Learning Together Young Knocknaheeny Process Evaluation, 2015 to 2017

Documenting and evaluating the implementation processes of the Young Knocknaheeny Programme during its first three years. Young Knocknaheeny, HSE Building, Harbourview Road, Knocknaheeny, Cork

021 601 0656 [email protected] youngknocknaheeny www.youngknocknaheeny.ie Young Knocknaheeny Area Based Childhood Programme

Learning Together Young Knocknaheeny Process Evaluation, 2015 to 2017

2018 Publication

The authors of this report are: Ms. Lynn Buckley and Dr Margaret Curtin

How to cite this report Any citation of this report should use the following reference: Buckley, L., Curtin, M. (2018) Learning Together: YK Process Evaluation, 2015 to 2017. Cork: Young Knocknaheeny (YK).

Young Knocknaheeny, HSE Building, Harbourview Road, Knocknaheeny, Cork YK Research Advisory Group Dr Margaret Curtin (YK Chairperson; School of Nursing and Midwifery, UCC), Dr Shirley Martin (Applied Social Studies, UCC), Dr Siobhan O’Sullivan (Applied Social Studies, UCC), Dr Maria Dempsey (Applied Psychology, UCC), Ms. Anne Horgan (HSE; YK Management Group), Dr Pat Corbett (YK Management Group) and Ms. Katherine Harford (YK Programme Manager).

Contributors Ms. Catherine Maguire, Ms. Grace Walsh, Ms. Sally O’Sullivan, Dr Shirley Martin, Ms. Jenna Russell, Dr Katrina Collins, and Ms. Emma Ní Neill. Ms. Braedon Donald, previous YK Research Officer, contributed to the development, design and data collection phases of the evaluation.

Acknowledgements YK Community YK would like to acknowledge all of the children and parents in the YK community and thank them for their engagement with the programme and for their participation in interviews and focus groups. We would also like to thank the many local practitioners who gave so readily of their time, taking part in the various capacity building trainings and participating in interviews and focus groups.

Service Delivery Partners YK would like to acknowledge the contribution of its many service delivery partners who committed their time, resources, skills and expertise to the implementation of the YK Programme; HSE, UCC, Cork City Council, Tusla, CUMH, Cork City Childcare Commitee, as well as local education, childcare and community services.

YK Team YK would like to acknowledge the contribution of all YK staff members and thank them for their support throughout all phases of the evaluation.

Lead Agency YK would like to thank NICHE for acting as lead agency for the programme.

Funders YK would also like to acknowledge the funding and support offered by its main funding bodies: The Department of Children and Youth Affairs and Atlantic Philanthropies. YK would also like to thank the Area Based Childhood (ABC) Programme Managers, the Centre for Effective Services and Pobal.

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Table of Contents Acknowledgements 4 Preface 10 Executive Summary 11 Glossary of Terms 13 Definitions 14

Chapter 1: Introduction 15 1.1 The YK Programme 17 1.2 History of Young Knocknaheeny 18 1.3 The YK Catchment Area 20 1.4 The Science 21 1.5 YK Development Process 23 Preparation 23 Planning 23 Implementation 27 Maintenance 29 1.6 The Evaluation Report 31

Chapter 2: Evaluation Methodology 33 2.1 Evaluation Rationale & Focus 35 2.2 Research Frameworks 35 2.3 Evaluation Purpose, Aims and Objectives 37 2.4 Research Questions 37 2.5 Research Design 38 2.6 Data Management 41 2.7 Ethical Considerations 42 2.8 Report Limitations 42

Chapter 3: Evaluation Results 43

3.1 Strategy 1: Infant Health and Well-being 45 3.1.1 Overview of Strategy 47 3.1.2 Evaluation of Strategy 1 48 3.1.3 IMH Practitioner Training and Coaching Programme 48 3.1.4 YK Inter-disciplinary IMH Home Visiting Programme 59 3.1.5 Engagement with Strategy 1 Programmes 75 3.1.6 Implementation Process of Strategy 1 77 3.1.7 Key Findings and Learning 81 3.2 Strategy 2: Speech, Language and Literacy 83 3.2.1 Overview of Strategy 85 3.2.2 Evaluation of Strategy 2 85 3.2.3 Babbling Babies 85 3.2.4 Hanen Programmes 95 3.2.5 Implementation Process of Strategy 2 109 3.2.6 Key Findings and Learning 112

3.3 Strategy 3: Early Years Care and Education 115 3.3.1 Overview of Strategy 117 3.3.2 Evaluation of Strategy 3 118 3.3.3 Environment Rating Scales Assessments 121 3.3.4 HighScope Training Programme 127 3.3.5 Mentoring Programme 135 3.3.6 Environmental Enhancement Funding 139 3.3.7 Implementation Process of Strategy 3 141 3.3.8 Key Findings and Learning 144

3.4 Strategy 4: Pro-social Behaviour and Self-regulation 147 3.4.1 Overview of Strategy 149 3.4.2 Evaluation of Strategy 4 149 3.4.3 Incredible Years Parenting Programme 150 3.4.4 IY Teacher Classroom Management Programme 160 3.4.5 Implementation Process of Strategy 4 166 3.4.6 Key Findings and Learning 169

3.5 Programme Level Results 173 3.5.1 Overview 175 3.5.2 YK Programme Reach 176 3.5.3 Process Evaluation 177 3.5.4 Key Findings and Learning 181

Chapter 4: Discussion and Recommendations 183 Why these Findings Matter 185 Recommendations 187 References 191 Appendices 195 Further Information 210 List of Tables Table 1.1: YK catchment area demographic profile (Total population 12,000) 20 Table 1.2 YK Strategies Summary 26 Table 1.3: YK Logic Model 2015 27 Table 1.4: Pro-social Behaviour Strategy Feedback 17 Table 2.1: YK Evaluation Stages and Processes 37 Table 2.2: Stage 3 and 4 Evaluation Questions 39 Table 3.1.1: Respondent characteristics, IMH masterclass questionnaires 50 Table 3.1.2: Strategy 1 Implementation Process, 2015 to 2018 78 Table 3.1.3: Strategy 1 Key Findings 81 Table 3.1.4: Strategy 1 Key Learning 81

Table 3.2.1: Parent awareness of communication development milestones 88 Table 3.2.2: General SLCN promotion strategies provided during BB clinics 88 Table 3.2.3: OLO concerns re child development 89 Table 3.2.4: OLO concerns re risk factors for communication development 89 Table 3.2.5: Advice offered by OLOs following the identity of risk factors 90 Table 3.2.6: Strategy 2 Implementation Process, 2015 to 2018 110 Table 3.2.7: Strategy 2 Key Findings 112 Table 3.2.8: Strategy 2 Key Learning 113

Table 3.3.1: Overall pre and post ECERS-3 results by subscale 122 Table 3.3.2: Overall pre and post ITERS-R results by subscale 123 Table 3.3.3: Overall Childcare Quality Improvement Results 124 Table 3.3.4: Summary of quality improvements in EY centres 125 Table 3.3.5: Strategy 3 Implementation Process, 2015 to 2018 142 Table 3.3.6: Strategy 3 Key Findings 144 Table 3.3.7: Strategy 3 Key Learning 144

Table 3.4.1: Duration of Consultation 152 Table 3.4.2: Type of support offered 153 Table 3.4.3: Type of IY strategy reports as used by parents at each consultation 153 Table 3.4.4: Intensity level at time of consultation 154 Table 3.4.5: Strategy 4 Implementation Process, 2015 to 2018 167 Table 3.4.6: Strategy 4 Key Findings 169 Table 3.4.7: Strategy 4 Key Learning 170

Table 3.5.1: Programme Level Findings 181 Table 3.5.2: Programme Level Learning 182 List of Figures Figure 1.1: YK Integrated Strategies 25 Figure 1.2: YK Spend by Year by Category, Jan 2015 to Dec 2017 29 Figure 1.3: YK spend per year versus total allocation, Jan 2015 – Dec 2017 30 Figure 1.4: YK spend per year versus total spend, Jan 2015 – Dec 2017 30 Figure 2.1: Overview of ‘The Framework for Programme Evaluation’: Elements of the framework [CDC, 2013] 36

Figure 3.1.1: Practitioner rates of encountering issues related to IMH 51 Figure 3.1.2: Practitioners’ interpretation of social and emotional development stages 51 Figure 3.1.3: Practitioners’ ability to identify lack of progress in children’s social and emotional development 52 Figure 3.1.4: Duration of home visit 62 Figure 3.1.5: Team members conducting home visits 63 Figure 3.1.6: Type of support offered via HVP home visits or phone calls 63 Figure 3.1.7 Intensity of visit by duration 64 Figure 3.1.8: Intensity of programme involvement by families, Jan ’15 to Dec ‘17 75 Figure 3.1.9: Geographical area of participants, Jan ‘15 to Dec ‘17 75 Figure 3.1.10: Nature of Referrals to YK, Jan ‘15 to Dec ‘17 76 Figure 3.1.11: Registration Pathways, Jan ’15 to Dec ‘17 76

Figure 3.2.1: ECERS-3 & ITERS-R Pre and Post Results 97

Figure 3.3.1: No. of participants in EY suite of quality improvement measures 120 Figure 3.3.2: Overall pre and post ECERS-3 results by subscale 122 Figure 3.3.3: Overall pre and post ITERS-R Results by subscale 123

Figure 3.4.1: IY Parenting Programme Participation, Apr ’15 to Dec ‘17 152 Figure 3.4.2: IY TCM Practitioner Participation, Jan ’15 to Dec ‘17 161 Figure 3.4.3: IY TCM participation breakdown by profession, Jan ’15 to Dec ‘17 162

Figure 3.5.1: Total family and children participation rates, Jan ’15 to Dec ‘17 176 Figure 3.5.2: Total practitioner participation rates, Jan ‘15 to Dec ‘17 176 Preface

The Young Knocknaheeny Consortium, and later the Young Knocknaheeny Area Based Childhood Programme (YK), grew from previously existing collaborative relationships among community-based organisations and statutory agencies and services. It was grown by people active in the community, and people working in those organisations. Young Knocknaheeny did not begin as an ABC Programme; it began as a consortium of people working the areas of Churchfield, Gurranabraher, Hollyhill and Knocknaheeny in 2011. As described in the report, the Consortium applied for funding in 2013, and is now, along with twelve other areas around the country, currently jointly funded by the Department of Children and Youth Affairs and Atlantic Philanthropies. The Consortium continues to be the foundation of the Young Knocknaheeny Programme. This report “Learning Together” evaluates and documents the implementation processes of YK over a three-year period (January 2015 to December 2017). More than 6,000 children, parents and practitioners participated in the Programme; partner services themselves provided significant time, resources and expertise; a wider context of urban regeneration, service and community change was also taking place during the 3 years. The report provides an account of the complexity of embedding evidence-based preventative and early intervention work at a community level, and a documentation and evaluation of the processes required to do so. We hope that it clarifies and illuminates the processes required, and the possibilities of working with the complexity of implementation and context. It was part of the YK logic model to evaluate the work as rigorously as possible, but it was not feasible to carry out an impact evaluation or a controlled study, while at the same time trying to build a new team, build a range of new working relationships, and begin to implement the strategies outlined in the model. From the beginning, however, processes were documented, data was recorded, child-level data was analysed and the voices of the parents, the consortium, our partners, and our team were listened to and recorded through qualitative methods, to inform our understanding of the establishment of YK, the implementation of its strategies, and of its practice; and we are convinced of the value of this report. Nevertheless, the YK team and consortium are committed to further studies of impact in the next phase of our work. In the long run, it is essential to show the impact of investment in preventative and early intervention programmes at community level in order to make the case for the continuation and expansion of such investment. The primary reason for producing this report is to be transparently accountable: firstly, to the children and parents who have worked with us; secondly to our consortium members, our lead agency NICHE (NICHE Community Health Initiative Cork CLG), our partners and collaborators in Early Years centres, primary schools, community services, Tusla, and the HSE; thirdly to our funders, the Department of Children and Youth Affairs and Atlantic Philanthropies; and finally to the Centre for Effective Services which provided programme support to the ABC Programme nationally, and Pobal which managed the funding of the ABC Programme nationally. Finally YK has a commitment to making the best possible use of the science of early child development, and as we have an underpinning Infant Mental Health framework, those involved wanted to show that a community-based programme can be a mechanism to translate evidence and science into prevention and early intervention practice. Indeed, we believe that over time, it will become evident that it is the best mechanism for doing so.

10 Executive Summary

This report provides a process evaluation that documents and evaluates the implementation processes of the Young Knocknaheeny (YK) Area Based Childhood Programme over the three-year period from January 2015 to December 2017. The primary objective of the YK Programme is to improve outcomes for children aged 0 to 6 years in the YK catchment area.

The purpose of conducting the evaluation was to establish an understanding of the implementation processes involved in the delivery of the YK programme and its individual activities. The overall aim was to deliver a coherent, concise, and readable evaluation of the YK programme that details the processes and approach to implementing and delivering individual activities and the overall programme. Thus, the main objectives were the following: to examine the processes involved in the implementation of the YK programme and its activities; to identify enablers and barriers to the implementation of YK activities; and, to examine the reach of the YK programme and its activities.

Chapter one introduces the programme, describing its early development in the local community, and its engagement with the national Area Based Childhood programme established by the Department of Children and Youth Affairs, and jointly funded by Atlantic Philanthropies in 2013. It introduces the knowledge base underpinning the programme; it describes the processes involved in the development of the YK Programme; it outlines the YK logic model; and it provides a summary of how the funding was used.

Chapter two describes the evaluation methodology and outlines the research frameworks which guided the evaluation and documentation. The Framework for Programme Evaluation in Public Health (CDC, 2013) provided the overall structure for the report. The purpose of the evaluation, along with its aim and objectives are provided; the research design is described; the process evaluation questions, derived from the logic model, are listed; and the method of data management is described. Chapter 3 provides the results of the evaluation. The results for each of the four strategies are given in separate sections, with an overview of each strategy provided, and a detailed description of how the strategy was implemented. A fifth section describes the Programme Level results.

Strategy 1, Infant Health and Well-Being was comprised of several elements all of which are described; but it primarily consisted of two components, firstly an Infant Mental Health Practitioner Training and Coaching Programme, and secondly, an Infant Mental Health Inter-disciplinary Home Visiting Programme; these two components of the strategy were evaluated and key findings, key learnings, and identified enablers of and barriers to implementation are outlined.

Strategy 2, Speech, Language and Literacy also comprised of several elements all of which are described; the two main components, firstly, Babbling Babies, and secondly, the Hanen Programme, were evaluated in greatest depth. Key findings, key learning, and identified enablers of, and barriers to, implementation are outlined.

Strategy 3, Early Years Care and Education consisted of the delivery of a suite of Early Years quality improvement measures to all seven of the Early Years centres (both crèche and pre-school rooms) in the YK catchment area. This suite of measures was as follows: 11 • The Hanen Learning Language and Loving it Programme; • HighScope Curriculum Training; • A Mentoring Programme; and, • YK Environmental Enhancement Funding

Along with the process evaluation, an Environmental Rating Scale Assessment was carried out by an independent organisation (A+ Education, a UK-based agency) in all seven centres to quantitatively measure quality improvement in the centres before and after the implementation of this suite of measures. The outcomes were uniformly positive. Key findings, key learning, and identified enablers of, and barriers to, implementation are outlined.

Strategy 4, Pro-social Behaviour and Self-Regulation, consisted of the implementation of a suite of Incredible Years (IY) Programmes through a whole-community approach to training parents and school staff in the YK catchment area. The following programmes were delivered: • IY Basic Parent Leader Programme Training • IY Basic Parent Programme (2 to 4 years and 5 to 8 years) • IY Teacher Classroom Management Training (TCM) Programme, and • IY Whole Classroom DINA Training Programme. Key findings, key learning and barriers to implementation are outlined.

The final section of Chapter three provides Programme Level results, offering overall rates of participation and an examination of the YK Programme’s adherence to its three overarching themes; capacity building, collaboration, and quality improvement. Key findings and key learning at programme level are outlined.

Among the many findings documented in Chapter 3 are the following key figures: • 300 families registered and engaged with the YK Interdisciplinary IMH Home Visiting Programme from January 2015 to December 2017; • 2,500 children benefitted from local primary school staff involvement in IY TCM and DINA programmes; • 1,200 children benefitted from Early Years and primary school educators’ involvement in Hanen language training programmes; • 63% of babies born in the YK catchment area were seen by YK OLOs at Babbling Babies over a two-year period; • 300 local practitioners completed IMH Masterclasses; • 29 local practitioners engage in monthly IMH Network Groups; • 90 primary school teachers completed IY TCM and DINA programmes; • 28 EY educators completed curriculum training as part of the EY quality improvement strategy; • 29 EY primary school educators completed Hanen language training programmes.

Finally, Chapter 4 provides a discussion of the findings of this process evaluation and explains why the findings matter. Finally, recommendations arising from the findings of this evaluation report are listed.

12 Glossary of Terms ABC Area Based Childhood Programme ACEs Adverse Early Childhood Experiences AP Atlantic Philanthropies BB Babbling Babies Clinics BOBF Better Outcomes Brighter Futures National Children’s Framework CAN Community Action Network CCC Cork City Council CDC Centre for Disease Control and Prevention CES Centre for Effective Services CNWQR Cork North West Quarter Regeneration Plan DCYA Department of Children and Youth Affairs ECCE Early Childhood Education and Care EY Early Years HSE Health Service Executive HVP Home Visiting Programme IMH Infant Mental Health IY Incredible Years NICHE Northside Community Health Project (Cork) CLG. OLO Oral Language Development Officer PEIP Prevention and Early Intervention Programme PHN Public Health Nurse RAPID Revitalising Areas through Planning, Investment and Development SLC Speech, Language and Communication TCM Teacher Classroom Management Programme Tusla Child and Family Agency UCC University College Cork YB Young Ballymun YK Young Knocknaheeny

13 Definitions

Theory of Change A ‘theory of change’ explains how activities are understood to produce a series of results that contribute to achieving the final intended impacts (CDC, 2013).

Logic Model A ‘logic model’ describes the sequence of events for bringing about change by synthesising the main programme elements into a picture of how the programme is supposed to work (CDC, 2013).

Population Health Approach ‘Population health’ refers to the health of a population as measured by health status indicators and as influenced by social, economic and physical environments, personal health practices, individual capacity and coping skills, human biology, early childhood development, and health services (HSE, 2007). Universalism. Universalism in service delivery is best understood or described as equal access and provision to services provisions. When applied to the provision of services, it refers to the equal right of the entire population to avail or access them.

Progressive Universalism The concept of Targeted Universalism or Progressive Universalism is also integrated into Young Knocknaheeny’s programme delivery. ‘At its core, progressive universalism is a determination to ensure that people who are poor gain at least as much as those who are better off at every step of the way toward universal coverage, rather than having to wait and catch up as that goal is eventually approached’ (Gwatkin & Ergo, 2011).

Infant Mental Health ‘Infant Mental Health’ refers to the optimal development of infants and toddlers within the context of secure and stable relationships with caregivers (Tableman & Weatherston, 2015).

Proforma Specific scheduled data collection questionnaires, ‘proformas’, were developed for a number of YK initiatives (see Appendix A). These reflect the only aspects of YK which involve direct service provision. Proformas were completed by YK team members on an on-going basis, immediately after each session or activity.

14 Chapter 1: Introduction

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Chapter 1: Introduction

‘The foundations for virtually every aspect of human development – physical, intellectual and emotional – are laid in early childhood. What happens during those early years, starting in the womb, has life-long effects’ (Marmot, 2010).

Advances in our understanding of neuroscience, biology and child development point to the centrality of the early environment (from conception to age six) in shaping life- long health and well-being. Nurturing relationships with parents and other caregivers provide the foundations from which children grow and develop. It is these early responsive relationships and supportive family environments that shape the child’s future well-being, educational engagement and health. Families, however, do not exist in a vacuum. Communities and nations that value families and create environments where children are supported to achieve their full potential, perform better across a range of health and social indicators.

