josh was demonstrating both at home and in the setting – even if this highlighted differences. Myra then explained to Alicia the range of things that could be done in the setting to support his language, including:

• building his vocabulary in meaningful ways, using words he was interested in, times when he was at ease and relationships he enjoyed
• linking activities between home and setting, encouraging playful approaches to talking, singing and using language
• exploring sources of local advice and activities that may be helpful such as Children’s Centre Chatterbox programmes or speech and language therapy service recommended activities
• looking at the ‘local offer’ to see which groups or services may be helpful.

Whatever the concerns being raised about a child’s progress, it is unlikely that parents and practitioners will have the same perception of the extent or implications of this discovery. Talking through what help or support is available, should it be needed, can be very reassuring for parents.

Each ‘local offer’ is detailed on local authority websites and continually updated with increasingly parent-friendly information. Some now include a parent or child’s reflections of their experiences of special educational needs, as well as news of fun events being run by local groups. Not all services and events are exclusively for those with special educational needs, but all are inclusive activities where organisers are setting out to welcome participants with a range of needs, abilities and talents.

The Integrated Review can be a significant point in the journey of identifying a child’s special educational needs. The direct link with health colleagues makes it a useful time to explore with parents the forms of support they would find accessible. Equally, it can be an opportunity to refer to specialist services for further advice or assessment.

All of these steps may seem positive for practitioners who are familiar with this process, but for each parent, they will be experiencing the discussions and decisions for the first time. The implications, real or imagined, can be very daunting. The more we are able to source reliable, factual information, the easier it may be to empower parents to take the first step to accessing support.

To feel confident, a parent is likely to want an understanding of what will happen after any referral. This may include the offer of attending a speech and language group, or a physiotherapist attending the setting to observe the child. As a trusted professional in the life of the family, it is important that we are also knowledgeable advocates for local services and support.

MORE INFORMATION

Kumari, V (2015). The Integrated Review: Follow up report on practice in two local authority areas. Available, along with further guidance developed from the report, at www.ncb.org.uk

Early Education (2012). Development Matters in the Early Years Foundation Stage (EYFS), Early Education.

4Children (2015). What to Expect, When? Available from www.foundationyears.org

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