Since 2007, the Breastfeeding Friendly Premises Awardshave helped businesses create a welcoming environment for breastfeeding mothers and their families. The award helps mothers to feel more confident breastfeeding in public while assisting local businesses to actively participate in the health and wellbeing of their community.
To date, we have over 50 local businesses and organisations participating certified as breastfeeding friendly.
To celebrate the our new look and our expansion into Midlothian, we are holding our official launch at The Burgh Café, 62 High Street, Musselburgh on June 28th from 10-11am.
Change X Change is a new partnership which has been developed between East Lothian’s community planning partners and the Scottish Government to evaluate the Equally Well test site in East Lothian – Support from the Start.
This new partnership sees the creation of a small team at Queen Margaret University that is designed to bring the world of academic research together with the world of service delivery. Two members of staff have been seconded for three days per week for one year to work with academics and researchers at the university as part of a ‘firefly team’. See the link below to find out about ‘fireflys’
This approach to the evaluation of Support from the Start will have the advantage of leaving a legacy beyond the report(s) that are produced at the end of the year. New networks and links wll be made, between the university and services which will be brought back to services along with the new skills of the two staff involved. The products at the end of the evaluation should also be better aligned to service need for the involvement of staff who have played a key role in the development of the test site and are aware of the issues confronting services in tackling health inequality
The Fast tracking of forest school is one initiative within Support from the Start – over the last year we have commissioned two forest school leader training courses for East Lothian staff that priortised staff in the target are.. The folowing year we hope to train more forest school leaders in partnership with Edinburgh Forest Education initiative, but also to offer training to staff who are supporting forest school leaders – known as level two training and a bespoke training course for nursery staff.
Here is a progress report on Forest School in East Lothian, giving an update on training delivered and equipment and kit purchased.
Councillor Mackenzie pointed out this website to me recently C4EO. Although it is a London based centre much of what it provides on the website is relevant to Scotland.
In particular its early years section contains a wealth of reseach and guidance on the following areas :
Narrowing the gap in outcomes for young children through effective practices in the early years
Improving children’s attainment through a better quality of family-based support for early learning
Improving development outcomes for children through effective practice in integrating early years’ services.
Each heading has literature review and a progress mapping section which contains a series of ‘Challenge Questions’ for services to use as part o a self evaluation process. There are also a number of case studies and good practise examples on the website.
Not one I was aware of and well worth locking into your favourites.
The following has been written by Maureen Black (Play Advisor)- hopefully other ‘stories’ about the impact of early years interventions will follow.
‘Support from the Start’ is about ensuring that mainstream services are doing all that can be done to improve the health and well being of children and families in the early years of life in areas of East Lothian where there is a record of health disadvantage.
We will know we have succeeded if: –
1) if children and families are engaged with the key health improvement challenges,
2) parents can access support for healthy living when they need it,
3) parents and children have good quality child friendly environments, and
4) those most at risk of poor health receive the most support
How did we tackle this in Whitecraig?
First of all we had to look to see what was already in place for the families within Whitecraig. There is a primary school, community centre, a shop, a Post Office and an hourly bus service to Musselburgh; the library bus also visits the school every second Friday. The services offered by the community centre to families with young children had become depleted over several years and last year consisted of a Toddler Group meeting twice a week with 2/3 parents and 3 /4 children attending. There were few toys and equipment and children spent most of the time running up and down the main hall screaming and shouting and seemed to constantly eat sweets and crisps and drink juice.
I was asked by Lena Hutton to come up to observe and offer any advice that I could to help create a better atmosphere. I came in and spoke with the parents and children and observed the group. A stalwart of the group told me that once it had been a very busy group and there had been lots of activities going on but nobody seemed to come now. (I couldn’t blame them to be quite honest). However I did get the impression that to try and change this group I would be up against fierce opposition so I decided to offer an alternative that did not interfere with anything already offered. As it so happened the school was having their 50 years open day in September and the community centre was being used for some of the entertainment. So in consultation with Lena we decided to have some messy play sessions for the under fives. This would hopefully let me meet and talk to other parents and carers in the village and find out if they would be interested in coming to a group in the centre. The day was a success and several people expressed and interest in coming along. It was decided to have six sessions from October to Christmas, every Friday morning in the centre. Thus Stay and Play was created.
It was a mad rush round to beg and borrow equipment however we managed to open the first morning with a good collection of toys and activities. There were a few rules attached to coming to Stay and Play – the main one was as a parent or carer you had to stay and play. Anyone with children up to the age of going to school could attend. It would be £1 per family regardless of the amount of children.