Conversely, risks which undermine family stability and relationships, undermine a child’s development. There is a powerful connection between the experience of adversity in childhood and the incidence of many health and social problems. Children who grow up in disadvantage, experiencing adversity in their early years are at much greater risk than their peers, of life-long poor outcomes in their physical and mental health, as well as their social, educational and economic achievement.

The psychological and neurodevelopmental mechanisms through which early experience of adversity impacts on the developing brain are now well understood. What, as yet, is not understood is how to translate the science into effective frameworks for practice. The Young Knocknaheeny ABC Programme is an attempt at creating such a framework for practice. The concluding observations of ‘Cherishing All the Children Equally’ states, ‘much of the variation in child outcomes may be associated with a family’s economic, educational and social resources, with migrant status, with a child’s special education needs, or a disability… The holy grail of policy or other overarching interventions to address the barriers facing children and their families is particularly elusive’ (DCYA, 2016). The science of early child development makes a powerful case that prevention and early intervention have a central role to play in policy and practice.

1.1 The YK Programme Young Knocknaheeny (YK) is a community-based prevention and early intervention programme, predominantly working across four areas in the north of Cork city; Knocknaheeny, Hollyhill, Gurranabraher, and Churchfield (for map see Appendix B). The overall objective is to measurably improve the lives of children (pre-birth to six years) and families living in the YK catchment area. Adopting a whole-community approach, the YK programme aimed to give every child the best possible start in life by:

• Respectfully enhancing the skills and early childhood development knowledge of all parents, practitioners and services in the area; • Strengthening and enhancing all relationships and environments that are important to every child’s early development; and, • Embedding systems and community change to support early childhood development and address childhood poverty.

17 Aligned to Better Outcomes Brighter Futures (DCYA, 2014), YK is part of the national ABC initiative, addressing areas of child health and development, child learning, parenting and integrated service delivery. The YK Programme is delivered through an inter- agency and partnership approach and uses early intervention and evidence-based practices which are holistic in their approach to child development. Set in a context of childhood disadvantage, the programme utilises a progressive, universal approach, implementing multi-system/multi-stage interventions.

YK draws on best international evidence and practice. It works to intercept the cycle of poverty experienced by successive generations of children, and in so bringing about lasting social change. To do this, YK works directly with families, guided by the IMH framework and complimented by the delivery of evidence-based parent programmes and groups. In addition, YK supports the development of quality skills and environments using coaching, modelling, mentoring and continuous professional development of practitioners working with children aged 0 to 6 years and their parents.

1.2 History of Young Knocknaheeny

Supporting families and communities is not new to the YK catchment area. There is a long history of collaboration between agencies, service and the community, and a strong tradition of good working relationships between health, education, social services and the local authority.

On the part of those working in the area, there has long been an understanding and admiration of the powerful commitment of parents to the best possible care and development of their children, often in difficult circumstances; an understanding of the very damaging impact of early adversity in a child’s earliest years; and an acceptance that many parents who have experienced adversity themselves benefit from collaborative, respectful, practical support in their care of their children.

The YK ABC Consortium, and later the Programme was built on and from resources and people already in place in our area. It provided an opportunity for likeminded individuals, representative of a wide variety of services for children, who shared a sense of concern for the future of the children of the area. It tapped into a shared desire across a range of services to develop a comprehensive prevention and early intervention programme and fostered the emergence of leaders and champions, recognising the extensive range and quality of expertise already available within the community.

The need to shift the balance from crisis management to prevention and early intervention was high on the agenda of many key stakeholders in services for young people. There was a broad recognition that many of the problems facing young people in the area could be best addressed by focusing on preventative strategies in the early years. At the same time, there was a recognition that new methods of inter-agency working were required in response to emerging social and economic conditions, if a focus on prevention was to be achieved.

In early-2011 a small group of local practitioners who worked together and held similar views began to discuss the possibility of developing alternative preventative ways of working. They learned from the existing Prevention and Early Intervention 18 Projects in Ireland, from international research and practice. They identified resources, opportunities and obstacles to developing a prevention and early intervention programme in this area. From this shared vision, YK emerged.

Over time, a shared understanding developed of how this knowledge base might best be applied locally, by the existing services and agencies, with the resources available. The design framework of a prevention and early intervention programme was developed, and this later became the basis of an application for funding to the DCYA. This core group established an evidence base, core purpose, values, and an approach and programme design. Solidarity and trust, and effective working relationships were established across agencies, services and disciplines. This was all completed before the development of a national Area Based Childhood Programme was announced in October 2012.

National Area Based Childhood Programme

The national Area Based Childhood Programme was established in 2013 in line with the commitment in the Programme for Government 2011 to adopt an area based approach to tackling child poverty. The programme was built on, and continued the work of, the Prevention and Early Intervention Programme (PEIP) 2007-2013. Its broad aim was to test and evaluate innovative prevention and early intervention approaches in areas of disadvantage, to improve outcomes for children, in particular children and families at risk of poverty. There were twelve ABC sites, most led by local consortia who co-ordinated the planning and delivery of services in their area.

The national programme was concerned with achieving the following outcomes for individual children and their parents participating in the ABC Programmes; improved child health and development, improved children’s learning, and improved parenting. Two remaining outcomes were concerned with achieving systems-change among service providers through integrated service delivery and embedded of local services in mainstream services.

Understanding of the central importance of our children’s earliest years, the impact of early adversity, and of the psychological and neurodevelopmental mechanisms through which these impact the individual, informed the establishment of, and the policy underpinning, the ABC Programme.

The ABC programme was co-funded by the Department of Children and Youth Affairs and the Atlantic Philanthropies on a matched basis with €29.7m being provided over the life-cycle of the programme. The Centre for Effective Services (CES) and Pobal were the Programme Managers for the ABC Programme and were involved in the implementation, support, governance and evaluation of the Programme.

At the time of developing the YK Process Evaluation report, summer 2018, the ABC Programme’s three-year funding period was coming to an end. Plans for the future management and funding of the ABC Programme nationally are under discussion by the Department of Children and Youth Affairs.

19 1.3 The YK Catchment Area

Prior to implementation of the YK Programme, a child-focussed profile of the catchment area; Knocknaheeny, Hollyhill, Gurrnanbraher, and Churchfield (Appendix B); was developed which included child-level data on language, literacy, and social and emotional development. This data informed the YK Programme throughout its first three years.

Based on data extracted from the 2011 census small area statistics, the population of the YK catchment area was 12,000. The total population of Cork city was 119,230, therefore 10% of the city’s population were resident in the YK catchment area. Of these 5,177 (43%) were children aged under fifteen years and 1,155 (10%) under six years – a demographic breakdown similar to that of the entire country.

When compared with the general population of Ireland, the YK area showed striking indicators of disadvantage. Less than one-fifth (17%) of the adult population (aged fifteen or over) have completed any post-secondary education, compared to the national figure of 44%. Only 34% were in employment. Almost one-third were either registered as unemployed (18%) or unable to work due to disability or permanent ill- health (12%). The proportion of households renting from the local authority (38%) was almost five times the national average (8%).

Only 45% of families consisted of couples with children compared with 78% in the general population. Lone mothers with children made up 54% of families (nationally 21% of families). The population was largely homogenous with 90% ethnically white Irish. A further 1.4% were Irish Travellers. A detailed demographic profile is outlined in Table 1.1.

Table 1.1: YK Catchment Area Demographic Profile (Total population 12,000)

YK catchment area Ireland (% population) (% population)

Post-secondary education (≥15 years) 16.9% 43.5% Unemployed 30.3% 14.7% Renting from local authority 38% 8% Ethnicity – White Irish 90% 84.5% Private households with Children 52.3% 48.7% Children under 15 20.75% 21.35% Families with children under 15: Couples with children 44.8% 77.9% Lone mothers 53.7% 20.6% Lone fathers 1.5% 1.5%

20 1.4 The Science

From the outset, YK sought to deliver evidence-based programmes and activities set firmly in the context of enhancing existing early childhood services, enhancing the service provision of local practitioners, sustainably meeting locally identified needs and delivering services within an inter-disciplinary framework. The body of science underpinning the YK approach to community prevention and early intervention was extensive.

The Impact of Early Experiences on Brain Development

The most critical period of human development is from conception to age six. It is a period of great opportunity and significant vulnerability. Unlike other organs in the body, the brain is not fully developed at birth and is only approximately one-quarter the size of an adult’s brain. The brain of the new-born infant increases gradually, growing to about 80% of its adult size by three years and 90% by five years (Zero to Three, 2001). During this period, the foundations and important structures of brain architecture are developed. Responsive relationships and quality consistent early experiences which are positive and predictable will build and consolidate brain structures. This period of early development is also influenced by the complex interplay between the nature and quality of early experiences and the biological processes which are also occurring in the social environment of the infant and his/her family. How well these brain structures and foundations are formed will determine the health, well-being, learning and behaviours which will follow (Shonkoff & Phillips, 2000).

Children are born with over 100 billion brain cells or neurons. For these neurons to function they must form connections or neural pathways. During the early years, up to 100 new pathways are formed every second. These pathways are formed in response to external stimuli. The opportunity for the various pathways to develop is broadly sequential - those necessary for sensory functions (sight, hearing etc.) form first followed those for higher function. When pathways are used or stimulated they strengthen and if not, they become redundant and are pruned or abandoned. If a baby gets too little nurturing, stimulation, affection and interaction, the formation and strengthening of these pathways will be negatively affected resulting in compromised developmental outcomes (Cohen et al., 2016). Conversely, warm and affectionate care-giving and a positive home learning environment strengthens early development and thereby enhances life-long health and well-being.

In addition, research has found that a considerable proportion of developmental delay is avoidable, particularly when we consider the strong evidence linking child development with parental socio-economic circumstances. Of concern is the widening gap between children from lower and upper-income families, resulting in children from poorer backgrounds doing less well in school and entering an inter-generational cycle of reduced employment opportunities, higher fertility and health inequalities (Leventhal & Brooks Gunn, 2000).

21 Infant Mental Health

Infant mental health is defined as ‘developing capacity from birth to 3 years to experience, regulate, and express emotions; to form close relationships; and to explore the environment and learn, all in the context of family, community, and cultural expectations for young children’ (Zero to Three, 2001). IMH prevention and early intervention programmes aim to promote healthy and holistic development of children from 0-3 years of age through advocating supportive and functioning attachments between infants and their caregivers (McKelvey et. al, 2015). Caregiver-infant relationships form the proto-type for subsequent relationships throughout the course of the infants’ lifespan, and the quality of this attachment has significant impact on future physical and mental health outcomes (McKelvey et. al, 2015).

As attachment security is the primary psychosocial outcome of infancy, understanding the wider ecosystem of factors that may promote or inhibit security is essential for prevention and early intervention IMH programmes (Coyl, Roggman and Newman, 2002). Thus, developing skilled IMH-informed professionals is pivotal to ensuring infants, and their caregivers, are provided with the right support, guidance and information to advocate these healthy and stable relationships.

Implementing Community-based Prevention and Early Intervention Programmes The quality and availability of evidence-based approaches to community-based prevention and early intervention has increased in recent years. Evidence suggesting that these programmes are more effective when they are implemented with fidelity to the original programme content and with effective delivery skills (Hutchings and Gardner, 2012). Indeed, a key component of the ABC programme was the adaptation of existing evidence-based programme.

At the same time, successful adaptation of any intervention is fully dependent on the availability of appropriate skills, structure and organisational supports within the local context. YK emerged organically from the local area, with a deep understanding of the context-specific requirements for successful adaptation of evidence-based interventions. Capacity building, integration and quality improvement were identified as three interconnected approaches which would be essential to drive any successful local intervention (see section 1.5, YK Strategies) (Hutchings and Gardner, 2012).

Population Health Approach

YK is a community-wide programme developed using the Population Health approach and underpinned by a Theory of Change logic model. A population health approach acts based on analyses and understandings of the entire range of the determinants of health within a given population. Particularly relevant to the YK programme, the Population Health approach recognised the complex interplay between the determinants of health. It used a variety of strategies and settings to act on the health determinants in partnership with sectors outside the traditional health system or sector. Approaches adopted were generally universal in nature, creating change across the whole community.

22 1.5 YK Development Process

Examining the processes involved in the development of the YK Programme allows us to identify the following: • Planned outcomes of the YK Programme; • How and why outcomes were decided upon; and, • Measures put in place to achieve the planned outcomes.

In line with The Framework for Programme Evaluation in Public Health (CDC, 2013), development processes will be documented under the headings; preparation, planning, implementation and maintenance.

1. Preparation

In 2011, a group of local practitioners in the Knocknaheeny area consulted with the Young Ballymun (YB) Prevention and Early Intervention Programme to discuss the YB model of service with the view to potentially replicating the service in the north Cork area. An information workshop was then organised to relay this information back to the Knocknaheeny community. Presentations by YB offered information about their approach to delivering YB and the specific elements of the programme. The YK development group received an overwhelming response from those who attended resulting in two main decisions being made which included: the endorsement of a Knocknaheeny prevention and early intervention strategy with a holistic, whole- community approach to child and family integrated services, the inclusion of parents, and a commitment to evidence-based practice; and, the development of a steering group, mandated by the seminar participants who represent a broad range of sectors and interests, established in order to progress thinking and decisions about next steps (YK, 2015).

The YK Steering Group consisted of twelve individuals working in the Knocknaheeny area and from a variety of different backgrounds and disciplines: education, health, social care, community development, and research. This broad representation allowed the group to identify the gaps present in service delivery in the Knocknaheeny area, and ways of addressing those gaps in a co-ordinated manner.

2. Planning

The establishment of an infrastructure to support the successful implementation of the YK programme took place during the ‘Planning and Resourcing’ stage of the programme. At this point the structural supports required included policy development, funding streams, human resources, referral mechanisms, and outcome and reporting frameworks. The YK Steering Groups (which later became the YK Consortium), while recognising the importance of this stage for later success of the programme’s implementation and sustainability, agreed and documented the core values, principles and strategic direction of the YK programme. The necessity to build capacity for change within organisations and practice was considered by the Steering Group to be a key feature of any programme of work.

23 The openness of local services toward capacity building emerged through an IMH workshop, hosted by the Steering Group in 2013, which was attended by forty-two local stakeholders. This created a precedent for inter-agency engagement with the concept of capacity building for change and introduced a common IMH language to the wide range of organisations.

YK Programme Design

During this planning phase, the Steering Group engaged in a parallel process of developing the YK Implementation Plan and the funding proposal for submission to the ABC programme. In 2013, through a facilitated planning meeting, the four key strategies emerged. These went on to become the implementation strategies in the ABC-funded programme, namely:

Strategy 1: Infant Health and Well-being; Strategy 2: Speech, Language and Literacy; Strategy 3: Early Childhood Care and Education; Strategy 4: Pro-social Behaviour and Self-regulation.

Design groups for each strand were established with the aim of developing a detailed, achievable, locally appropriate programme of work for each strategy. A fifth design group was also formed to focus on research and evaluation.

Although the main purpose of the design groups was to develop a work plan based on the core values and vision of the YK initiative, they were also extremely effective in achieving the aim of developing inter-agency engagement and facilitating the move from individual service-led provision to a universal, multi-disciplinary, cross-community approach.

Leadership and Governance

Steering Group members remained consistently engaged throughout the formation of the YK programme. The Northside Community Health Initiative (NICHE) was the lead agency for the programme with YK becoming a sub-group of NICHE, governed by NICHE policies and procedures. Following this, the final stage in the development of the governance structure was the agreement and documentation of Young Knocknaheeny ABC: Terms of Reference and Memorandum of Understanding for the YK ABC Governance Structure. The final governance document of the Consortium was signed off by the senior management of all Consortium member organisations.

Funding

Despite the significant level of commitment from all organisations involved in the YK programme up to this point, the level of planning and development required in the next stage of the planning process required additional external resources. NICHE provided a small programme budget with a co-ordinating and administrative function. Cork City Council (CCC) provided important resources through the City North West Quarter Regeneration (CNWQR) budget. The grant from CCC supported initial implementation and on-going quality governance practice.

24 YK Strategies and Overarching Themes

Figure 1.1: YK Integrated Strategies

The YK Programme, consisted of four interconnected strategies: Infant Health and Well- being; Speech, Language and Literacy; Early Childhood Care and Education; and Pro- social Behaviour and Self-regulation. It was supported by an integrated research and evaluation process. The strategies were connected by three overarching themes:

1. Capacity Building (focused on practitioner skills and capacity, embedding new competencies into practice); 2. Collaboration (systems-change and collaboration among practitioners); 3. Quality Improvement (environmental changes and overall quality of service).

25 Table 1.2 YK Strategies Summary Strategy 1: Infant Health and Strategy 1 focussed on supporting the conception to three years developmental period, within the context of care-giving Well-being relationships. Components of the strategy provide interventions to scaffold these relationships to build the strong foundations that are necessary for infant and toddler’s developing brain, social and emotional health and well-being across the lifespan. The strategy is underpinned by an IMH Framework and delivered by the YK Inter-disciplinary Team. Strategy 1 offers many service components, among those are: practitioner IMH Training and Coaching and the Inter-disciplinary IMH Home Visiting Service. Strategy 2: Speech, Language Strategy 2 aimed to support and strengthen emerging oral language development for babies, toddlers and children. As part and Literacy of the strategy, YK OLOs were involved in: the development and provision of Babbling Babies; the YK IMH inter-disciplinary service; workforce capacity building across the Early Years and primary schools’ sectors including provision of Hanen programmes; the provision of universal speech and language assessments and follow-up across four local primary schools within the YK catchment area; and, S&L consultation to parents, practitioners and organisations. Strategy 3: Early Childhood Strategy 3 involved the delivery of a suite of EY quality improvement measures; language training, curriculum training, mentoring Care and and environmental enhancement; to all Early Years (EY) centres Education (both crèche and pre-school rooms) in the YK catchment area. Strategy 3 was co-ordinated by Barnardos Brighter Futures, based in Knocknaheeny. It was guided by an Early Years Co-ordinators Group and aligned to the National Early Years curriculum and quality frameworks of Aistear and Soilta. Strategy 4: Pro-social Strategy 4 involved the implementation of a suite of Incredible Years programmes through a whole-community approach to Behaviour and training parents and school’s staff in the YK catchment area. The Self-regulation main objective of the strategy was to support the embedding of IY skills locally to reach a wider community of parents, teachers, and practitioners.

The YK Team Throughout the period of January 2015 to December 2017, the YK inter-disciplinary team was made up of the following: • Programme Manager • Administrator • Infant Mental Health Specialist (IMH-E®) • Senior Oral Language Development Officer • Oral Language Development Officer • Infant Parent Support Workers (x4) • Child Health Development Worker (Public Health Nurse) • Research Officer • Programme Assistant YK also had service-level agreements with the programme’s Early Years Strategy Co- ordinator (Consortium Member), Incredible Years Strategy Co-ordinator (Consortium Member), Early Years Quality Improvement Mentor (Independent), Archways (Incred- ible Years), and A+ Education (Early Years ERS Assessments). YK also contracted an IMH Masterclass trainer and IMH International Consultant. See page 210 for current YK team and contractors. 26 3. Implementation

The YK Logic Model

The implementation plan and logic model for YK were developed by the Consortium, with initial assistance from YB. As a result of the high level of engagement of key stakeholders in the design phase and the trust that had developed between partners, the process of implementing changes in practice and engaging in innovative approaches within existing services was a seamless progression rather than a perceived threat to existing work practices. In order to accurately document the processes involved in the delivery of the YK programme, the YK Logic Model 2015 and subsequent annual work plans have been used throughout this report. Initial budgets were also reviewed.

The YK Logic Model 2015 (Table 1.3) mapped how the programme planned to bring about specific long-term outcomes through a logical sequence of intermediate outcomes. It outlined the initial aims of the programme, its objectives, and desired outcomes. It linked the key objectives of the programme to proposed activities and intended outcomes.

Table 1.3: YK Logic Model 2015

Vision/Overall Aim of Consortium (2015): YK aims to strengthen the capacities of practitioners, services and parents in Knocknaheeny and surrounding areas of north Cork, to measurably improve outcomes for children and their families in line with national norms. Monitoring and evaluation: Evidence: City Profile, Barnardos Emotional Well-being Survey, PHN discharge stats, Census data, Speech and Language Project evaluation, Kidscope data, community consultation. Baseline: e.g. EDI for child development and ERS for service level. PHN data, Pre and post programme data collection (SDQ questionnaires etc.); and process evaluation methods. Qualitative /Quantitative data for process (training, mentoring, capacity building & integration) and outcome learning and dissemination Objectives Inputs Key Activities and Short-Term Longer-Term Outputs Outcomes (by 2016) Outcomes YK will facilitate •Financial resources 1.Infant Health and Well- •Practitioners will •Continued and support an being(0-3): have improved implementation integrated, high- •Support from NICHE Practitioners: IMH knowledge and by practitioners quality, whole- BoM and NICHE training; Mentoring, skills into practice. of skills community systems/policies/ sharing and •Parents are developed approach to procedures implementing more effectively through services and Services: multiservice/ engaged in child capacity practice in child •Existing inter-agency multi-disciplinary development building development. partnerships and planning, co-ordinating and have supported practice to build on protocol development. skills to build by existing It will focus Parents: Parent led play strong healthy mainstream on the •Commitment and groups in community & relationships service development support of mainstream 0-2 parent programmes: with babies and (schools/HSE of four key service providers PEEPS toddlers. etc.). Early Years’ to engage with YK •Increase in prevention approaches, values 2.Early childhood care numbers of •Services have and early and practice and education (0-6): expectant/ sustainable intervention Practitioners: Tailored new parents capacities, strategies for •Participation of training and supports for specifically willingness, children age 0-6: children and families in Early Years educators attending a commitment Infant Health YK area to meet action plan range of relevant and and well-being; targets. Services: services. understanding Early childhood •YK staff and Engagement Early •Access to of inter-agency Care & contractors’ skills, Years services; Baseline perinatal settings/ practice Education; Pro- commitment and assessment (i.e. ECCERS) services. to improve social Behaviour openness to approach of services carried out •Practitioner’s outcomes for & Self-regulation; Individual action plan for capacity to children. Speech, each service implement Language Parents: Awareness and quality practice is & Literacy engagement process improved. Development. for early childhood education

27 Objectives Inputs Key Activities and Short-Term Longer-Term Outputs Outcomes (by 2016) Outcomes YK will develop •Expert guidance 3.Pro-social behaviour •Improvements •Parental- partnerships from educators/ and self-regulation (3-6) taking place led activities with mainstream practitioners across Practitioners: Incredible across all domains becoming services to the strands Years whole class/parent in each service mainstreamed embed the programme/classroom setting. and supported approaches •Provision of management training/ by mainstream •Increase in and support professional coaching/mentoring services. the numbers of sustainability supervision and Services: numbers children taking up •Parental shared practices with of IY practitioners free pre-school capacity It will foster mainstream service implementing year. developed a “bottom providers Programmes: quality to be able up” capacity standards; access to •Services are to engage in building •Process /outcome assessments open to training service delivery approach that evaluation findings Parents: Local availability and programme and design. empowers of IY /parents plus parent delivery. and engages •Local staff able, programme; Access •Parents enjoy •Practitioners services, willing, interested to community supports their role and are undertaking practitioners in engaging models can meet training and and parents in professional barriers of on-going to measurably development and 4.Speech Language everyday life. mentoring and improve child training Literacy interventions (0- are implementing •Parent /child health and 6) Hanen, PALLL, ELKAN programmes. relationships are social emotional •Provision of buildings e.g. strengthened well-being in line /materials by existing Practitioners: •Improvements with national service providers Development of Hanen in children’s •Wide and norms. and Elklan informed emotional imbedded •ABC programme training for teachers. and social awareness structure and direction Services: Responding development. of and to at-risk groups: incl. engagement •Increased •Supports/partnerships travellers; Whole class with early child parental arising from existing approach to S&L services by capacity to relationships with development. mainstream manage routines/ similar projects Parents: Promotion services, behaviours and of S&L during the parents and boundaries. perinatal period; S&L community. stimulation skills at home; •School and Early •Early Years community awareness re Years’ service settings are S&L stimulation; practitioner’s delivering high- Research, monitoring, capacity to quality service evaluation & implement across the communication: language areas. monitoring and development evaluation systems initiatives is •Measured with supports for enhanced. improvements data collectors; in child speech, Establishment of regular •Parents actively language community learning and engaging in S&L literacy engagement, review promotion with development forums children. from birth to six •Key services are approximating Common practices incl. being delivered at national norms. Practitioner support, whole-community •Measured parental inclusion, level through outcomes for transition protocols, capacity building children in response to emerging interventions YK area are need; service integration in partnership reaching social, and mainstreaming. with mainstream emotional, service. educational •Robust referral/ norms in line transition/ with national engagement standards. systems are functioning. •Services and practitioners •Data collection are able and is taking place at equipped to a local level. respond to emerging need.

Evidence: Knocknaheeny and surrounding areas of north Cork city experience long-term, significant levels and complex variants of deprivation. Children are under-achieving in several child development domains and are achieving poor outcomes in terms of employment, education, health and well-being. Parents and communities experience a lack of empowerment. Engagement with services is limited. Quality practice and service integration for children and families is inconsistent and limited.

28 4. Maintenance

Enforcement

Sustained enforcement of the YK programme throughout the three-year period, from 2015 to the end of 2017, was achieved through continued efforts from all stakeholders; funding bodies, YK’s Management Group, YK’s Consortium Group, YK team members, and the YK community. At a local level, monthly and bimonthly Management and Consortium Group meetings ensured the smooth and effective running of the programme. Suffi cient engagement with key stakeholders allowed successful implementation of the programme and encouraged a collaborative process to programme enforcement and adherence to fi delity of design.

At a team level, weekly inter-disciplinary team meetings dealt mainly with new registrations and issues relating to existing cases, however, issues and queries related to the continued enforcement of the YK Programme were regularly discussed.

Visibility

In addition, members from both YK’s management group and IMH inter-disciplinary team were involved in a variety of local and national network groups and public health initiative groups. Developing links was a valuable strategy of the YK programme in terms of increasing its visibility locally and nationally. Such groups included: the Child and Family Support Network; Northside Community Network; Oral Language Forum; ABC Programme Managers Forum; ABC Ante-natal to Three Group; ABC Education Group; Cork Healthy Cities; Children’s Research Network; Nurture; IY Peer Learning/Support Group; Hard to Reach Families Group; and, the YK Early Years Managers Forum.

Compliance

Work plans developed during the interim years of the Programme, 2016 to December 2018 (stages 3 and 4), offer insight into the plan and processes put in place to realise the desired outcomes addressed in YK’s Logic Model. They demonstrate the evolution of the YK Programme throughout the three years, documenting changes/additions made to the YinitialK Sp planend whereby Ye anecessaryr by Cate togo deliverry on the short and long-term outcomes.

Economic Spend YK Spend Per Year by Category

€800,000 €421 €27,129 €700,000 €1,630 €29,830 €126,782

€600,000 €136,856

€500,000

€400,000 €13,640 €14,586 €542,428 €300,000 €128,438 €447,126

€200,000 €156,296 €100,000

€- 2015 2016 2017 Programme Costs Figure 1.2:Salaries YK Goods & Services Spend by YearCapital Costs by Category, Jan 2015 to Dec 2017 29 YK Spend Per Year versus Total Allocation

Figure 1.3: YK Spend Per Year versus Total Allocation, Jan 2015 to Dec 2017

YK Spend Per Year versus Total Spend

Figure 1.4: YK spend per year versus total spend, Jan 2015 to Dec 2017

30 Leverage: As a contractual requirement of funding, through its Service Delivery Partnerships, YK had to provide 20% of total budget allocation with monetary and or nonmonetary contributions. Through its reporting mechanisms to CES and Pobal, a total calculation of €421,932.94 was provided through the provision of staff time, office and practice space. As a conservative figure, given the full reach of the programme, it is still over the 20% that was required.

1.6 The Evaluation Report

This evaluation report describes how the Young Knocknaheeny Programme achieved its aim of getting every child’s life off to the best possible start. It draws on learning from the perspectives of all key stakeholders (including families, the community and those who work in the area) and delivers conclusions and outlines views on the programme’s next steps.

The three main reasons for undertaking this evaluation were:

1. To build awareness of the Programme and to support the basis for asking questions; 2. To identify gaps in YK service delivery in order to facilitate growth and improvement; 3. To demonstrate accountability through the provision of evaluation results.

Structure of Report

This report is presented in four chapters:

Chapter 1: Introduction Chapter 2: Evaluation Methodology Chapter 3: Evaluation Results Chapter 4: Discussion and Recommendations

31

Chapter 2: Evaluation Methodology

33

Chapter 2: Evaluation Methodology 2.1 Evaluation Rationale & Focus

The YK programme and many of its activities are innovative in their approach, content, and intention. YK aimed to implement evidence-based practices, or at minimum evidence-informed practices, through multiple strategies. Little evidence is available regarding the processes which enable and support the implementation of an initiative delivering such activities, particularly in the socio-economic and organisational context of the YK catchment area. Thus, a process evaluation of YK programmes and activities, delivered during the period of January 2015 to December 2017, was warranted in order to: 1. Document the implementation processes undertaken in order to achieve planned outcomes; 2. Document the reach of the YK Programme and its individual activities; and, 3. Add to the knowledge and evidence base.

2.2 Research Frameworks

The Young Knocknaheeny Process Evaluation was guided by The Framework for Programme Evaluation in Public Health (CDC, 2013). In addition, The Framework Method (Richie & Spencer, 2003) was used to guide the qualitative analysis.

The Framework for Programme Evaluation in Public Health

The Framework for Programme Evaluation in Public Health is a validated tool, developed by the Centres for Disease Control & Prevention (CDC) to guide public health professionals when developing and conducting programme evaluations. It is the chosen framework for the YK evaluation because of its emphasis on ‘practical, on- going evaluation strategies that involve all programme stakeholders, not just evaluation experts’ (CDC, 2013, p.5).

The framework is ‘a practical, non-descriptive tool, designed to summarise and organise essential elements of programme evaluation’ (CDC, 2013, p.5). It is comprised of six steps and thirty standards, which (if adhered to consistently throughout the evaluation) allow a clear understanding of the programme’s context from its initial stages of development through to the publishing and dissemination process. The thirty standards guide the quality of evaluation activities. These are grouped into four headings; 1. Utility: Serve the information needs of intended users; 2. Feasibility: Be realistic, prudent, diplomatic and frugal; 3. Propriety: Behave legally, ethically and with due regard for the welfare of those involved and those affected; 4. Accuracy: The evaluation is comprehensive and grounded in the data.

(Sandars and The Joint Commission on Standards for Educational Evaluation, 1994) Adhering to the framework steps and standards has facilitated an evaluation that was formal, visible and justifiable. The application of the standards is documented throughout this report. 35 Figure 2.1: Overview of The Framework for Programme Evaluation: Elements of the framework [CDC, 2013]

The Framework Method

The Framework Method (Richie & Lewis, 2003) guided thematic analysis of the qualitative data. This method is particularly relevant for research studies with a multi- disciplinary and mixed-method approach. A systematic and fl exible approach to qualitative data analysis, the Framework Method is effectively a thematic method of data analysis, focusing on commonalities or differences in qualitative data, whilst also focusing on relationships between different parts of the data, thereby seeking to draw descriptive and/or explanatory conclusions clustered around themes (Gale et. al, 2013, p.1). The procedure of analysis involves seven stages; transcription, familiarisation with the interview, coding, developing a working analytical framework, applying the analytical framework, charting data into the framework matrix, and interpreting the data.

For this evaluation, raw data were read by the YK research team in accordance with the Framework Method’s main stages, data were then categorised and emerging codes were selected. Refl exive dialogue ensured that codes and the subsequent expansion of the codes into themes were informed and driven directly from the data set of lived professional experiences rather than from theory. Sub and overarching themes were repeatedly refi ned through the analysis of patterns across the data set and direct quotes from participants were used to group and illustrate themes.

36 2.3 Evaluation Purpose, Aims and Objectives Purpose To establish an understanding of the implementation processes involved in the delivery of the YK programme and its individual activities.

Overall Aim To deliver a coherent, concise, and readable evaluation of the YK programme that details the processes and approach to implementing and delivering individual activities and the overall programme.

Objectives

1. To examine the processes involved in the implementation of the YK programme and its activities; 2. To identify enablers and barriers to the implementation of YK activities; 3. To examine the reach of the YK programme and its activities.

2.4 Research Questions

In line with The Framework for Programme Evaluation in Public Health (CDC, 2013) (see Section 2.2), the YK Programme is conceptualised in four stages as follows:

1. Preparation (environment and assets have been assessed/Programme is in development); 2. Planning (Programme has not yet been approved/has been approved but not implemented); 3. Implementation (Programme has been in effect for less than one year); 4. Maintenance (Programme has been in effect for one year or longer).

Table 2.1: YK Evaluation Stages and Processes

Evaluation of YK Programme

Stage of Stage 1 & 2 Stage 3 & 4 Development

Process in Preparation Planning Implementation Maintenance Action (2011-2012) (2013-2014) (2015-2016) (2017+)

37 Documentation of stages one and two was completed in 2015 and is documented in the YK publication ‘Preparing for a Whole Community Prevention and Early Intervention Programme’ (YK, 2015), summarised in Chapter 1.

This process evaluation pertains particularly to stages three and four of the YK programme. Guided by the YK Logic Model 2015 (Table 1.3), the main research questions were developed in 2015 and supplemented in 2016 as new programme activities emerged. The research questions are outlined below (Table 2.2).

2.5 Research Design

This report is a process evaluation of the YK Programme from January 2015 to December 2017 (implementation and maintenance stages).

A mixed-method approach to the research was adopted, entailing both quantitative and qualitative data collection:

• Programme reach was measured to determine levels of engagement. Quantitative analyses were conducted where it was possible to collect sufficient data. • Qualitative data was used to understand the processes involved in the implementation of YK activities across the four strategies, in addition to the contextual and organisational enablers and barriers to implementation.

The focus of the evaluation was on:

1. Perspectives of individual’s engagement with the YK programme and individual activities; 2. Implementation - contextual and organisational enablers and barriers to implementation of the various activities; 3. YK Themes (section 1.5)

38 Table 2.2: Stage 3 and 4 Evaluation Questions

YK Programme Reach Process Evaluation Questions

Strategy 1 Practitioner Capacity Practitioner Capacity Building: Infant Building: 1. To what extent do practitioners believe they Health and 1. How many have benefitted from participation in IMH Mas- Well-being practitioners have terclasses? participated in YK 2. To what extent do practitioners believe they IMH Masterclasses? have benefitted from participation in IMH Net- 2. How many work Groups? practitioners 3. What enables/acts as a barrier to practition- participate in the er’s implementation of IMH skills and concepts YK IMH Network into practice? Groups? Direct IMH Home Visiting Service Delivery: Direct IMH Home 1. What are the specific components of the YK Visiting Service IMH Inter-disciplinary HVP? Delivery: 2. How have families experienced engaging 1. How many families with the YK IMH Inter-disciplinary HVP? have engaged with 3. To what extent do parents believe they have the YK IMH Inter- benefitted from the HVP? disciplinary HVP? 4. How have the YK inter-disciplinary team experienced developing and implementing an IMH-informed Home Visiting Programme? 5. What enables/acts as a barrier to the YK inter-disciplinary team’s implementation of IMH skills and concepts into practice?

Strategy 2 Babbling Babies: Babbling Babies: Speech, 1. How many families 1. What are the specific components of Language have engaged with Babbling Babies? and Literacy Babbling Babies? 2. What are practitioner’s perspectives of the implementation and benefits of Babbling Practitioner Capacity Babies? Building: 3. To what extent do parents believe they have 1. How many EY benefitted from Babbling Babies? educators and primary school Practitioner Capacity Building: teachers have 1. What changes to ‘Language and Literacy’ participated in the and ‘Interaction’ have been observed across EY Hanen Programmes? centres as measured by ERS assessments? 2. To what extent do practitioners believe they have benefitted from participation in the Hanen programmes? 3. How have practitioners experienced implementing Hanen strategies? 4. What enables/acts as a barrier to participants implementation of Hanen strategies?

Strategy 3 EY Suite of Training 1. What quality improvements have been re- Early Programmes: corded in the seven EY centres? Childhood 1. How many children Care and have benefitted Environmental Enhancement: Education from EY educator’s 1. What improvements have been made to EY involvement in the settings and services? HighScope Training 2. How have EY staff perceived the benefits and Environmental and acts as a barrier to of the Environmental Enhancement Enhancement Programme? Programmes?

39 YK Programme Reach Process Evaluation Questions

Strategy 3 2. How many EY Mentoring Programme: Early educators have 1. What support was provided to EY staff by the Childhood participated in the on-site specialist mentor? Care and HighScope Training 2. How have EY staff experienced having an Education Programme? on-site mentor?

HighScope Training: 1. To what extent do staff believe they have benefitted from the HighScope Training Programme? 2. What enables/acts as a barrier to staff participation in the training? 3. To what extent have EY staff been able to implement HighScope strategies? 4. What enables/acts as a barrier to the implementation of HighScope strategies into practice?

Strategy 4 Practitioner Capacity Practitioner Capacity Building: Pro-social Building: 1. How have schools’ staff experienced Behaviour 1. How many participating in the IY TCM Programme? and Self- schools’ staff have 2. How have schools’ staff experienced regulation been trained in the IY implementing IY TCM strategies? TCM Programme? 3. What are teachers’ perspectives of the 2. How many impact of their IY TCM training in the classroom? children were in the classrooms of staff Parental Support & Capacity Building: trained in the IY TCM 1. What are the specific components of the YK- Programme? implemented IY Parenting Programme? 2. How have parents experienced participating Parental Support and in the IY Parenting Programme? Capacity Building: 3. How have parents experienced 1. How many implementing skills learned in the IY Parenting parents have Programme at home? taken part in 4. What are parent’s perspectives of the the IY Parenting impact of their involvement in the IY Parenting Programme? Programme in their home? 2. How many children live in families where parents participated in the IY Parenting Programme?

Overall 1. How many families 1. How have families experienced participating YK have engaged with in the YK Programme? the YK Programme? 2. How have practitioners experienced Programme 2. How many engaging with the YK Programme? practitioners have engaged with the YK Programme?

Table 2.2: Stage 3 and 4 Evaluation Questions

40 2.6 Data Management Data Collection and Collation Quantitative Data YK Administrative Database Demographic data on every family and child registered, and every practitioner engaged with the YK programme were collected and collated on an on-going basis by the YK team using a Microsoft Excel database purposefully designed by YK’s Research Officer. The data included: • Family history (name, address, telephone number, child dates-of-birth, number of children per household, school/EY setting child attends) • YK Registration Details (referring agent details, month/year of registration to programme, month/year of allocation to YK key worker, YK key worker name) • Details of programme involvement (pre-birth to three years, Home Visiting, EY-based programmes, School-based programmes, Parent IY Programme, Practitioner training programmes)

Routine Administrative Data Collection A separate, linked database was developed for each programme activity. The purpose of these databases was twofold - on-going administrative use by the YK inter- disciplinary team, and research and evaluation.

Proformas Specific scheduled data collection ‘proformas’ were developed for a number of YK initiatives, namely the IMH Interdisciplinary Home Visiting Programme, Babbling Babies, and the Incredible Years Parenting Support Programme. These reflect the only aspects of YK which involve direct service provision. Proformas were completed by YK team members on an on-going basis immediately after each session or activity. They served as a tool for monitoring and quality control and provide a rich source of data for evaluation (see Appendix A).

Data collected between January 2015 and December 2017 specifically, were used in this evaluation.

Qualitative Data Interviews & Focus Groups - Semi-structured interviews and focus groups were conducted with programme partners, practitioners, staff and families in the YK community to evaluate the implementation processes of the YK programme and its activities.