The first few weeks, even months were hard. I felt I was tested in many ways. My ‘stalwart’ had not come but managed to put spokes in the wheels from afar. I was constantly questioned about ‘ the council’ was this something they were just doing for a wee while and taking away – as they usually did. We had the odd person who tried to drop their child off. However as I turned up week after week barriers began to break down and numbers started to increase. Everyone started to become involved – someone collecting the money, some making snack. *, Others cleaning and tidying the playroom, washing up, even holding and entertaining other people’s babies so everyone gets a little time to themselves to enjoy a cuppa. On the register** now have fifteen registered parents/ carers and 22 children. Not that everyone comes every week some weeks can be very busy and others only a few, we have mums, dads, grannies, aunties and a childminder everyone is welcome.
A year down the line Stay and Play is very much a part of the community. Why does it work? I think it is because it is a safe controlled environment –when perhaps much of your life is chaotic there is an oasis of calm you can come to for a couple of hours a week and switch off. There is always something to laugh about and people to laugh with you. Having a playleader has many benefits
· Keeps the ideas fresh – always something different to do – creates activities that mean parent and child have to work together – however there is always paints etc if you want to be creative and many sit creating long after the children may have lost interest in the activity.
· Its controlled by someone who is not part of the community- who does not sit in judgment and who treats everyone fairly.
· Someone is there to ensure that everyone is included and involved in decision making
· To discuss behaviour and other issues regarding child development ***
· To give new ideas you can try at home
· Just being there to listen and support or even just have a moan to or a blether with or to signpost you to other services. To notice not just the children but the fact you have had your hair cut, or to ask how you got on a parent’s night.
The best thing to happen is ‘my stalwart’ eventually decided to give us a try and is now a regular and cannot speak highly enough of Stay and Play.
What other things have happened?
There is now a baby group on Monday morning. This was supported by funds from NHS Lothian Community Health Grants. This has focused on the 0-2 age group but has been mostly populated by the 18month to two-year age group. The group has benefited from input from the play workers simply for the reasons highlighted above and it is envisaged that this will continue for some time yet.
A playgroup has opened two morning a week, ten places, and is just about to open for another morning after the Easter holidays to accommodate the ever increasing waiting list.
The children are involved in Childsmile and brush their teeth after snack every morning. We have been offered the garden at the church next door so children can be out more in the fresh air. The children are offered a health snack every morning.
This is the story of the centre but there is also the story of the people and the impact on their lives, their children’s lives and of their futures. If we are to have an impact on these families it must be from the very start.
*Snack – in the beginning although we stressed snack was provided – parents still came with juice, crisps etc three and four year olds were still drinking from baby bottles. Now a year on we have toast, milk, water and lots of fruit – no constant grazing. Young children drinking from cups not bottles. Parents have time to sit down and have tea/ coffee and toast together. The children all sit together at one big table and are learning lots of skills that will become invaluable to them in life. The first being sitting at a table, sharing, enjoying the company of others – it is a lovely sociable time for everyone.
** Register – at first we started with three or four families and then numbers started to increase by word of mouth – the only way we advertise.
*** Child Development – there is no tag of parenting skills attached to Stay and Play however indirectly lots of problems are handled and dealt with in the playroom. The play leader dealt with situations in a positive way and be it by example or through discussion issues can be dealt with. However being is such a positive environment children quickly and easily learn what is acceptable. Parents and carers have the opportunity to have positive interaction with their children and this can only help their relationship to develop. Lots of praise is encouraged and this includes lots of positive interaction with the parents and carers too.
With Healthy Start, you can get free vouchers every week which you swap for milk, fresh fruit, fresh vegetables and infant formula milk. In theory you can also get free vitamins. Healthy Start replaces the Welfare Food Scheme. The vouchers have to be taken to a participating retailer – the website has a list of the retailers searchable by postcode.
It is a means tested benefit that an applicaton form has to be filled in for – part of which has to completed by a health professional – it can be applied for online
Have never been keen on means testing as a method of targetting – probably because I have some not very fond memories of standing in the free school meals queue at Sedgefield Comprehensive. Aside from the stigma issue with means testing I would argue that it is often an inefficient way of doing things – creating large bureacracies in order to establish entitlement and then police the system, and by so doing limiting the take up of the very people that are being targeted. (The only evidence on uptake I have been able to find so far suggests that it is similiar to the welfare food scheme it replaced at around 55% of the potential beneficiaries.) Hence, other people have also to invest time and effort in advising and supporting people to make claims – a quick internet search will reveal the level of confusion about healthy start vouchers – who is entitled, how do you make a claim who fillsi in the form and so on. See Emma’s diaryNetmums
Having said that a means tested scheme for supporting early years nutrition for pregnant women and parents on low incomes is better than no scheme.
One of the distinctie features of this scheme is the availability of vitamin supplements. However, I am aware that there has been some difficulties with the supply of vitamins The website has the following to say about the vitamins available on the scheme
Why are vitamin supplements important?