Data Cleaning

Data quality processes were adhered to throughout the YK evaluation process. To minimise error, data quality control checks were regularly conducted by the YK Research Officer to check for data accuracy.

41 Data Analysis

Microsoft Excel was used to measure YK programme reach. IBM SPSS Version 20.0 was used to conduct quantitative analyses for some sections of the report. NVivo Pro 11.0 was used to collate qualitative data for thematic analysis. The Framework Method (Richie & Spencer, 2003) (see Section 2.2) was used to guide the thematic analysis.

2.7 Ethical Considerations Consent

Consent was obtained from practitioners and parents in advance of all interviews, focus groups, and questionnaires. Individuals were given an information sheet detailing the purpose of the YK evaluation, reasons for collecting data on the programmes in which they were specifically involved, and YKs contact details for further information.

For practitioner interviews and focus groups, consent was obtained in writing and recorded orally at the beginning of each interview via dictaphone. The same procedure was in place for parent one-on-one interviews, however, for those that took part in telephone interviews signed consent was obtained by the YK team member working with the parent or family prior to contact from the YK research team. At the beginning of each phone call parents were reminded of the purpose of the call and verbal consent was obtained.

2.8 Report Limitations

• As described earlier, this report is a process evaluation which documents and evaluates the implementation processes of the YK Programme over a three-year period (January 2015 to December 2017). No claim of impact is being made, an impact evaluation was not feasible, and comparison or control communities were not examined alongside the YK Programme. • Data was collected at specific time periods and reflects the views of stakeholders at these times. • Some evaluation participants may be more positively disposed toward the YK Programme, i.e. parents who took part in interviews and focus groups may have done so due to a positive experience with the programme, and stakeholders who took part in practitioner interviews may have been involved in the developing, planning and/or implementing the YK Programme.

42 Chapter 3: Evaluation Results

43

3.1 Strategy 1: Infant Health and Well-being

45

3.1 Strategy 1: Infant Health and Well-being 3.1.1 Overview of Strategy

The aim of the Infant Health and Well-being Strategy was to develop knowledge, skills, practice and services for the pre-birth to three years period of development.

This was essentially a capacity building strategy utilising a relationship-based approached, which was cognisant of the inter-generational impact of adversity on individual families and communities. IMH Masterclasses and Network Groups aimed to enhance the capacity of practitioners to engage with vulnerable families, particularly regarding early social and emotional development. While the home visiting and parental support programmes aimed to enhance the capacity of families to support their child’s early development and enhance engagement between vulnerable families and appropriate services.

The strategy was delivered by the Young Knocknaheeny (YK) Inter-disciplinary Team comprised of four Infant Parent Support practitioners (IPS), two Oral Language Development Officers (OLOs), a Child Health Development Worker and an IMH Specialist IMH-E®, who is also the Strand and Clinical Lead.

Strategy 1 of the YK Programme, Infant Health and Well-being, comprised of the following:

IMH Practitioner Training and Network Groups This involved the provision of a two-day inter-disciplinary IMH Masterclass followed up with facilitation of two on-going Infant Mental Health Network Groups (IMH-NGs) for frontline practitioners working in statutory and voluntary agencies within the YK catchment area. IMH-NG’s provided a mentoring and coaching facility following the IMH Masterclass. These were developed to support the consolidation of IMH core competencies and skills and facilitate their integration into frontline service delivery.1 . Inter-disciplinary IMH Home Visiting Programme This relationship-based home visiting service, provided by the YK inter-disciplinary team, was available to all families who required additional support. It was modelled on the Michigan Association for Infant Mental Health (MI-AIMH) Home Visiting framework.

Ante-natal Programme This was a holistic and relational-based programme which incorporated ante-natal visits in the family’s home. These visits provided a time for parents-to-be to reflect on their emerging relationship with their baby, and their new roles as parents, with an assigned member of the IMH Inter-disciplinary team. A comprehensive screening tool was used to explore the holistic health and well-being of parents-to-be, including social and emotional preparation for parenthood.

1 YK delivered two-day IMH Masterclasses to other ABC sites, Cork University Maternity Hospital, and to a range of post-graduate professional training programmes at University College Cork in order to support workforce capacity in IMH. In association with ABC colleagues in Young Ballymun, through a memorandum of agreement, YK also supported the development of IMH-NG’s at Cork University Maternity Hospital and CDI ABC at Tallaght, Dublin. 47 Infant Massage This was offered to parents and their babies up to the seven to nine-month developmental stage to promote understanding of their baby’s non-verbal cues and signals. It supported parent’s attunement and capacity to bond with their baby.

ELKLAN Let’s Talk with your Baby Programme (3-12 months) Delivered by IPS, this was an eight-week programme for caregivers and their baby. It promoted parent-infant interaction, development of attachment, and early communication skills.

Peers Early Education Partnership (PEEP) (1-3 years) This six-week programme, delivered by IPS, promoted parent’s awareness of their infant and toddler’s very early learning and development capacities through every day interactions and activities.

3.1.2 Evaluation of Strategy 1 The following components of Strategy 1 are evaluated: 1. IMH Training and Coaching Programme (section 3.1.3); 2. YK Inter-disciplinary IMH Home Visiting Programme (section 3.1.4). 3. Engagement with Strategy 1 Family Support programmes (section 3.1.5);

Implementation of the overall strategy is evaluated in the following section: 4. Implementation Process of Strategy 1 (section 3.1.6).

3.1.3 IMH Practitioner Training and Coaching Programme Introduction

The aim of the IMH Practitioner Training and Coaching Programme was to build the capacity of frontline practitioners to support early nurturing relationships, thereby promoting healthy social and emotional development. A two-day IMH Masterclass was offered to practitioners working with children and families within the YK catchment area. These were facilitated by YK’s IMH Specialist IMH-E®, Catherine Maguire, and co- facilitated by Clinical Psychologist, Mairead Carolan. To support and facilitate consolidation and integration of core competencies and skills following IMH-Masterclasses, on-going mentoring and coaching was provided through the IMH-NGs.

IMH Masterclasses Guided by the MI-AIMH Competency Guidelines, an inter-disciplinary two-day IMH- Masterclass was developed. A blended learning format, which included pre-training preparation and exposure to web podcasts and evidence-informed literature was used. Video-based learning, small group activities and reflective exercises were also utilised. Pre and post-training evaluations were completed to assess the effectiveness of IMH Masterclasses. 48 IMH Masterclasses facilitated in-depth, intensive relational training and provided practitioners with a developmental/relational language to apply to experiences that many encountered in their professional practice. The training was designed to facilitate participants in having a safe felt experience regarding the nature and quality of early development in the context of care-giving relationship.

Research Questions

The evaluation of the implementation of YK’s IMH Masterclasses aimed to answer the following questions:

Programme Reach Process Evaluation

How many practitioners To what extent do practitioners believe they have participated in YK IMH have benefitted from participation in IMH Masterclasses? Masterclasses?

Methodology Data Collection Programme Reach The YK administrative database was used to determine the level of engagement with IMH Masterclasses.

Masterclass Questionnaires Pre and post-Masterclass questionnaires containing both closed and open-ended questions, were completed by participants to assess the effectiveness of Masterclasses in terms of learning outcomes.

Masterclass Discussion Group Questions Pre Masterclass discussion groups were conducted prior to the first teaching session on day one and following the last teaching session on day two of the Masterclass (n=106 participants).

Data Analysis Microsoft Excel was used to generate data from the YK administration database. SPSS (IBM 20.0) was used to conduct quantitative analyses of pre and post IMH Masterclass questionnaires. NVivo Pro 11.0 was used to collate qualitative data for thematic analysis. The Framework Method (see section 2.2) was used to guide thematic analyses.

Evaluation Results Programme Reach • Nine Masterclasses were delivered between April 2016 and December 2017; • Over 300 practitioners completed the training during this period.

Process Evaluation Sources used for this section of the report include:

49 • Pre and post-Masterclass questionnaires (n=106); • Pre and post-break-out discussion group responses (16 groups, n=106 participants).

Results from IMH Pre and Post Masterclass Questionnaires

Four IMH Masterclasses were evaluated. All participants completed pre and post questionnaires and took part in pre and post-break-out discussion groups. Responses from a total of 106 participants inform this section of the report.

Table 3.1.1: Respondent characteristics, IMH Masterclass questionnaires

Respondent Characteristics

Characteristics Total n=106 (%) Profession type Community and Family Support Worker 28 (26%) Early Years Practitioner 7 (7%) Nurse 24 (23%) Midwife 13 (12%) Allied Health Professional 27 (26%) Other 7 (6%) Duration in profession <1 year 8 (7%) 1 to 3 years 15 (14%) 4 to 6 years 9 (9%) 7 to 10 years 18 (17%) 10+ years 56 (53%) Work directly with children and parents Yes 101 (96%) No 5 (4%) Previous training in IMH Yes 44 (41%) No 62 (59%)

Questionnaire Responses

Most participants described their profession as Community and Family Support Workers (n=28, 26%), Allied Health Professionals (n=27, 25%), or nurse (n=24, 23%). At the time of the training, 70% of practitioners worked 7+ years in their individual professions, and 96% worked directly with parents and families.

Level of IMH Knowledge

Across the four IMH Masterclasses, 59% of participants (n=62) noted that they had ‘no prior IMH training’, while the remaining participants had ‘some previous knowledge’

50 and/or ‘some previous training in the area’. Post-Masterclass responses revealed 93% of participants felt the IMH Masterclass ‘met their expectations’ or ‘exceed their expectations’.

Most participants found that the IMH content included in the training was ‘very relevant’ to their practice (n = 88, 83%).

How often do you encounter issues relating to IMH?

Figure 3.1.1: Practitioner Rates of Encountering Issues Related to IMH

How would you rate your knowledge of social and emotional developmental stages from 0 to 3 years?

Figure 3.1.2: Practitioners interpretation of social and emotional development stages

Figure 3.1.2 illustrates practitioners’ interpretation of their knowledge of social and emotional developmental stages from 0 to 3 years pre and post-IMH Masterclass. In pre-questionnaires, only 17% of practitioners were ‘very’ and ‘extremely knowledgeable’. Post questionnaire results revealed a signifi cant increase with almost half of practitioners (49%) rating themselves as ‘very’ and ‘extremely knowledgeable’.

51 How able do you believe you are to identify lack of progress in a young child’s social and emotional development?

Figure 3.1.3: Practitioners ability to identify lack of progress in children’s social and emotional development

Figure 3.1.3 demonstrates practitioners’ interpretation of their ability to identify lack of progress in a young child’s social and emotional development pre and post-IMH Masterclass. Pre-questionnaire found that only 23% of practitioners felt they were ‘very able’ and ‘extremely able’ to identify lack of progress, while post questionnaires saw this rise to 40%.

In summary, post-IMH Masterclass training results demonstrated increased capacities in practitioner’s perceived ability to understand and interpret social and emotional developmental stages in young children.

Additional post-Masterclass results also highlighted that the majority of participants felt they had a ‘very good understanding’ of red fl ags in a parent-child relationship following the two-day intensive IMH Masterclass, and that they would be ‘extremely able’ to identify indicators of red fl ags in their daily practice.

Results from Pre and Post-Masterclass Discussion Groups

Thematic analysis of pre and post IMH Masterclass discussion group responses resulted in the following themes and sub-themes:

Theme Sub-themes Practitioners previous IMH Knowledge • Attachment theory

Outcomes • IMH language • IMH concepts • Practitioner capacity buildingq

52 Practitioners Previous IMH Knowledge

Analysis of pre-Masterclass responses indicated that practitioners, on average, had a good sense of the importance of relational health development between baby and caregiver prior to participation in the training, ‘how a mother, or caregiver, and baby begin and develop their relationship can forecast a lot in terms of a child’s development’.

Attachment Theory

Pre-Masterclass responses also reported that practitioners had some knowledge of underpinning IMH theories, namely ‘attachment theory’, influenced by their professional practice. The majority of practitioners across the four Masterclasses had an awareness of the primary function of attachment for a baby to their caregiver for secure holistic development to occur. Participants from one IMH Masterclass in particular, attended largely by Family Support Workers, noted that often external factors such as ‘financial woes’ and internal factors such as stress levels and ‘individuals’ own parenting blueprint’ have a profound impact on how parents respond to their children’s behaviour.

Outcomes IMH Language

IMH language and terminology increased in frequency in post responses across all sixteen discussion groups. Phrases such as ‘serve-and-return’ and ‘rupture and repair’ were consistently used in discussions.

IMH Concepts

Participants reported learning a significant amount of new information in relation to IMH concepts. ‘Adverse Childhood Experiences’ (ACEs) and the ‘inter-generational impact of poverty’ were named most frequently as being innovative terms and topics. The impact of ACEs experienced by a primary caregiver was found to be of most interest to participants, ‘how these mould a caregivers’ template for future care-giving is amazing’. Practitioners also commented on the importance of a reflective space in their professional work practice in order to ‘consider their impact as professionals on the lives of babies and families’, how to further empower individuals on their parenthood journey was noted by the majority discussion comments.

Practitioners Capacity Building

Practitioners reported IMH Masterclasses were very beneficial in building their professional capacities, ‘the last two days have been useful for our practice, it has given us the information we needed to engage with families at a deeper, relational level’. Practitioners noted that it was extremely validating to attend a workshop that acknowledged the work that they facilitated with caregivers and infants every day in their respective lines of work. Finally, several practitioners across the four Masterclasses indicated that, due to the two-day intensive IMH training, they felt ‘energised’ to continue to advocate for similar IMH training to be rolled out nationally to their counterparts.

53 IMH Network Groups

To facilitate the embedding of IMH core competencies into practice, IMH-NGs were established. IMH-NGs were educational meetings with both theoretical and experiential components, case discussions and reflective practice processes. IMH-NGs provided opportunities to integrate IMH research, science and literature into everyday practice. They facilitated shared learning and created a reflective space with a relational focus to facilitate group processes and the opportunity to ‘learn to use yourself as a tool’ (Emde, 2009). All practitioners working in the YK catchment area who had attended the IMH Masterclasses were invited to participate in IMH-NGs. A small number of practitioners working outside the YK catchment area but linked to services or families within, were also included.2 Two YK IMH-NGs were developed to meet demand. Meetings were held monthly on two differing weekdays to accommodate practitioners’ varying work schedules.

IMH-NGs were facilitated by YK’s Infant Mental Health Specialist IMH-E®. Two members of the YK inter-disciplinary team acted as group co-ordinators and circulated the schedules, and reading and teaching materials in advance. Meetings lasted 1.5 hours and Terms of Reference and Protocols were developed in a collaborative process by IMH-NG members and facilitators.

Research Questions Evaluation of YK IMH Network Groups aimed to answer the following questions:

Programme Reach Process Evaluation

How many practitioners 1. To what extent do practitioners believe participate in YK IMH Network they have benefited from participation in IMH Groups? Network Groups? 2. What enables/acts as a barrier to practitioner’s implementation of IMH skills and concepts into practice?

Methodology Data Collection Programme Reach The YK administrative database was used to determine the level of engagement with IMH Network Groups.

Focus Groups Two focus groups (n=12) were conducted to obtain practitioner perspectives of the IMH Network Groups and to ascertain insight into the level of learning achieved. Each focus group was fifty minutes in duration and questions were open-ended.

Consent Consent was obtained prior to all one-to-one interviews and focus groups. All participants were provided with an information sheet and contact details of the research if any further queries arose. 54 Data Analysis

Microsoft Excel was used to generate data from the YK administration database. NVivo Pro 11.0 was used to collate qualitative data for thematic analysis. The Framework Method (see section 2.2) was used to guide thematic analyses.

Evaluation Results

Programme Reach • A total of twenty-nine local practitioners actively attend monthly IMH Network Groups.

Process Evaluation Sources used for this section of the report include: • Two Network Group Focus Groups (n=12)

Thematic analysis of focus group transcripts resulted in the following themes and sub- themes:

Theme Sub-themes IMH Network Group Delivery • Content and teaching materials Enablers of Implementation • Structure of network groups • IMH Masterclasses • Need for training in YK area Barriers to Implementation • Time given to practitioners to participate in training/ value on training • Initial obstacles Knowledge and Skills Acquisition • Subject matter Outcomes • IMH language • Reflective space • Engagement and Collaboration • Impact on families Recommendations for Improvement • Value of Training

Results from Network Group Focus Groups

IMH Network Group Delivery

The delivery of IMG-NGs was found to be successful by all focus group participants. One noted, ‘I really enjoy the group, it is always informative and I use many of the skills discussed at the group in my daily practice’.

Content and Teaching Materials

The content and material used to reinforce IMH themes and concepts were found to be useful, ‘the material is fully explained and supporting readings and materials are always given to help us understand it further’. The process by which readings were provided to participants prior to IMH-NG’s via a drop-box system allowed them to attend the groups with a background knowledge of the concepts due to be discussed. Another pointed out, ‘I find the readings really useful as I know what will be discussed

55 at the group and I can have questions prepared about the topic prior to going into the group’. The use of case studies as examples to guide network group discussion were also found to be helpful for knowledge-acquisition and reinforcing of IMH skills and concepts, ‘the case studies really translate the relevance of the content in terms of our practice’.

Enablers of Implementation Structure of Groups

The IMH-NGs, held monthly on two weekday mornings (practitioners were able to choose the group that suits best on initial registration) was regarded as ‘useful for participation’ and important in terms of ‘offering practitioners options to fit training into working schedules’. On reflection of previous training courses held over a short period of time, participants reported that ‘a significant amount of knowledge is lost if not reinforced or sustained via regular refresher sessions’. The nature of IMH-NGs, therefore, was welcomed by all participants who agreed that ‘all future training should adopt this approach if possible’.

IMH Masterclasses

Focus group feedback found that the success of IMH Masterclasses, in terms highlighting the significant role of IMH in professional practice, led to increased numbers of practitioners participating in IMH-NGs, ‘I really enjoyed the Masterclass and I wanted to continue on learning about IMH’.

Need for Training in YK Area

The need for training practitioners in the area of IMH was flagged on several occasions throughout each focus group. One participant noted, ‘I am in the community sixteen years, this is something very new to Knocknaheeny, there are huge mental health issues in the area, there always has been, and there just wasn’t this level of support before’. The innovative nature of IM-NGs; reinforcing previous IMH training and encouraging continued IMH learning; was, therefore, a facilitating factor in terms of engagement and practitioners’ continued presence at the groups, with one group member pointing out, ‘this is the first time I have come to a group like this, this form of training is so new and so important’.

Barriers to Implementation Time to Participate

One of the biggest barriers to IMH-NG participation was practitioners’ ability to sign-up to and/or attend all IM-NGs. Hectic working schedules and obstacles such as staffing was noted as hindering practitioners’ ability to attend such training, ‘some weeks are more difficult than others to get the time to attend groups, it depends if I have cover at work or not’. In addition, practitioners based in Early Years settings, where training is not included in contracted hours, found it challenging to participate in IMH-NG’s in their own time. On this note, focus group participants reported that upskilling and continuous professional development is not often valued to the extent that it should be in many services and is regularly regarded as less important than other issues. One participant indicated that ‘it should really be at the forefront of our work and yet it still isn’t even a priority’.

56 Initial Obstacles

Issues with emailing reading materials and articles arose at the initial stages. This problem was rectified through the development of a Drop-Box system in which participants were invited to join the YK IMH Network Group account and were then able to view the articles on a monthly basis in this manner.

Knowledge and Skills Acquisition

Participants from both focus groups noted the significant impact participation in IMH-NG’s had in terms of informing professional practice through building their competencies and confidence. The reinforcing of IMH knowledge and concepts through monthly IMG-NGs was described by focus group participants as ‘invaluable’.

Subject Matter

The psychological nature of the teachings has been noted by participants as a very welcome addition to their skill-set. Many practitioners, both statutory and voluntary, did not have a background in psychology, thus IMH-NGs provided participants with an opportunity to further understand the root causes of the challenges that individuals and families encounter. Practitioners noted that their increased understanding of how and why challenges arise for families allowed them to empathise more with families, ‘I work in child care and before would have seen mental health issues in children but not have had the confidence to discuss them with a parent. Now I have the confidence, and even to be able to bring my questions to the Network Group… this has been so beneficial’.

Outcomes IMH Language

The development of a ‘common IMH language’ was reported as having the greatest impact on professional practice and service provision in the area. Practitioner’s newly- acquired IMH language was found to enable ‘discussion with peers on a wide range of issues, sometimes of a complex IMH nature’. This was also found to facilitate ‘more comfortable inter-agency discussions’. Practitioners found that the IMH language allowed them to pass on valuable information regarding the needs of the children with whom they work, and allowed them to discuss the development of parent-child relationships in the YK area more effectively, ‘just having that information and language allows us to explain cases more accurately and to provide evidence-based information to our colleagues in the area’.

Reflective Space

Hectic schedules and the nature of work for most practitioners on the ground in the area was felt by all as having previously hindered their capacity to engage in reflective practice. IMH-NGs were found to offer practitioners the time, one-and-a-half hours per month, to reflect on the cases and families they engage with while also learning from and discussing the evidence-based literature provided to them. It was noted that ‘it’s very grounding to be in a network group, it gives you an hour to settle yourself and gather your thoughts, and it really validates your work too which I find hugely reassuring’. Some practitioners also noted that value is not traditionally attributed to reflection in their areas of work. Focus group participants felt that this idea was turned on its head by IMH-NGs through ‘experiencing the importance and benefit of reflection on professional practice’.

57 Engagement and Collaboration

A consistent trend throughout focus group feedback was the benefit of IMH-NGs in terms of engaging and interacting with other practitioners, ‘a lot of the time we don’t get to meet each other, and that inter-disciplinary remit can be lost… network groups bring us, statutory and community-based services, together once a month to discuss cases’. Such inter-agency collaboration was praised by participants who explained that the group gave valuable insight into the work of other practitioners in the YK area, ‘everyone that comes into contact with the child plays an important role, and to see this from everyone’s point of view has been invaluable’. This collaboration and engagement was found to ‘afford local practitioners an opportunity to engage and interact with other practitioners’, offering support and encouragement to continue scaffolding their learning and to share ideas.

Impact on Families In addition to the positive impact IMH-NGs have had on service provision in the YK catchment area, practitioners also noted an observed benefit of the groups on families with which they work. Increased collaboration among services in the YK catchment area was found to have impacted on family’s experiences of engaging with services, ‘rather than lots of services being disjointed there is now more cohesion, it makes them feel more at ease with the different professionals’. On a similar note, focus group participants also commented on the usefulness of IMH-NG’s in relation to practitioner’s increased ability to hone their reflective capabilities. Since participation in the groups, practitioners reported using the skills learned in the groups, such as ‘listening and being present’, increasingly more with families they engage with in the community. One revealed, ‘I am much better at listening to my families now and taking time to be present in the moment and hear what they are saying’. Focus group participants reported that this approach to family support has made a positive impact on their relationships with families in the area. Another pointed out, ‘being with people and just hearing them is really valuable. You don’t have to go in and fix things because sometimes you can’t, it’s about hearing them, being with them and helping them reflect’.

Recommendations for Improvement

Value of Training

Many focus group participants commented on the need for services and management to put increased value on staff training and upskilling. In terms of IMH-related training, suggestions were made that services need to adapt their current ways of thinking to allow for increased incorporation of continuous learning, similar to the approach of IM-NGs, into staff contracts. ‘It’s so important, continuous training needs to be at the forefront of practitioner’s role in order for services to be their best’, noted one participant.

58 3.1.4 YK Inter-disciplinary IMH Home Visiting Programme

Within the YK Programme, home visiting was initially envisaged as a mechanism for building the capacity of the most vulnerable parents to access the supports and services appropriate to their family’s needs. Four IPS workers were employed to deliver this programme. As YK evolved, however, it became evident that there was an un-met need for home-based support for parents in meeting the developmental needs of young children. The IMH Home Visiting Model was an evidence-based approach with which to deliver this home-based support.

Following the appointment of YK’s IMH Specialist in January 2016, a review of home visiting was conducted. Through international collaboration the Michigan Association for Infant Mental Health (MI-AIMH) Infant Mental Health Home Visiting: Supporting Competencies/ Reducing Risks was identified as an appropriate model for YK. This relationship-based manualised prevention and early intervention home visiting programme provided the goodness-of-fit and specificity necessary to enhance parental capacity and provide nurturing care to support early social and emotional developments (Lawler, Rosenblum, Muzik, Ludtke, Weatherston and Tableman, 2017) and meet the needs of the pre-birth to three population and their caregivers.

The MI-AIMH Home Visiting (2016) Programme has six Core Components: 1. Concrete assistance; 2. Emotional support; 3. Developmental Guidance; 4. Early relationship assessment and support; 5. Advocacy; 6. Infant-parent Psychotherapy (provided by IMH Specialist IMH-E® only).

The development of an IMH inter-disciplinary team was central to the delivery of the YK Home Visiting Programme (HVP). In addition to the IPS, two OLOs and a Public Health Nurse (PHN) joined the team, which was lead and supported by the IMH specialist. To guide safe work standards and practices, the Young Knocknaheeny Inter-disciplinary Operational Policy was developed. Given the nature of the HVP and the quality of support offered to families, fortnightly reflective practice supervision was provided to the inter-disciplinary team.

59 Research Questions

This evaluation of the YK IMH Inter-disciplinary Home Visiting Service aimed to answer the following questions:

Programme Reach Process Evaluation

1. How many families have 1. What are the specific components of the YK engaged with/withdrew from the IMH inter-disciplinary HVP? YK IMH inter-disciplinary HVP? 2. How have the YK inter-disciplinary team experienced developing and implementing an IMH-informed home visiting programme? 3. What enables/acts as a barrier to the YK inter- disciplinary team’s implementation of IMH skills and concepts into practice? 4. How have families experienced engaging with the YK IMH inter-disciplinary HVP? 5. To what extent do parents believe they have benefitted from the HVP?

Methodology

Data Collection

Programme Reach The YK administrative database was used to determine the level of engagement with the YK HVP.

HVP Proforma A quantitative proforma (see Appendix A) was designed by the YK research team to record specific details of the HVP, i.e. duration of visit, intensity level of visit, support provided to parents. YK team members completed a proforma for every home visit, or HVP related phone call31, conducted over a seven-month period from January 2017 to June 2017 (n=363).

Interviews One-to-one interviews were conducted with the Clinical Lead of Strategy 1, the YK inter-disciplinary team (n=8), and local PHNs (n=4). Telephone interviews also took place with a sample of parents who have participated in the HVP (n=5).

Consent Consent was obtained prior to all one-to-one interviews and focus groups. Consent was obtained in writing by a YK team member prior to all parent telephone interviews. All participants were provided with an information sheet and contact details of the YK researcher.

3 Due to the nature of the HVP, with the YK team offering support to families both during a home visit and via the telephone following a home visit, it was important to record HVP-related phone calls (i.e. calls made directly to the family or advocacy work for particular families) in addition to face-to-face HVP sessions. 60 Data Analysis

Microsoft Excel was used to generate data from the YK administration database. SPSS (IBM 20.0) was used to conduct quantitative analyses of HVP proformas. NVivo Pro 11.0 was used to collate qualitative data for thematic analysis. The Framework Method (see section 2.2) was used to guide thematic analyses.

Evaluation Results

Programme Reach

• 150 families registered with the HVP from April 2015 to December 2017 of which only twenty were registered in the ante-natal period; • Of the twenty registered for ante-natal home visiting services, thirteen continued to engage with the post-natal HVP; • Eleven families failed to engage with their allocated YK worker following registration. After several follow-up attempts, these cases were closed; • Nine families began the HVP process but disengaged after a period, these cases were subsequently closed; • Twenty-four cases withdrew voluntarily, with reason, from the HVP from April 2015 and December 2017 due to ‘parents being well with no need for support’ and ‘returning to work after parental leave’; • Eighty-two families completed the HVP between April 2015 and December 2017; most cases were disengaged from the post-natal HVP due to ‘needs being met’ and families registered with ante-natal one-to-one support disengaged following ‘birth of baby’.

Process Evaluation

Results will be offered for the process evaluation of the Inter-disciplinary IMH HVP as follows: 1. Components of the Inter-disciplinary IMH HVP 2. Delivery of the Inter-disciplinary IMH HVP: a. Development of the Inter-disciplinary team b. Parent’s perspectives of the HVP

61 Components of Inter-disciplinary IMH HVP

The section of the report provides answers to the following process evaluation question:

What are the specifi c components of the YK IMH Inter-disciplinary HVP?

Sources used for this section of the report include: • IMH Home Visiting Proformas

Results

Practitioner-completed HVP proformas for the period between January to June of 2017 were analysed to provide a snapshot of the home visiting process42. In total, fi fty-seven families were registered for the HVP during this period, and 217 home visits (plus 100 supporting phone calls) took place. Eight families were visited during the ante-natal period (eighteen visits in total).

Figure 3.1.4: Duration of Home Visit Duration of Visit

The mean number home visits per family was fi ve (range 0 to 18). Eleven families required only one visit by a YK team member. Four families required telephone support only. The majority of visits to the home (64%) lasted between thirty-one and sixty minutes (see Figure 3.1.4).

4 It is important to note that the above results are a snapshot of the HVP in practice only. Some families were registered with the HVP prior to January 2017, thus results are not intended to offer an overview of each family’s experience of the HVP in its entirety. 62 Figure 3.1.5: Team Members Conducting Home Visits

Team Members Conducting Home Visits

In total, seven of the families (30%) were supported by one YK team member only. Twenty cases (35%) involved two team members; fi fteen (26%) involved three team members; and fi ve (9%) involved four team members. Twenty-seven cases (47%) required either a visit from, or a consultation with the IMH specialist. Twenty-two families (39%) were referred to any outside agency. Only eighteen (32%) cases were closed by July 2017.

The mean age of the key child was twenty-three months (range 1 to 58 months) at the fi rst visit (not including families visited in the ante-natal period). Twelve (27%) of the key children were aged under one year at the fi rst visit (the age range would possibly change once the programme is more established).

Figure 3.1.6: Type of Support Offered Via HVP Home Visits or Phone Calls

% visits offering each type of support

63 Type of support offered was defi ned according to the Six Core Components of the MI- AIMH Home Visiting Programme. Each visit had a primary focus but also offered other types of support (Figure 3.1.6). Emotional (73%) and developmental (76%) were the predominant types of support offered.

Figure 3.1.7 Intensity of Visit by Duration

Intensity of Visit by Duration

Almost half of visits (46%) were of medium intensity, a further 31% of high intensity, and only 23% of low intensity. There was a signifi cant correlation between length of visit and intensity5, with 83% of all visits lasting thirty minutes or less considered as low or medium intensity, while all visits lasting three hours, and 83% of those lasting 1.5 to 2 hours were of high intensity (see Figure 3.1.7).

Delivery of the IMH Inter-disciplinary HVP

This section of the report looks at the delivery of the IMH inter-disciplinary HVP through the development of YK’s IMH inter-disciplinary team and the implementation of the Home Visiting Programme. Answers will be provided for the following questions:

How have the YK inter-disciplinary team experienced developing and implementing an IMH home visiting programme? What enables or acts as a barrier to the inter-disciplinary team’s implementation of IMH skills and concepts into practice?

Sources used for this section of the report include: • One-to-one interviews with YK’s inter-disciplinary team (n=8) • One-to-one interview with Strategy 1 lead Results

Thematic analysis of interview transcripts resulted in the following themes and sub-themes:

5 A family’s level of need is determined at the intake assessment stage which takes place during weekly YK Interdisciplinary Team meetings. Low = Light touch cases and universal groups, Med = Cases that have more needs and require weekly support, High = Cases that need intensive support. 64 Theme Sub-themes HVP Implementation • Delivery of YK Inter-disciplinary team • Transparency • Approach • Inter-agency working Enablers of Implementation • Michigan Model of IMH Home Visiting • Internal YK processes • Team meetings • Weighting system • Innovative nature of HVP Barriers to Implementation • Provision of acceptable supports to the most vulnerable families • Fear of services • Ante-natal referrals • Pulling back from cases Outcomes • IMH language • Inter-agency collaboration • Family benefits Building Relationships • Impact of IMH Recommendations for Improvement • Continued training and supports

HVP Implementation Development of YK Inter-disciplinary Team

The development and practice of the YK inter-disciplinary team has been a key element of the YK programme. A team member reflected,‘we’re all coming from different backgrounds and from a wide variety of experiences, that’s been really important for us as a team to offer families the best possible service’. The dynamics of the team and the building of strong working relationships developed in conjunction with the team’s participation in an intensive IMH learning environment, ‘establishing relationships among the team was very important, and a whole-team approach to IMH training helped these relations to develop’. YK team members highlighted the impact IMH training and coaching has had on the development of the IMH inter-disciplinary team, ‘we were all new to the training, it was nice to start the journey together… first to attend the IMH Masterclass, to attend monthly IMH Network Groups together, and now to develop IMH skills together at team meetings and individual reflective supervision sessions’.

Transparency

YK team feedback highlighted that during initial HVP meetings with families, a plan was developed between the parents and the allocated YK team member. Parents were fully informed of the voluntary nature of the programme and assured that they would be consulted if the team needed to contact other services. Parents were regularly consulted throughout the process if their allocated YK team member planned to consult with external services. Team members commented on the usefulness of giving parent’s the opportunity to consider this as it allows those who are not entirely comfortable with information-sharing to voice their concerns and to reflect on any issues with their YK team member, ‘the family is aware of the reason we visit, the core goals we hope to achieve, and that there is always an opportunity to question us about

65 what we are doing. The relationship we have with them is most important, there is no agenda and they know they have the right to withdraw at any time’.

Approach

The approach to delivering the HVP was noted on several occasions by YK team members as being an important element of the programme’s success. The team’s adoption of a ‘flexible’ and ‘non-judgemental’ approach to home visitation; offering alternative days and times that would suit families; aided the development of trust between YK key worker and families, ‘being flexible with families and allowing parents the opportunity to tell us a time that suits them for us to call, or even just being understanding when they needed to reschedule an appointment, definitely allowed us to develop trust and relationships’.

Inter-agency Working

During 2016 and 2017, due to increased visibility of the programme, inter-agency working became a recurring element of the YK team’s workload. As part of the HVP, inter-agency meetings between YK key workers and local practitioners, also working with a particular family, regularly took place. Continuous IMH training and capacity building of the YK inter-disciplinary team, and some local practitioners, via IMH Network Groups aided the team’s interaction and engagement with other services as practitioners had a common language in which to discuss families and the needs in the area.

Enablers of Implementation Michigan Model of IMH Home Visiting

Adoption of the Michigan IMH Framework was noted by the YK team as being a vital element in the evolution of the YK Programme and the turning-point at which the programme began to operate with increased fidelity to design. A team member pointed out, ‘it brought a structure and a framework to the home visiting and our practice in terms of developing relationships and supporting families’. YK’s IMH Specialist IMH-E® recalled the importance of the framework in terms of offering different components in order to support families, ‘the framework is really helpful… there is a component where you can work very simply straightaway at the whole area of family support, what we call concrete support, and it also allows you to provide for very basic needs of the family or very complex needs of families’.

Managerial Support

YK’s IMH Specialist IMH-E® highlighted the importance of the support offered by YK’s Programme Manager in terms of training an inter-disciplinary team and implementing an IMH-informed home visiting service, ‘despite the challenges, to work within a supportive team and to work in an organisation with very strong managerial support has encouraged us all to achieve our goals in terms of delivering an IMH Home Visiting Programme’.

Internal YK Processes

The YK team found the internal processes put in place throughout 2016 facilitated effective implementation of the HVP, ‘the development of an IMH inter-disciplinary team would not be possible without the supervision element’. Fortnightly reflective practice supervision sessions with YK’s IMH Specialist IMH-E® gave the team the 66 opportunity to discuss cases and to hone their individual IMH skills and competencies, ‘supervision allows us time to recap over our practice, using an IMH lens to discuss our cases with the IMH Specialist’.

Team Meetings

Weekly inter-disciplinary meetings allowed the development of the team’s IMH skills and competencies through case discussions. This scheduled time for discussion gave the YK team the opportunity to voice difficulties they faced in terms of engaging or managing families. It also provided an opportunity to expand their understanding of IMH themes and concepts further. Monthly team meetings were also noted as being an essential process to the implementation of the HVP as it offered the YK team an additional opportunity to discuss any issues or challenges of the HVP with the YK Programme Manager. These key developments allowed YK team members to ‘label supports required for individual families, ensuring the programme offers specificity, and affords the YK team the opportunity to meet each family at the individual stage they are currently at’. Furthermore, supervision sessions and regular meetings were also noted by the YK team as being essential for increased team relationship building.

Weighting System

YK Team members commented on the ‘weighting system’ introduced in 2017 to allocate the correct number of referrals to each team member. Based on the Hardiker Model of Need (Hardiker, 1991), the weighting system took into consideration the intensity level of each case, the existing workload of the team member, and the capacity of the individual in terms of their weekly contracted hours and their facilitation of other YK activities. YK team members regarded this as a significant aid to the implementation of the HVP, ‘this new approach to allocations allows greater accountability and transparency in terms of how many families we are working with, it has greatly aided our practice’.

Innovative Nature of HVP

YK OLOs highlighted the valuable opportunity the HVP gave them to observe children in their own environment and properly assess their Speech Language and Communication need/s. OLOs pointed out, ‘sometimes you will see a lot of observations in the home that might not have happened in a clinic setting. The opportunity to see a child interacting, engaging and socialising within their own natural, comfortable environment is really helpful’.

Barriers to Implementation Provision of acceptable supports to the most vulnerable families

Difficulty engaging with some families in the YK catchment area was found to be the most frequent challenge to HVP implementation. Experienced mainly in the initial stages of registration, YK team members noted, ‘a family may be referred into YK by another service in the area and, when contacted by a YK team member, may not want to engage’.

Fear of Services

YK team members recalled an evident fear of services in the YK area due to families and individuals experiencing negative encounters with child and family services in the past, ‘I found that some families have had such negative experiences with services that 67 they just didn’t want to listen and they feel that there was too much going on for them already’. The YK team found that the development of trust with families was not always easily attainable, ‘people are cautious of a programme that allows people enter the home, many families in the area have bad memories of services engaging with their family over the years’. In addition, team members found that a small number of families who initially engaged with the HVP began to pull back after time, ‘you find that when you are talking about psychological and emotional issues with a family, there can sometimes be a pull back because they are not ready, they feel maybe they have disclosed a lot to you and they don’t really want to go there again’.

Ante-natal Referrals

Achieving the desired number of referrals into the ante-natal element of the YK HVP was found to be the most challenging aspect of ante-natal one-to-one implementation. PHNs, community services such as Early Years Centres, and voluntary organisations such as NICHE, were found to have been the main referring agents to the Ante-natal Programme. Significant efforts made by the YK team throughout 2016 and 2017 did not result in the desired quantity of referrals, ‘regular visits to other primary care services where information about the YK programme and its services was provided to parents-to-be did not lead to the number of referrals we wanted’.

Pulling Back from Cases

YK team members recalled the difficulty in pulling back from a case when a family disengaged or withdrew from the HVP. One team member explained, ‘it can be difficult as a practitioner, very often we have formed a bond with families and it’s hard to lose them’. Family’s withdrawal or disengagement, particularly if the goals set- out for a family have not been reached, was found to be a significant challenge by another team member who stated, ‘you become quite close to them and you want to help as much as possible’. On this note, attrition was also highlighted as a challenge to implementation. YK team members highlighted that in some cases, following the disclosure of personal information, parents begin to pull back, ‘in a handful of instances, we get so far with a family and just after we begin to look at a complex issue they are facing, they start to become scared, almost that they have overshared, and they begin to pull back’.