You will get most of the vitamins you need if you eat healthy foods. However:
your young children may not get enough vitamin A, C and D from their food
pregnant and breastfeeding women may not get enough vitamin D or folic acid which may harm their baby
Ask your health visitor or midwife where to get the free vitamins for you and your children. Take the letter attached to your vouchers with you to claim your free vitamins.
The Healthy Start vitamins are also for sale at some NHS clinics.
Over the next week will contact all the pharmacies in the Support from the Start target area to ask if Healthy Start vitamins can be obtained and if not why not. I will post the result of this survey here.
Just before xmas the Service and Community champions met to review how the test site had developed over the last year. The first part of the session was an informal chance to catch up with each other and review the year using a timeline. The timeline showed key activities since the test site was announced and champions were asked to record their impression with sticky post its.
Below are photographs of the Support from the Start Storyboard which was displayed at the Champions Get Together, held on Monday 21st December 2009 in John Muir House Haddington. Th notes from the discussion are linked get-together-group-discussion-notes
This event was a good opportunity for the Service Champions and Community Champions to meet each other, the Project Board members and East Lothian council Chief Executive Alan Blackie was in attendance. It was a fun event with relaxation and culminated in a facilitated group discussion looking at future priorities.
The storyboard is a timeline for the test site from initiation in October 2008 to the time of the Get Together in December 2009, which details major events and deliverables from the project and lists the outcomes driving the project forward. There is also a list of the Service Development Fund proposals and many of the activities which have taken place. The Champions were encouraged to add their thoughts to the storyboard of what inspired them/disappointed them and what have been the achievements or barriers. These thoughts are also listed here.
The evaluation process considers impact, through observation, collecting quantitative and qualitative data, focus groups, questionnaires, documentation review and utilising other evaluation tools and processes. Formative evaluation will also consider added value, partnership (as appropriate), the development process and the extent to which original aims and objectives have been met or revised.
The most valuable piece of advice about ‘evaluation’ that I have ever had was from a New Zealand based researcher who gave a presentation at an evaluation summer school I attended in 2006 (apologies but her name has gone from my memory). The advice was that the first question one should always ask is, ‘Why am I doing this evaluation?’; and this should be followed by what and who is it for before you get anywhere near the how question.
I think the why, what for and who for questions are particularly important because so often evaluation is an externally imposed condition: ‘Thou shalt evaluate’ has been one of the commandments of health improvement (particularly for community based work) at least since the 1990s. Funding for project work became increasingly dependant on the ‘How will you evaluate?’ question.
I believe many of us are tempted to skip past the why am I, or we, doing this evaluation, straight to how am I / we going to evaluate this work because it became a given, a must do. When the why question is not asked, (and why bother asking if it is a given) evaluation can easily become degraded to a process of self justification, or a sometimes pointless counting of outputs. There’s nothing wrong with self justification – its vital in a world of limited resources – but its not the process of open, honest, and organised critical reflection which creates the learning of the evaluation process. Maybe the real importance of the questions – ‘why am I doing this’, ‘who is it for’, and ‘what does it aim to achieve’ – is that they lay bare our motivations as evaluators.
When funders project commissioners don’t make explicit why they want want evaluation, who its for, and what they are going to do with it, it can have significant consequences. Countless thousands of ‘evaluation’ reports or products have been produced on initiatives and projects the length and breadth of the country that have simply disappeared. If nobody is asking why do we want evaluation, what we will we do with it once we have got it, and who is intended for then it should be no surprise that much of the product of evaluation is unused and neglected, nor that those that are tasked with ‘evaluating’ their own work become cynical and disillusioned with ‘evaluation’.
I think many professonal evaluators also make the mistake of focusing on method without asking why and what for. It can seem that some evaluators are trained to look down their noses at less formal methods of appraising, weighing up, estimating the worth or forming opinions on a programme or project.
So why do we want to evaluate Support from the Start, the East Lothian Equally Well test site.
My answer has two parts, firstly, because we want to be able to understand and explain with the most confidence we can manage, what we have done, why we we did it that way and what we think have have been the positives and negatives of what we have done. Secondly we want to be able to monitor progress towards the outcomes we have established for the test site. What we want from the evaluation is reliable means of explaining / understanding what we have done and what the impact of that has been. Who is it for – in no particular order the ministerial taskforce, the community planning partnership and partners agencies and the communities that are the target for the test site. So what we want to do is assess the change process within the test site and use that as evidence to a range of local and national audiences that the approach we have taken has produced service change.
Note that i have not mentioned anything about measuring change in health inequalities, although we may well try to do this for specific initiatives. I have said from the start that the timescale of the test site is far to short to measure changes in health inequalities. Also I have grave doubts that quantitative methods can be applied across a complex and dynamic service environment with any confidence that you can attribute change to one service change or another.