Outcomes

IMH Language

The development of a common IMH language across the YK team was an important requirement for the implementation of the HVP, ‘tweaking the narrative used with families needed to be carefully tailored so that language was simple, easily understood and, most importantly, consistent across the team’. As the YK team was developing fluency in this new IMH language, it began to influence interactions with each other and their interactions with families in the community, ‘it has permeated through our entire practice, with our families and with each other. I also use it with other practitioners in the area as I know many of them have taken part in the IMH Masterclasses’.

Inter-agency Collaboration

The HVP also saw the establishment of solid working links between the YK team and other services in the community. The complexity of some cases often saw a family 68 engaging with several services at one time. For the YK team to be fully informed of external strategies offered to a family, inter-agency discussion and collaboration was essential as ‘gaining information about the supports already in place for the family was essential in order to organise subsequent supports’. The YK team noted the impact of this wrap-around service which offered families ‘an efficient network of support’. Inter-agency collaboration was evident throughout the HVP, services were often consulted at the initial stages of a family’s registration, as well as throughout their time in the programme, for advocacy purposes, arranging inter-agency meetings, and/ or informing relevant services following closure of work. YK’s IMH Specialist IMH-E® also highlighted the importance of inter-agency and partnership working relationships in order to deliver an effective IMH home visiting service, as ‘it has allowed a transparent process of service delivery to develop, facilitating stronger bonds and relationships with families’.

Family Benefits

YK team feedback regularly highlighted the benefits of the HVP on the families with whom they have worked. They have variously observed that ‘parents-to-be often have so many questions and concerns, it’s nice that we can be a support to them during this time’, and ‘the family has come such a long way, I met them at a very difficult time and they have been able to overcome some really stressful issues… both parents and their child have more supports in the community now and seem a lot happier’. In addition, the benefits of participation with ante-natal one-to-one support was also noted in terms of the links that have developed between parents-to-be and their area PHNs prior to the birth of the child, ‘parents were able to get to know their PHN and to have that link established before giving birth’. In addition to building relationships at an earlier stage, PHN’s were supplied with additional information about the mother’s ante-natal history following the birth of the baby. One YK team member highlighted the benefit of this,‘developing this link was important for both parents and practitioners… It allowed parents to become familiar with supports in the community, and it informed practitioners of the needs of parents-to-be in the area and what families might require after the birth of their baby’.

YK team feedback highlighted that parents involved in the post-natal HVP also found the concrete assistance offered to them through the programme to be ‘very beneficial’. In relation to helping parents in the completion of referral forms to different services in the community, YK team members noted, ‘often this paperwork is extensive and can contain complex language, parents are going through so much often they struggle to complete these forms also’. Furthermore, interview feedback highlighted that families are not always aware of why their child has been referred to a particular service in the community, ‘we often find that the reason why their child is being referred to a service is not fully explained to parents by the referring agent, and this can cause a lot of stress for families’. The YK team reported frequently assisting families in acquiring the relevant information from external services, reassuring them of the reasons for referral, and filling out the referral forms, ‘it has been a regular part of my work as part of the Home Visiting Programme’.

Building Relationships

Between January 2015 and December 2017, concerted efforts were made by the YK team to gain the trust of the families with which they were involved, and to progressively build relationships in the community. YK team feedback explained that ‘building relationships was priority throughout a family’s time in the Home Visiting 69 Programme’. With an identified fear of services in the YK area, and due to the intensive nature of the HVP which involved entering a home and gaining personal information about families, YK team members noted, ‘establishing trust with families was essential for successful implementation of the HVP’. A flexible, understanding and non-judgemental approach was found to have achieved this, in addition to engaging and interacting with families at a level and pace that suited them, ‘we tried our best to support parents, to understand the different challenges families faced, and to keep checking in. We always explained that they could take as much time as they needed to engage again with the service’.

Impact of IMH

As a consequence of using an IMH-informed approach to home visiting, the YK team recorded having more in-depth discussions with parents about a family’s needs which led to team members acquiring the necessary information to devise the optimal plan and goals for a family and to offer the best supports, ‘using an IMH-model to develop relationships and to work within the home offers a whole new side to engagement and rapport building with families and it’s a lot less threatening. Overall, it has allowed us to support families better’.

Recommendations for Improvement Continued Training and Supports

YK’s IMH Specialist IMH-E® commented on the importance of providing continued IMH training and supports for the YK team in order to maintain effective delivery of the HVP, ‘I think the YK team has to be a notch above so we can be real advocates for the area, so I think we definitely need more training’. Likewise, YK team members stated, ‘in order to continue managing complex cases, continued training of the entire team in IMH skills and competencies is necessary’. In addition, the elements required for continued roll-out of the HVP were also highlighted, ‘going forward, the nature of supports and the scaffolding required for practitioners to effectively implement the HVP need to be revised’.

Parents’ Perspectives of the Inter-disciplinary IMH HVP

This section of the report provides answers to the following process evaluation questions:

How have families experienced engaging with the YK IMH inter-disciplinary HVP? To what extent do parents believe they have benefitted from the HVP?

Sources used for this section of the report include: • Parent telephone interviews (n=6); • Family Case Studies (n=3).

Thematic analysis of the parent and family case study transcripts resulted in the following themes and sub-themes:

70 Theme Sub-themes HVP Programme Delivery • Approach to delivery Enablers of Participation • Innovative nature of HVP • Flexible and understanding approach • Relationship building Outcomes • Family Benefits Recommendations for Improvement • Increased visibility of the YK service

Results

HVP Delivery

The HVP was well-received by parents who described participation as ‘amazing’ and ‘incredible’.

Approach to delivery

The personal approach to delivery, with sessions taking place in the home, was the greatest appeal for the families involved. Parents described the benefits of having a practitioner visit the home and being able to see children in their own settings with one observing, ‘my daughter doesn’t like communicating in general so when the YK worker came she was able to communicate comfortably in her own environment’. In addition, parents also commented on the stressful nature of clinic-based appointments in comparison to the more personal approach of the HVP. One parent explained, ‘hospital appointments were so stressful’, and another parent noted, ‘a person is watching every aspect of your child and their communication and then just ticks a box that your child has ‘a need’ and then sends you away… the home visiting is totally different’.

Enablers of Participation Need for HVP

Parents frequently commented on the innovative nature of the HVP and it being a much-needed service in the area, ‘I have older children and if I had this service when they were going up it would have been great’. Another stated, ‘I didn’t have anything like this in my previous two pregnancies, the service just wasn’t out there, so I felt very lucky to have someone call to give support this time around’. As waiting-lists for mainstream community services grew significantly in recent years, parents explained how useful it was to receive advice on how to manage their children’s needs as they waited for community intervention, ‘our YK worker calls every week and I can ask her about issues I am having with the tips and advice or ask her for additional help’.

Flexible and Understanding Approach

YK’s understanding and flexible approach to delivering the home visiting programme was found to be one of the main enablers of participation in the HVP, ‘our YK worker was very friendly, very helpful, approachable, and understanding’. Parents commented on the ease of scheduling appointments as YK team members offered a number of different times to visit the house and parents were able to choose a date and time that suited their family best. It was pointed out by one parent that ‘it was just lovely to be asked when suits you. My son has so many appointments it was so nice to have 71 been given an option that was best for us’. Similarly, parents highlighted that the understanding approach of their allocated YK team member was very helpful if they needed to reschedule an appointment. One parent noted that this approach further increased their trust in the service, ‘I knew if I had to cancel for some reason that we would get another chance to meet, it was really nice because sometimes life takes over and you have to cancel things’.

Relationship Building

An ingrained fear of services observed in the YK catchment area was alleviated through the development of trust and the development of strong family-practitioner relationships. A parent observed that ‘she [allocated YK team member] took her time with us because I was worried at first, she never forced me to do anything and never called without checking it was ok… she feels more like my friend now than anything else, the kids jump up and down when they see her coming’. Likewise, one parent noted how easy it was to engage with the HVP due to the bond her son and the YK team member developed, ‘my son is so comfortable with her, which is unusual as he doesn’t normally like other people’s company. She is actually the only one he asks for. He is more comfortable with her than some members of our family!’

Outcomes Family Benefits

In terms of child and parent outcomes, parents who received speech and language advice and strategies, while waiting for referral to mainstream services, recorded substantial benefits from engaging with the HVP. In one case a parent revealed ‘she gives us strategies like reading more books, naming objects and modelling language. Because of using these I have seen a huge improvement in my daughter’s communication and it has also been important for us to learn these things, now we can help her’.

The importance of services like YK’s HVP was noted on several occasions by parents through descriptions of the challenges that families faced when trying to access mainstream services. Parent interviews recalled difficulties filling out complex referral forms, being unsure as to why their children were referred to certain services, and not knowing how referral systems work. Parents noted the important role of the YK key worker in assisting them in this process, ‘I have been extremely happy with the support and advice offered to me... their help with filling out forms, and their tips and advice about how to manage our situation, as well as our daughter’s needs, it has been amazing’. Likewise, another parent stated, ‘it has definitely had a positive impact on me and my son. All the worries and concerns I had about my son have all been confirmed and diagnosed now, all with the help of our YK worker, she put us in touch with the right people and referred us to different services’.

Similarly, one parent described the strain that accessing services for her child had on her relationship with her partner and the benefits of the HVP in terms of offering them much- needed emotional support. She claimed, ‘it has not only supported my daughter with her speech and language needs but it has helped myself and my partner out so much too, we were so stressed and at our wits’ end’. Similarly, in describing the stresses they faced while trying to access services, another parent recalled, ‘having that support when I was so stressed helped my family also as having my YK worker to talk to meant that my children didn’t see me upset at home… I wasn’t worried or stressed after chatting with her’. 72 Parents who engaged with ante-natal one-to-one support also found participation in the HVP very beneficial,‘during my pregnancy I had a stressful time and my YK worker was there to support me and to listen’. Likewise, one parent who is not originally from Ireland described her lack of a support network and the impact the HVP had on herself and her family, ‘I feel great because I have support, I have at least one person with who I can speak about everything - my baby, my life, and my worries… Our lives are better because I will never get this much information if I didn’t have the home visiting’.

Recommendations for Improvement Increased Visibility of YK Service

Parents highlighted the need for increased advertising of the YK Programme throughout the community, in particular the HVP. Word-of-mouth appears to have been the most common reason for registration among the parents interviewed, ‘the only suggestion I would have is that I didn’t know of the home visiting at all before, maybe YK could advertise more in the community’, ‘thank God my neighbour told me about Young Knocknaheeny, I would not have known about it otherwise’. Finally, parent satisfaction with the HVP inspired many to comment on the need for similar home visiting services to be made available to all parents-to-be and families, ‘I just feel that this service wasn’t there when I was pregnant with my first two children and it was so useful I think it would be good for all pregnant women to have this service’.

73 Parent’s Perspectives of the YK HVP Parent experience of IPS support ‘Our YK worker goes above and ‘I am not from Ireland, beyond and I am so grateful to her for I have never seen in my life the that, nobody has helped me more than her. support that I am getting here. I have She has helped with me everything and has never seen a service like YK that comes never let me down. I feel so lucky to have into your house and helps you if you feel such help, I don’t know how people out bad. I had very bad moments and what there do it, who have children with a YK does for me and my baby is need or with challenging behaviours, great’. without the help of programmes like YK’.

Parent experience of ‘I think this Ante-natal PHN support home visiting service is ‘I am very happy with the advice brilliant as it is the best place offered through the HVP, it was lovely to see a child that has needs like have that support through my pregnancy. I my son who loves his comfortable didn’t have anything like this in my previous surroundings. It is where he can two pregnancies, the service just wasn’t out there. I felt very lucky to have someone really be himself and be like my YK worker to call or come out assessed properly’. to the house to give support this time around’. Parent experience of HVP OLO support ‘Our YK key worker ‘I have been extremely happy with was very friendly, very helpful, the support and advice offered to me approachable and understanding. She through YK home-visiting. Their help with was also very flexible if we needed to filling out forms, and their tips and advice reschedule appointments, which we had about how to manage the situation with to do occasionally due to the amount of different appointments that my referrals as well as my daughters’ needs son has’. has been amazing. Other appointments were so stressful, our YK workers ‘Anything I was concerned literally saved me from a about I would ask our YK key nervous breakdown’. worker and I was always happy with her answers and the support she would give to try to help the problem. There was nothing I felt I asked her that she couldn’t give some useful advice for’.

74 3.1.5 Engagement with Strategy 1 Programmes

As part of Strategy 1, YK offered several specifi c family support and capacity building activities as outlined in Section 3.1.1. As these are primarily well-tested, evidence-based approaches, they have not been individually evaluated. However, as these were delivered directly by the YK inter-disciplinary team, participation in these programmes involved registration with the YK Programme. Registration with the programme between January 2015 and December 2017 was recorded via the programme administrative database and was analysed to give an indication of the level of participation in these activities.

Figure 3.1.8: Intensity of Programme Involvement by Families, Jan ’15 to Dec ‘17

Intensity of Participation by Families

• 383 families participated in at least one YK Strategy 1 activity, 146 took part in two activities, forty-six took part in three, and eight families took part in four activities; • A total of 196 families were wait-listed for groups at one point in time between January 2015 and December 2017 but were subsequently included when places became available;

Figure 3.1.9: Geographical area of participants, Jan ‘15 to Dec ‘17

Geographical area of registrations, Jan ‘15 to Dec’17

75 • On initial registration, the majority of families (73%, n=276) were living in the YK catchment area61; • The majority of referrals (37%, n=143) were made through PHNs located within the YK catchment area. Referral through YK team members and EY centres were also popular registration pathways;

Figure 3.1.10: Nature of Referrals to YK, Jan ‘15 to Dec ‘17 Nature of Referrals, Jan ‘15 to Dec ‘17

• The majority of families (79%, n=302) registered with the YK Programme because they were interested in groups, parent support was required, and/or parents had concerns about their child’s development; • A total of seventy-seven families disengaged from the YK Programme between January 2015 and December 2017: • Fifty-two families disengaged without follow-through and the majority of these did not give a reason for their leaving. • Twenty-fi ve families withdrew from individual YK Programmes and the majority of these reported ‘lack of time’ and ‘family reasons’ for their withdrawal.

Figure 3.1.11: Registration Pathways, Jan ’15 to Dec ‘17 Registration pathways, Jan ‘15 to Dec ‘17

*Note: ‘Other’ category is comprised of referrals from CUMH, EIT, teachers, principals, and missing data

6 The remainder of families, (23%, n=107) although not living in the YK catchment area, gained access to the programme via the KidScope clinic (inter-agency agreement) or due to living within the wider sector of a PHN linked with the YK programme. 76 3.1.6 Implementation Process of Strategy 1

Table 3.1.2 outlines the implementation process of Strategy 1 over the three-year period. Through examining each column; activities, short-term outcomes, and long- term outcomes; across each time point (2015, 2016/17 and 2018), we can track the evolution of the strategy from 2015 to 2018 and to assess whether the strategy has achieved its immediate goals (short-term outcomes) and ensured fidelity to its long- term aims. The 2015 YK Logic Model (see section 1.5 for full table) outlines the strategy’s initial short and long-term outcomes and the main activities proposed to achieve these goals. Work Plans from 2016/17 and 2018 allow insight into the evolution of the strategy.

77 Table 3.1.2: Strategy 1 Implementation Process, 2015-2018

Strategy 1: Infant Health & Well-being

2015 Logic Model 2016-17 Work Plan 2018 Work Plan (Long-term outcomes not outlined due to uncertainty of YK funding beyond 2018)

Short-term Long-term Activity Short-term Outcomes Long-term Activity Short-term Activity Outcomes Outcomes (by 2018) Outcomes Outcomes (by 2016) (2018+) !Practitioners !Continued !Infant Health !Increase and maintain !Continued !Registration in !Further !Pre-birth preparation will have implementation by and Well-being registrations to YK programme implementation of skills collaboration with consolidation of the programme improved practitioners of skills (0-3): (pre-birth x2 per week and developed by CUMH, GPs and IMH service model knowledge developed through Practitioners: post-birth 2 per week) practitioners through others. !Ante-natal home screen and skills into capacity building IMH training; workforce capacity !Full !Work in collaboration with practice supported by existing Mentoring, building and supported !Suite of Home implementation of !IMH Home Visiting partners to develop tools. mainstream services sharing and by existing services Screening Tools the Operational Programme !Parents are implementing !TtP: Provide a psychological Policy more !Services have component to the !Parent-child !Transition to !Let’s Talk with Your Baby effectively sustainable !Services: programme relationships are Parenthood (TtP) !Further (Elkan) engaged in capacities, willingness, multiservice/ strengthened implementation and !HVP: Intervention model child commitment and multi- !Inter-disciplinary consolidation of the !PEEP defined by the use of IMH development understanding of inter- disciplinary !Improved capacity for Home Visiting Model IMH capacity principles and intervention and have skills agency practice to planning, co- pro-social behaviour (pre-natal – 3 years) building approach !Baby Massage strategies to build strong improve outcomes for ordinating and capacity to self- (HVP) healthy children protocol !Integration and embedding regulate !Strategic review !Targeted Transition to relationships development of evidence base into !IMH Inter- and monitoring parenthood research and with babies !Parental-led practice !Measured outcomes disciplinary \Model process after two implementation strategy and toddlers activities becoming !Parents: for children in the YK of Service Delivery years of !IMH Model of Service mainstreamed and Parent led play area, reaching social development !IMH Masterclasses Delivery: Integration and !Increase in supported by groups in and emotional norm in !IMH Consultations embedding of evidence numbers of mainstream services community line with national (Practitioners and !IMH partnership YK/CUMH base into practice across expectant/ and 0-2 standards Services) disciplines new parents !Parental capacity !IMH Inter-agency specifically developed to be able !Parent !IMH Consultations: CPD and !Services and !Fortnightly Consultation attending a to engage in service Programmes: initial training of practitioners practitioners are able reflective practice range of delivery and design PEEPS and EY educators and equipped to supervision to YK !Kidscope clinic review relevant respond to emerging inter-disciplinary meetings !Sharing experiences and services !Parents enjoy their relational needs team case studies role and can meet !YK/YB IMH Masterclass & acts as a barrier to of !KS: YK will help provide !Wide and embedded !IMH Masterclass IMH NG Strategy everyday life admin support to clinic. YK will awareness of, and (MC) attend post-clinic meeting to engagement with, EY ! IMH teachings, !Parent/child help support families services in the YK area !IMH Network (NG) conference submissions. relationships are Contribution and subject

strengthened !Kidscope (KS) matter expertise to HSE

support Nurture Infant Health and Well-being Programme.

78 Implementation and Evolution of Strategy 1

The YK Logic Model (detailed in Table 3.1.2), proposed three short-term outcomes from Strategy 1:

1. Practitioners will have improved knowledge and skills into practice - IMH training and coaching; 2. Parents are more effectively engaged in child development and have skills to build strong healthy relationships with babies and toddlers; 3. Increase in numbers of expectant/new parents specifically attending a range of relevant services.

In 2015, Infant Parent Support practitioners facilitated ELKLAN ‘Lets talk with your Baby’ and PEEP Early Education Partnership within the local community, in collaboration with other early childhood services. Through early-2016 and throughout 2017 the IMH Masterclasses and Network Groups (IMH-NG’s) were developed.

As the planned programmes were developed throughout 2015, however, it became apparent that a significant gap remained. The need for home-based supports to promote early social and emotional development and enhance parental capacity to engage with appropriate services was highlighted, and found to be outside the scope of existing services.

The 2016-2017 Work Plan reflected YK Programme adaptation and a new direct service provision, IMH Home Visiting, was put in place to meet the emerging needs of families with children in the pre-natal to 3-year developmental period. Thus, the following were implemented:

1. The development of the inter-disciplinary IMH team; 2. An IMH Model of Service Delivery which included the following programmes: • An Infant Mental Health Home Visiting Programme which became the pivotal service delivery model; • Ante-natal Screening and Ante-natal Home Visiting; • Fortnightly Reflective Practice supervision. 3. Collaboration and partnership with Cork University Hospital to support engagement and registration with the Ante-natal service. Provision of IMH Masterclasses, alongside support for the development of their first IMH-NG within the Maternity services; 4. Provision of IMH Training to allied health services and agencies within the community; 5. Consultation and participation with the community-based Kidscope Paediatric Clinic; 6. Facilitation of fortnightly IMH-NG’s to support embedding of core competencies and skills into practice; 7. Continuation of IMH Masterclass training programmes including collaboration with university departments regarding the incorporation/introduction of IMH modules in undergraduate professional Early Years training (SLT/ OT/PHN/D.Clin.Psych);

79 8. Facilitation of ELKLAN ‘Let’s Talk with Your Baby’ (3-12 months and PEEP Parent Group Programmes (1-2 Years). 9. Workforce capacity building through IMH training and coaching remained a core strategy for 2018. In addition to the IMH HVP, parent and baby groups such as PEEP, ‘Let’s Talk with Your Baby’, and Baby Massage continued.

Increased interest in IMH approaches was evident from requests for conference presentations both at national and international conferences and increased requests for IMH consultations.

The ‘Transition to Parenthood Programme’ was one of the only Strategy 1 activities not implemented as of January 2018. Early consultation with local parents found that there was not sufficient need for the programme in the area. Trialling such a programme without sufficient buy-in was deemed unrealistic. The programme’s roll-out was placed on hold until a community-based scoping exercise could be completed with parents- to-be in order to determine the nature and quality of components they would consider beneficial.

At the time of writing this report, the development of a community group for mothers- to-be was underway in order to create a holistic space to reflect, share and learn from one another, whilst supporting the vision and objectives of the YK Ante-natal Programme. It was anticipated that this group would develop and strengthen links between parents and support networks within the local community.

Similarly, engagement with the Ante-natal Programme remained low. However, as families began to engage with the YK Programme and the Inter-disciplinary IMH Home Visiting Service via other referral pathways, engagement with services in this form did not remain a primary focus of the strategy in 2018.

80 3.1.7 Key Findings and Learning

Table 3.1.3: Strategy 1 Key Findings

Evidence gathered suggests that the IMH Training & Coaching Programme contributed to positive changes in local service provision in the following ways:

1. Over 300 practitioners from a range of disciplines completed IMH Masterclasses from April 2016 to December 2017. 2. Twenty-nine practitioners working in the YK area attended monthly IMH Network Groups to sustain and develop IMH skills and competencies. 3. An IMH model of service delivery has been adopted by the YK inter-disciplinary team. 4. Local practitioners have reported adopting new approaches to professional practice since completing the IMH training.

Evidence gathered suggests that the YK IMH Home Visiting Programme (HVP) has been successfully implemented in the YK area:

1. 150 families engaged with YK’s HVP from April 2015 to November 2017. 2. Parents reported very positive experiences from engaging with the HVP – development of the parent-child relationship, assistance with referral forms, support with their child’s development, and emotional support offered to families. 3. Parental capacity building – parents reported increased confidence in their parenting abilities and improvements in parent-child relationship. 4. Positive child outcomes – parents reported visible positive effects on children due to engagement with the HVP.

Table 3.1.4: Strategy 1 Key Learning

Feedback from local practitioners suggests that the IMH Training and Coaching Programme was aided by the following factors: 1. Successful buy-in and commitment of frontline practitioners and service managers played a critical role in securing changes to service provision. 2. Evidence-based nature of IMH motivated participants to take part in the training and to implement concepts and theories into their daily practice.

Feedback from local practitioners suggests that barriers to the implementation of the IMH Training and Coaching Programme included:

1. Initial issues regarding logistics of IMH Network Groups. 2. Time to participate in IMH Masterclasses and attend IMH Network Groups.

81

3.2 Strategy 2: Speech, Language and Literacy

83

3.2 Strategy 2: Speech, Language and Literacy

3.2.1 Overview of Strategy

Strategy 2 of the YK Programme, Speech, Language and Literacy, aimed to support and strengthen emerging oral language development for babies, toddlers and children. As part of the strategy, YK Oral Language Development Officers were involved in: • The development and provision of Babbling Babies; • The YK IMH inter-disciplinary service (OLOs are members of the YK IMH inter- disciplinary team); • Workforce capacity building across the Early Years and primary schools’ sectors including provision of: • Learning Language and Loving It™ - The Hanen Program® for Early Childhood Educators/Teachers to Early Years Educators across seven EY centres; • ABC and Beyond™ - The Hanen Program® for Building Emergent Literacy in Early Childhood Settings to teachers across four local primary schools within the YK catchment area. • Provision of universal speech and language assessments and follow-up as required in Junior Infant classes across four local Primary Schools within the YK catchment area; • Consultation to parents, practitioners and organisations in terms of emerging speech, language and communication development, including signposting to appropriate services as required.

3.2.2 Evaluation of Strategy 2

The following innovative elements of Strategy 2 are evaluated in greater depth: 1. Babbling Babies (BB) (section 3.2.3); 2. Hanen Programmes (section 3.2.4).

Implementation of the overall strategy is evaluated in the following section: 3. Implementation Process of Strategy 2 (section 3.2.5).

3.2.3 Babbling Babies Introduction

Babbling Babies (BB) is a universal service which was offered to all parents in the YK catchment area when they attended their baby’s routine 7-9 month developmental check-up with their PHN (other families attending the PHN clinic were also offered the opportunity to attend BB). BB evolved from the overall YK Programme objective to deliver a child development initiative based on the concept of prevention and early intervention. This was facilitated through a partnership between YK and the HSE Primary Care Services. 85 Speech and Language Therapists in Ireland predominantly provide assessments and interventions for Speech, Language and Communication (SLC) delays and/or disorders. ‘Research findings support the provision of high-quality supports to parents and families before children start to talk, rather than waiting until a delay or disorder emerges’ (Rafferty, 2014). The need to move, therefore, from an impairment-based model of speech and language therapy (SLT) practice to a preventative model in the YK area was identified as a core goal for Strategy 2.

In mid-2015, an initial planning meeting was organised between relevant stakeholders including OLOs, PHNs, YK Programme Manager, and senior HSE figures. Discussions facilitated the development of BB, a unique, collaborative, universal, health promotion service. BB utilised this early contact point as an optimal opportunity to support the nature and quality of parent-baby interactions; specifically providing developmental guidance to promote language and communication in the context of overall development. BB facilitated a paradigm shift moving to an earlier and preventative contact point rather than providing intervention when the toddler becomes symptomatic.

Conversational serve-and-return between a parent and baby helps to build the language centres in the brain (Romeo et al., 2018). It is from this evidence base that BB aimed to provide accessible information to all parents about how best to support their baby’s communication and overall development as early as possible. BB provided an opportunity to start the conversation about conversations with parents, in the context of their baby’s first relationships during the 7 to 9-month period of development.

BB provided a space for parents to reflect on their relationship with their baby, specifically in terms of interaction and the promotion of language development. The OLO completed a brief checklist with parents initially to screen their baby’s current level of communication development. Through BB, parents had the opportunity to meet with an OLO to discuss any concerns they may have had about their baby’s communication and interaction skills. The OLO provided information and modelled specific parent-child interaction strategies which support communication, interaction and the relationship. Thus, they provided parents with further knowledge as to how best they can support their child’s development. In addition, BB offered an important port- of-entry into other areas of the YK IMH Inter-disciplinary Service for families as required.

Through collaboration with local PHNs, BB was successfully implemented in the YK community in October 2015. The IMH Specialist IMH-E® joined YK in January 2016. Following this, collaborative work focussed on the embedding of relational health language and strategies to promote parent-infant interaction in the promotion of language development. In addition, the arrival of the IMH Specialist IMH-E® provided OLOs with an opportunity to engage in a competence-based blended learning environment. This work focussed on the development of reflective practice narratives and strategies to aid OLOs in their delivery of BB. Participation in two-day IMH Masterclass training and continuous membership in the YK IMH Network Groups (see Section 3.1.3) further supported and enhanced OLO’s skills and competencies for the delivery of BB.

86 Research Questions

Evaluation of Babbling Babies aimed to answer the following questions:

Programme Reach Process Evaluation

1. How many families have 1. What are the specific components of engaged with Babbling Babbling Babies? Babies? 2. What are practitioner’s perspectives of the implementation and benefits of Babbling Babies? 3. To what extent do parents believe they have benefitted from Babbling Babies?

Methodology

Data Collection

Programme Reach The YK administrative database was used to determine the level of engagement with Babbling Babies.

BB Proformas A quantitative proforma (see Appendix A) was designed by the YK research team to record specific details of BB, i.e. specific advice and/or information provided to parents; and the nature of any concerns regarding a baby’s speech, language and communication development. OLOs completed a proforma for each baby seen at BB over a twelve-month period (January 2017 to December 2017, n=¬65).

Qualitative Data: Interviews • One-to-one interviews were conducted with three YK OLOs (1 of whom is Strategy 2 Lead). • One-to-one interviews were conducted with four PHNs who had direct involvement with BB. Practitioner interviews ranged in duration from thirty to fifty minutes. • Phone interviews were conducted with parents of babies who were seen at BB (n=7). Parent interviews lasted ten to fifteen minutes.

All interviews were semi-structured in nature.

Consent For one-to-one interviews and focus groups, consent was obtained from all practitioners prior to each interview. For parent interviews, signed consent was obtained by YK OLOs at the end of each BB contact if parents wished to participate. The researcher also obtained verbal consent from parents at the beginning of each phone call.

Data Analysis Microsoft Excel was used to generate data from the YK administration database. NVivo Pro 11.0 was used to collate qualitative data for thematic analysis. The Framework Method (see section 2.2) was used to guide thematic analyses.

87 Evaluation Results

Programme Reach

• A total number of 163 families engaged with BB from October 2015 to December 2017. • OLOs saw approximately 63% of babies born in the YK catchment area in a two- year period71.

Process Evaluation

BB Proforma Results

In order to determine what BB looked like in practice, a quantitative proforma (see Appendix A) was designed by the YK research team to record details of each BB contact, i.e. parents’ awareness of communication development milestones, specific advice and/or information provided to parents, and the nature of any concerns regarding a baby’s speech, language and communication development. OLOs completed a proforma for each baby seen at BB over a twelve-month period (January 2017 to December 2017).

Time Frame: January 2017 and December 2017 Total number of babies seen by OLOs at BB: 65

Table 3.2.1: Parent awareness of communication development milestones

Parent awareness of communication milestones Number % (total = 65)

Yes 16 25 No 14 22 Not sure 35 54

Proforma analysis shows parental awareness of communication milestones and parent concerns regarding baby’s SLC development was low. Table 3.2.1 shows sixteen parents (25%) indicated an awareness of communication development milestones, a further thirty-five parents (54%) were uncertain and fourteen (22%) were not aware.

Table 3.2.2: General SLCN promotion strategies provided during BB clinics

Type of language promoting information offered Number % (total = 65)

Modelling 55 85 Singing 46 70 Reading 40 62

7 PHN sector area statistics record the birth rate in the YK catchment area in 2015 was approximately 130 babies per annum. 88 Type of language promoting information offered Number % (total = 65)

Play strategies 20 31

Parent/ baby interaction 14 22 Other 3 5

Table 3.2.2 shows a snapshot of the SLCN promotion strategies which were provided to parents/caregivers during BB clinics. Modelling SLC strategies was the form of advice received by most parents (n=55, 85%), followed by singing (n=46, 70%) and reading (n=40, 62%). Table 3.2.3: OLO Concerns Re Child Development

Concern Number % (total = 12)

Communication 9 75 Interaction with parents 6 50 Developmental delay 6 50 Feeding / weight gain 3 25 Play 2 17 Eye contact 2 17 Hearing 1 8

OLOs noted a developmental concern for six babies (9%), and a possible concern for a further six babies. Out of the twelve babies that OLOs reported having concerns about, nine caused concern in terms of ‘communication’ (75%), six in terms of ‘interaction with parents’ and six in terms of ‘developmental delay’. Table 3.2.3 outlines the particular concerns regarding baby’s SLC development recorded by the OLOs.

Table 3.2.4: OLO Concerns Re Risk Factors for Communication Development

Risk factor Number % (total = 26)

TV/Screen-time 15 58 Lack of reading books 13 50 Lack of interaction 8 31 Dummy use 8 31 Parental anxiety/ emotional state 5 19 Lack of play opportunities 2 8

Proformas also recorded the possible risk factors for communication observed by OLOs, seen in Table 3.2.4. OLOs recorded concerns regarding possible risk factors to SLC development for twenty-six babies (40%) who attended BB clinics. ‘TV and screen-time’ was found to have been the largest risk factor to the communicative development (n=15, 58%), followed by a ‘lack of reading books’ (n=13, 50%) and a ‘lack of interaction’ and ‘dummy use’ (n=8, 31% each).

89 Table 3.2.5: Advice Offered by OLOs Following the Identity of Risk Factors

Advice Number % (total = 26)

Increase reading to child 24 93 Reduce screen-time 14 54 Increase modelling 7 27 Reduce soother use 8 31 Bilingual language development 2 8

Table 3.2.5 illustrates specific advice offered to parents where OLOs flagged concerns regarding risk factors to SLC development.

Process Evaluation This section of the report looks at the processes involved in the implementation and benefits of BB and provides answers to the following questions:

What are practitioner’s perspectives of the implementation and benefits of Babbling Babies? To what extent do parents believe they have benefitted from Babbling Babies?

Interviews used for this section of the report include: • One-to-one interviews with local PHNs (n=4); • One-to-one interview with Strategy 2 Lead/Senior OLO; • One-to-one interviews with YK OLOs (n=2); • BB Parent telephone interviews (n=5).

Thematic analysis of interview transcripts resulted in the following themes and sub-themes:

Theme Sub-themes BB Implementation • BB Development • Inter-agency collaboration and partnership working • Infant Mental Health and BB Enablers of Participation • Parent engagement • Time of BB • Innovative nature of BB Barriers to Implementation • YK catchment area • Staff turnover Outcomes • Parent capacity building • Increased access to information for parents • Supporting PHN practice • Prevention and early intervention • Port-of-entry to additional YK services Recommendations for Improvement • BB information

90 BB Implementation BB Development In mid-2015, an initial planning meeting was organised between relevant stakeholders including OLOs, PHNs, YK Programme Manager, and senior HSE figures. OLOs noted that a collaborative approach was taken in order to deliver a preventative initiative, ‘a collaborative, universal health promotion service, as early as possible in a child’s life, so as to begin the shift from an impairment-based model of service provision to a prevention, early intervention model’. As referrals to speech and language therapy services largely occur at the twelve to eighteen-month mark; at which point speech, language and/or communication needs are already visible; the decision was made to implement BB at the seven to nine-month developmental check-up, ‘we felt the seven to nine-month mark was an appropriate time point in order to fulfil the aim of providing a universal, preventative, health promotion service for families in the catchment area’. Through continued collaboration with local PHNs, BB was successfully implemented in the YK catchment area in October 2015.

Inter-agency Collaboration and Partnership Working OLOs and PHN feedback highlighted that BB development and implementation hinged on their successful collaboration and partnership working. PHNs noted, ‘collaboration from the get-go in terms of developing and implementing the clinic has led to its success so far’. This sentiment was reiterated by OLOs who pointed out, ‘the building of relationships with PHNs has greatly aided the implementation of BB. Their engagement, enthusiasm and co-operation in terms of admin, co-ordinating clinics and the whole clinic set up has been vital’.

Infant Mental Health and BB OLOs highlighted the role of IMH in terms of BB implementation and the importance of the IMH training and coaching in order to develop their IMH competencies and skills, ‘BB is all through the IMH lens. It’s hugely linked to communication because the relationships develop in the context of communication whether it’s verbal or non- verbal, you build a relationship through communicating with somebody’. Thus, BB provided an opportunity for OLOs to observe the development of the parent-baby relationship with an informed IMH perspective, ‘the BB clinic is more than an observation piece around communication, although that is the aim, there is also an opportunity to add an IMH-focussed perspective into that early PHN developmental check-up’.

Enablers of Implementation Parent Engagement The buy-in of parents and their willingness to engage was found to be integral to BB implementation and success. One OLO noted, ‘parent interest was essential, and their interest in BB from the get-go has been brilliant’.

Time of BB Parents frequently commented on the usefulness of BB taking place after the routine PHN developmental check-up. One mother noted that it was useful to attend two appointments at the one time due to the numerous appointments that she and her baby often had to attend, ‘we have been to so many appointments, it was lovely to have two under the one roof’.

91 Innovative Nature of BB The innovative nature of BB was found to have positively impacted on BB development and implementation. OLOs noted, ‘It’s unique for me as a Speech and Language Therapist. In previous employment, I generally saw clients referred with a query around a problem, a delay, or a disorder. The universal nature of the BB clinics is so unique. BB takes place at the seven to nine-month mark which shows we are working at a preventative level’. The innovative nature of BB clinics was also highlighted by parents who felt that it was a great opportunity to speak with a speech and language specialist at an early stage of their baby’s development. One remarked, ‘it was a completely new experience, I had never been to a Speech and Language Therapist with my son before, and it would not have been something discussed at other check-ups’.

Barriers to Implementation

YK Catchment Area The YK catchment area was highlighted as an obstacle both in the development and implementation phases of BB. The service was offered to all PHN’s working across the YK catchment area. However, a PHN’s assigned sector occasionally included areas outside the YK catchment area. During development of BB, it was felt by all parties involved that it would be unequitable to offer BB to families living within the direct YK catchment area only. It was therefore decided that all babies living within the PHN’s entire sector area would be offered the opportunity to access BB. As one PHN noted, ‘it was the fairest option’. OLO feedback highlighted further challenges regarding catchment area. OLOs were unable to offer registration with the YK Programme, thus access to all YK services, to parents who attended BB that lived outside of the YK catchment area. As one OLO noted, ‘a barrier remains in terms of offering the entire YK service to all families seen at BB’.

Staff Turnover Staffing issues were found to have hindered the implementation of BB at times. Some PHNs reported that the delay in replacing an OLO on maternity leave prevented the provision of BB at points, ‘there was a period of time when BB had to stop due to maternity leave’. Similarly, high rates of PHN staff turnover within the YK catchment area presented as a barrier to BB implementation over the three years. The time required to build professional relationships and to inform new PHNs of BB was found to be challenging, ‘trying to introduce and train up someone in a new way of working takes a bit of time and it’s something that has been difficult’.

Outcomes Parent Capacity Building From its inception, the aim of BB was to deliver a universal and accessible Speech, Language and Communication (SLC) promotion service for all parents and babies in the YK area. The importance of BB for parents in terms of prevention, early intervention, and capacity building was noted by various practitioners. PHNs noted that this is an extremely useful service for parents in the area, particularly at the seven to nine-month stage in their child’s life, ‘BB pushes speech and language to the forefront of parents’ minds. If parents understand what children should be doing at certain developmental stages, in this case in terms of speech and language, they can better understand if they are meeting their milestones’.

92 Parent interviews demonstrated the extent to which the information and strategies offered by the OLOs impacted on their capacity to promote and encourage their baby’s SLC development. One parent described the sense of relief gained from the information and strategies offered to her in BB as she had previously worried about her baby’s SLC development due to a family history of speech and language delay, ‘since we attended the clinic, I am definitely using the advice and information regularly as I know that he can do it now’. Another parent who was already aware of strategies to promote his baby’s SLC development felt that the advice provided in BB added to their existing knowledge and served as a refresher of the importance of continuing to use these strategies, ‘there were some new tips that we wouldn’t have been aware of too…. Also, we are a bit more conscious that we are doing these more frequently now’.

The extent to which the information regarding SLC promotion and development resonated with parents was apparent through telephone interviews conducted several weeks after parent’s visit to BB. Parents frequently recalled and described the strategies suggested and shown to them by the OLO during BB. They were able to explain the general advice offered to them such as reading, singing, and reciting rhymes with their baby. Specific strategies such as ‘picking up keys, shaking them to make a sound, and saying the word ‘key’, ‘modelling, reading’, ‘naming objects’ and ‘copying actions’’ were among the numerous activities recalled. In addition to the potentially significant impact that knowledge-acquisition can have on outcomes for babies, this evident parental capacity building has also been noted as having a positive impact on parent- baby interactions and relationships. One parent stated, ‘I have used the information that the OLO mentioned everyday now with my son. We look at books more together and I always point out what’s in the pictures’.