Using storytelling as one of the hows or methods for evaluation has lots of attractions for me, but I acknowledge that it is looked upon as being unscientific, unreliable too simplistic.
What can storytelling offer us as an evaluation tool :-
tapping into knowledge that practitioners gain through reflection on their own experiences;
providing an environment that enables people to tell their stories;
helping practitioners to share their practice knowledge with one another more effectively;
creating more generalised knowledge about practice, from practice, for practice;
incorporating practice knowledge in project evaluation.
And reading the output might be far more interesting and engaging than tables describing enumerated outputs.
Storytelling could help us evaluate at the same time as involving service providers and community member in the process of change that we are trying to generate. If we can get people to trust that we want to hear their stories and are systematic in listening and recording their stories then as an evaluation process it will have as much validity as ‘focus groups’ or questionnaires. Combined with identifying appropriate indicators linked to service pathways for the medium term outcomes for the test site I think this is the best we can both assess / evaluate change and the change process.
The Kings Fund managers that visited the East Lothian encouraged the test site team not to be discouraged by the scale of the task we had set ourselves. One of the managers said, in the feedback to the test site, that if the process we have set in place was successful in creating small sustainable fires, then this might be more productive in the longer term than a large fire that created a lot of heat and light but ultimately wasn’t sustainable.
I really like this analogy because I felt it accurately described the way we are going about ‘service redesign’ within the test site – .i.e. not attempting to change the whole system at once with a clever plan – but placing emphasis on supporting managers, practitioners and communities to come up with their own solutions to tackling health inequality. Key to this approach will be sharing and learning from the solutions that are developed so that the fires are allowed to spread and develop, rather than become isolated pockets of innovation and good practise.
I also liked the analogy because it chimed with the work we are doing on fast tracking forest school in the test sites target communities. Camp fires are often used as a focal point within a forest school. Learning how to respect fire, to be safe around fire and finally to make fire, are familiar activities in forest school.
Humans are the only species that can combine the knowledge and skills that are needed to create and manage fire. it is a learnt skill that requires practise and perseverance to master as well as knowledge. Successfully making fire in a safe environment can be a very powerful learning experience for children and adults. There are required elements – combustible material – oxygen and an ignition source – without a balance of which you won’t create fire no matter how hard you try. There are also some simple rules that make it more likely that you will succeed in making a fire, and certainly far more likely that you will be able to repeat the task successfully.
At a early years conference hosted by Health Scotland on Friday I tried to use making fire as an analogy for service redesign because to my mind there are both required elements and simple rules to service redesign. If the required elements are not in place and in balance then you won’t get service redesign no matter how hard you try, and I am sure there are simple rules that make you more likely to succeed and replicate that success.
The analogy works for me I’m not sure how successful I was in communicating this but here are the slides from the presentation.
On the 19th November Adam Ingram visited East Lothian to see for himself the work of Support from the Start. This vist was part of a series of ministerial visits to Equaly Well test sites that are part of the reconvening of the Ministerial taskforce on health inequalities which published the Equally Well strategy.
The programme was tight for the hours visit and began with the minister being welcomed by the senior champions for the test site including Dr Sue Ross, Director of Community Services on her penultimate day with East Lothan Council before leaving for new opportunities.
The first stop involved the minister meeting staff and children from Whitecraig primary who had been involved in a forest school programme. The fast tracking of Forest school in the test site area is one of the redesign initiatives sponsored by the test site. He then met staff involved in initiating the redesign of early years play services in the community of Whitecraig in response to the output from a civic conversation in the community that demonstrated a community demand for more play opportunities.
The minister then had short conversations with some of the twenty eight service champions who provide leadership for learning about how services can tackle health inequality within the test site.
Carol Golightly – Oral Health Promoter described the redesign of oral health services in Wallyford and Whitecraig initiated by a review of the service pathway which supported the outcome of reducing dental caries by P1
Helen Duncan, Cultural Coordinator – spoke of the use of art and culture to engage people in health issues within the test site
Pauline Homer, Early Years Development officer – spoke to the minister about wraparound care and the redevelopment of breakfast provision
Fiona Herriot Children 1st described the work she has beien doing with Homestart a community champion for Support from the start in ‘Making connections’ between services involved in the early years
Ann Hume Early Years manager spoke to the minister about the links between the test site and the early years framework in East Lothian
Anne Rooney & Rebecca Haack both from Midlothian council spoke of the plans to extend the test site into Midlothian communities
Finally there was an opportunity for ten minutes of questions and group discussion before the Minister left. Hopefully, he didnt find the programme too gruelling and got a flavour of what we are trying to achieve and how we are going about it.