Increased Access to Information for Parents Interview feedback highlighted the importance of providing accessible information to parents at the earliest possible stage of their baby’s development. Prior to their BB visit, the majority of respondents would not have considered their baby’s SLC development at that point as they felt that seven to nine months of age was too young, ‘to be honest I never considered speech and language strategies as my child is still so young’. The majority of parents interviewed praised the clinic and felt that such an initiative should be available to all families. One parent noted, ‘this is a great service. We all need to know more about helping to encourage baby’s speech and language’.

Supporting PHN Practice PHNs frequently referred to the important contribution of BB to their professional practice, in addition to outcomes for families. PHNs noted that although they incorporate speech and language development into the seven to nine-month developmental check-up, they do this in a general manner due to time constraints and the broad nature of the developmental check-up. They therefore felt that BB clinics were beneficial and supported their practice, by providing parents with the opportunity to access OLOs with expertise in terms of SLC development, ‘we would have a certain amount of input but we’re very much generalists and we wouldn’t have the expertise that the OLOs have…it seems very useful, one or two parents have said to me that it is nice to get that extra bit of information, tips, and tricks to promote their child’s speech and language development’. One PHN noted that BB enabled parents to recognise signs of potential SLC delay or difficulty, which they could then flag with the PHN at a later stage if needed. It was also noted that the preventative nature of BB may reduce SLC needs at further 93 developmental check-up appointments, ‘by showing parents what they can do to bring on (baby’s) language it may help to reduce speech and language problems when you are meeting children at eighteen months to two years’. PHNs also felt that the information parents received at BB would likely have a positive knock-on effect in terms of how parents encourage and promote their subsequent baby’s SLC development, ‘parents can recognise signs of non-verbal communication as well as how they can promote good communication going forward for their older children, or children to come, so I find it very beneficial that way as well’.

Port-of-Entry to the YK Programme BB offered OLOs an important opportunity to inform eligible parents of the wider YK Programme and to offer entry to specific programmes based on their baby’s needs and interests. For example, BB provided an opportunity for families to access parent- baby groups and/or the IMH Inter-disciplinary Home Visiting Programme, ‘there is a port- of-entry via the BB clinic to link families in with YK, particularly those who may need extra support at that eight to nine-month stage’.

Recommendations for Improvement BB Information PHNs noted that occasionally parents were not aware of BB taking place after their routine developmental check-up, despite the inclusion of the BB information leaflet with their appointment details, ‘we need to be mindful that this period is a very busy time in new parent’s lives and that the BB information leaflet may not have been read when received in the post’. In order to improve this aspect of the service PHNs suggested giving parents the BB information leaflet as they are waiting to go into their PHN check- up appointment so that, ‘parents would have the chance to learn about BB, whether they knew about the service already or they are hearing about it for the first time’. In addition, PHN feedback highlighted that due to the increasing numbers of bilingual and multilingual families in the community, it is important to ensure that all parents are fully informed of BB when inviting them to engage, ’going forward it might be useful to translate the existing BB information leaflet into different languages’.

94 3.2.4 Hanen Programmes

As part of the Speech, Language and Literacy Strategy, Learning Language and Loving It™ - The Hanen Program® for Early Childhood Educators/Teachers, and ABC and Beyond™ - The Hanen Program® for Building Emergent Literacy in Early Childhood Settings were delivered to practitioners in Early Years (EY) centres and primary schools within the YK catchment area.

Learning Language and Loving It™

Learning Language and Loving It™ is an evidence-based and research-validated programme which views a child’s development of language, social skills, and emergent literacy within the context of the early caregiver - child relationship and interactions. Learning Language and Loving It™ provides EY educators with practical, research- based strategies for:

• Promoting young children’s language and communication development using natural everyday activities, routines and play; • Becoming attuned to individual children’s interests to follow their lead; • Adjusting the way you talk with children; • Promoting interaction among the children themselves; • Facilitating language-learning in pretend play; and, • Fostering emergent literacy skills. (The Hanen Centre, 2016)

The Learning Language and Loving It™ programme was facilitated by Hanen-trained YK OLOs on two occasions during the period of April 2016 and December 2017. The programme was offered to a group of up to fourteen Early Years educators per roll-out. The programme was facilitated in one EY centre in the community. In keeping with the Hanen Co-operative Agreement, this intensive programme consisted of two major components: • Seven group training sessions (17.5 hours); • Four individual video-taping and feedback sessions for each participant.

Each EY centre was provided with a copy of the Learning Language and Loving It™ programme guidebook to support learning and implementation.

Research Questions Evaluation of the implementation of the Hanen Learning Language and Loving It™ programme aimed to answer the following questions:

Programme Reach Process Evaluation

1. How many EY educators have 1. What changes to ‘Language and Literacy’ participated in the Hanen and ‘Interaction’ have been observed Learning Language and Loving across EY centres as measured by ERS It™ programme? assessments? 2. To what extent do practitioners believe they have benefitted from participation in the Hanen Learning Language and Loving It™ programme?

95 Programme Reach Process Evaluation

3. How have practitioners experienced implementing Hanen Learning Language and Loving It™ strategies? 4. What enables or acts as a barrier to participants’ implementation of Hanen Learning Language and Loving It™ strategies?

Methodology

Data Collection

Programme Reach The YK administrative database was used to determine the level of participation in the Learning Language and Loving It™ programme. ERS Assessments. ERS assessments (Section 3.3.3) were conducted at each EY site at baseline (pre-intervention, January 2015) and at follow-up (post-intervention, October 2017).

Qualitative Data • Hanen Learning Language and Loving It™ Interviews. One-to-one interviews with ten EY educators (eight pre-school, two crèche). Interviews were semi-structured and lasted approximately forty-five minutes. • Hanen Learning Language and Loving It™ Feedback Forms. Hanen ‘Final Evaluation’ and ‘Session Feedback’ forms were completed by a total of six participants following the final sessions of Learning Language and Loving It™ programme. These comprised of both quantitative and qualitative (open-ended) questions. • Focus Groups. An EY Service Managers focus group was conducted (n=6) in May 2017. It was semi-structured in nature, used open-ended questions, and lasted approximately one hour.

Consent Consent was obtained in writing from all practitioners prior to each interview and focus group. Participants were given an information sheet detailing the purpose of the interview/focus group which included the research officer’s contact details.

Data Analysis

Microsoft Excel was used to generate data from the YK administration database. ERS Assessments (Section 3.3.3). Pre and post ERS assessment scores were analysed and compared by an independent assessor from A+ Education. The assessor assigned a descriptive value, on a scale of 1 to 7 (1 = inadequate and 7= excellent), to describe the quality of specific items within the early childhood environment for each of the seven sub-scales. NVivo Pro 11.0 was used to collate qualitative data for thematic analysis. The Framework Method (see section 2.2) was used to guide thematic analyses.

96 Evaluation Results

Programme Reach • 21 EY educators from seven EY centres in the YK catchment area completed the Learning Language and Loving It™ programme between April 2016 and December 2017.

Process Evaluation ERS Assessment Results • Following the implementation of the suite of EY quality improvement measures (see Section 3.3), which included the Learning Language and Loving It™ programme, ECERS-3 and ITERS-R assessment (see Section 3.3.3) results indicated significant improvements in ‘language and literacy’ and ‘interaction’ sub-scales, in both pre- school and crèche rooms.

Figure 3.2.1: ECERS-3 (pre-school) & ITERS-R (crèche) Pre and Post Results

• As illustrated in fig. 3.2.1, ‘Language and Literacy’ in pre-school rooms across the seven EY centres increased from a sub-optimal pre-ECERS-3 score of 3.8 to an above average score of 5.3, improving by a score of 1.5. ‘Interaction’ increased from a sub-optimal score of 4.2 to an above average score of 6, improving by a score of 1.8. • As illustrated in fig 3.2.1, ‘Language and Literacy’ in crèche rooms across the seven EY centres increased from a sub-optimal pre-ITERS-R score of 3.7 to an above average score of 6.3, improving by a score of 2.6. ‘Interaction’ increased from a sub-optimal pre-ITERS-R score of 3.7 to an above average score of 6.3, improving by a score of 2.6.

Practitioner’s Perspectives of Hanen Learning Language and Loving It™

Sources used for this section of the report include: • One-to-one interviews and small group interviews with eight EY educators (six pre- school, two crèche).

97 Thematic analysis of interview transcripts resulted in the following themes and sub-themes:

Theme Sub-themes Programme Delivery • Approach to delivery • Enablers of participation • Barriers to participation Outcomes • Benefits to children • Benefits to EY educators Capacity Building • Quality improvement • Knowledge-acquisition • Empowerment • Need for EY training & CPD Recommendations for Improvement • Scheduling of training • Releasing EY Staff for Training • Refresher workshop

Learning Language and Loving It™: Results from Interviews with EY Educators

Programme Delivery

The majority of EY educators highlighted that the Hanen Learning Language and Loving It™ programme was well-received. One interview participant pointed out, ‘I could find no fault with the course, the delivery of the course was brilliant’. Course structure and content were described as ‘very good’ and ‘manageable’. Overall the programme was reported to have greatly benefitted EY centres, ‘it did have a major effect, we changed the way we communicate with the children which is everything really’. Participation was found to have impacted positively on EY educators’ professional practice, ‘my whole approach to communicating with the children has changed for the better, the course was great and I don’t think it could have been better’.

Approach to Delivery EY educators reported that the approach to programme delivery by facilitators was a significant aid to participation and implementation ofLearning Language and Loving It™ strategies. ‘We couldn’t have done it without the support of the girls, they visited us to see how we were getting on implementing the strategies and if we needed any help’, stated one EY educator. Participants also noted the benefits of the additional advice and support offered by facilitators throughout the programme noting that, ‘they didn’t just give the training, they gave us tools and advice to use in the future to aid our practice and to continue our awareness of children’s speech and language development’.

Enablers of Participation The easily accessible course content, and its adaptability to practice within EY centre settings, were two of the main aids to participation and it was pointed out that ‘the strategies were great, straight away after the session we could bring the information back to the room and use the strategies with the children no problem’. The video coaching aspect of the programme, whereby OLOs visited each EY centre and recorded the implementation of strategies by participants, was also found to be a 98 significant aid to implementation. Video coaching highlighted and emphasised EY educators’ strengths, providing an opportunity for discussion and support in any areas that needed improvement. Participants described the video coaching element as essential to support knowledge-acquisition and embedding of the strategies into practice, with one noting ‘when you take a piece of video and you sit down to analyse it, you can actually see how much communication is going on, what strategies you are using and if they are having an impact, and what areas of interaction you need to work on more’.

Barriers to Participation Scheduling of the group training sessions was noted as a challenge to participation. As these group sessions took place in the afternoon, participants reported some difficulties in maintaining concentration toward the end of the working day, ‘a morning session might have been better, it’s hard to pay attention at that time of the day’. A number of participants who attended Learning Language and Loving It™ training simultaneously engaged in the YK-facilitated HighScope curriculum training in EY centres (see section 3.3.4). Participants experienced learning fatigue as a result of the two courses running concurrently, ‘by Friday evening I was exhausted’.

Finally, due to staff shortages in EY centres and limited opportunities for EY educators to engage in continuous professional development, a small number of staff members from two EY centres were allowed to take part in the training. This was found to have impacted on these participant’s experience of the training, ‘I found it hard in a sense that everyone had two from their centre and it was just me for our centre’. On a similar note, another participant explained, ‘I had to try to inform the other staff in my room of what changes would be made which took a lot of time, and there was also no one there I could bounce ideas off’.

Outcomes

EY educators frequently recalled the benefits they observed since implementing the communication-promoting strategies, ‘the whole-centre has benefitted, all the staff in the room are much more confident managing children’s communication development and the kids have come on so much’.

Benefits to Children Improvements in children’s’ ability to express themselves were noted by EY educators following implementation of the programme strategies, ‘since we started adding in the strategies into our daily routine the children have come on so much’. In addition, some EY educators reported significant improvements in terms of language acquisition and confidence in children who presented as non-verbal. One EY educator stated,‘I’m even proud of myself now when I see the children interacting with me. Sometimes they are still not talking back to me or they do not have loads of language. They might just have a phrase or they look closer at me and that’s something I really took away from Hanen and I will carry with me for ever.’

‘Communicating with children at their individual levels of development’, in addition to ‘pausing and waiting to allow children time to initiate conversation’, were the two main strategies that EY educators recalled as having the most significant impact on children. Utilising small group sizes, and strategically positioning children within groups, were also recorded as having impacted positively on children’s communication development within EY centres, ‘I discovered that I wasn’t paying that much attention to the children 99 who had the high level of language and I was focusing on the children who had the low level of language. The programme showed me how to balance both, by sitting the quiet child in front of me in the group and the vocal child next to me. This has had a massive impact on both children’s communication and interaction skills… and this has really enhanced my daily work too’.

Benefits to EY Educators EY educator feedback highlighted the extent to which Learning Language and Loving It™ training has impacted on daily practice. Interview participants recalled using the strategies on a daily basis, namely the tips used to encourage children’s communication, ‘putting objects up high so they have to point and name what they need...everything that they taught us is definitely used to its full extent in the rooms, one hundred percent’.

The important role of the EY educator in young children’s language and vocabulary acquisition was new to many participants of the Learning Language and Loving It™ programme. EY educators described how they now put more value and emphasis on interacting and communicating with children at their individual levels of development, instead of the expected level of communication for their age. Interview feedback revealed, ‘they gave us observation guidelines for children’s different speech and language levels so that…..you can gauge whether they are the sociable child etc., what their language level is, and what activities you can do to support that child’. Throughout interviews, EY educators frequently described challenges they faced prior to participation in the training in terms of supporting children with speech, language and communication difficulties within their EY setting. Participants commented on how they were not adequately equipped with the appropriate information and skills to support all children, ‘there is such a high level of speech and language needs in our centre, before this we were not given any training on how to work with children who could not speak yet or who had difficulties speaking’. EY educators noted the importance of being able to access training, coaching and resources, ‘this course was a great one for us to help manage and support all the children in our classroom, I would recommend for all EY centres to train their staff in this’.

Capacity Building

A strong sense of capacity building was evident throughout EY educator feedback, ‘it taught me so much, my whole approach to work has changed’.

Knowledge-Acquisition Following completion of the programme, participants described an increased awareness of their role in ‘encouraging children to lead’, ‘supporting increased child interactions’, and the importance of ‘listening and providing ample opportunities for children to speak or respond in their own time and their own way’. Participants also reported learning important strategies to support pre-verbal or more reluctant children, ‘with the child that says nothing… I remind myself every single day to OWL and that works’. Participants reported that ‘owling’, ‘mirroring’, and ‘listening’ were the core strategies implemented. They described using these strategies on a daily basis, ‘I use these every day, particularly OWL, breaking up sentences, or breaking your kids up to categories so you have the early sentence user or the confident one’.

100 Need for EY Educator Training & CPD In terms of supporting bi-lingual children, one participant stated, ‘we are not taught how to deal with children who do not speak the language, there’s no training given on that at all’. Following completion of the programme, EY educators reported a significant increase in their capacity to support the growing number of bi-lingual children in the EY setting, ‘we now know what strategies to use to encourage and support these children’.

Recommendations for Improvement Scheduling of Training Participants suggested that consideration should be given to ensure an even balance when scheduling training programmes, noting that ‘holding one on an afternoon at the beginning of the week and another toward the end’ might be beneficial. Equally, some participants suggested extending the duration of the Learning Language and Loving It™ programme in order to give additional time to more complex topics, ‘I would have loved a few more week on topics like supporting children with needs’.

Releasing EY Educators for Training EY educators outlined the difficulties that emerged when only a few members from a centre were released to engage with the programme. Participants commented that Learning Language and Loving It™ should be offered to all EY educators in each centre, so as to maximise the effectiveness. One revealed, ‘I would love more staff to do it, that way everybody would be singing off the same hymn sheet and that all children can get the full effect of the strategies from all the team’.

Refresher Workshops EY educators recommended implementing ‘refresher workshops’ for those who completed the programme, ‘it’s important to keep the strategies fresh in our minds, so we don’t go back to old habits’. Suggestions were made that refresher training should take place every six months, to recap on important concepts and strategies and keep an awareness of children’s speech and language development at the forefront of their minds.

101 ABC and Beyond™

Hanen ABC and Beyond™ is an evidence-based programme which supports educators to promote emergent literacy skills that all children need to develop when learning to read and write. By taking the latest research in early literacy development and ‘translating’ it into practical, immediately usable strategies, ABC and Beyond™ makes it easy for educators to:

• Take advantage of everyday conversations to promote emergent literacy skills; • Build literacy naturally into every part of the day; • Promote the identified building blocks of literacy: • oral language; • vocabulary; • story comprehension; • language of learning; • print knowledge; • phonological awareness. (The Hanen Centre, 2011)

ABC and Beyond™ was facilitated by Hanen-trained YK OLOs on one occasion between October 2016 and February 2017. This programme was offered to a group of up to fifteen Early Years (EY) educators and primary school teachers and was facilitated in one of the primary schools in the community. This intensive programme consisted of two major components:

• Four group training sessions (approximately twelve hours in total); • Two individual video-taping and feedback sessions for each participant.

Research Questions

Evaluation of the implementation of the Hanen ABC & Beyond™ programme aimed to answer the following questions:

Programme Reach Process Evaluation

1. How many primary school 1. To what extent do teachers believe that they teachers have participated in have benefitted from participation in the the Hanen ABC & Beyond™ Hanen ABC & Beyond™ programme? programme? 1. How have teachers experienced implementing Hanen ABC & Beyond™ strategies? 1. What enables or acts as a barrier to teachers’ implementation of Hanen ABC & Beyond™ strategies?

102 Methodology

Data Collection

Programme Reach The YK administrative database was used to determine the level of participation in the Hanen ABC & Beyond™ programme.

Qualitative Data: Interviews: • Small group and one-to-one interviews with eight primary school teachers (including one based in an ASD unit). • One-on-one interviews with three primary school principals. Interviews were semi- structured and lasted approximately forty-five minutes.

Hanen ABC & Beyond™ Feedback Forms Hanen ‘Final Evaluation’ and ‘Session Feedback’ forms were completed by a total of five participants following the final session of the programme.

Consent Consent was obtained from all practitioners prior to each one-to-one and small group interview.

Data Analysis Microsoft Excel was used to generate data from the YK administration database. NVivo Pro 11.0 was used to collate qualitative data for thematic analysis. The Framework Method (see section 2.2) was used to guide thematic analyses.

Evaluation Results

Programme Reach Nine primary school teachers from four local primary schools completed the Hanen ABC & Beyond™ programme.

Process Evaluation Sources used for this section of the report include: • One-to-one interviews with eight primary school teachers; • One-to-one interviews with three primary school principals.

Thematic analysis of interviews resulted in the following themes and sub-themes:

Theme Sub-themes Programme Delivery • Course structure and content • Approach to delivery Enablers of implementation • Group setting • Video coaching • Principal support Barriers to implementation • Cover for teachers Knowledge-acquisition • ABC & Beyond™ strategies

103 Theme Sub-themes Outcomes • Impact on children • Impact on teachers Recommendations for Improvement • Refresher training

ABC & Beyond™: Results from Interviews with Primary School Staff

Programme Delivery The majority of those interviewed enjoyed participating in the ABC and Beyond™ programme and felt its delivery, structure, and content were all very effective, ‘The Hanen programme, I couldn’t fault it’, ‘I really enjoyed it, it’s my favourite course that I have done’.

Course Structure and Content The structure of the Hanen ABC & Beyond™ programme was reported by the majority of participants to be ‘very good’ and ‘useful for knowledge and skills uptake’. Focusing on one topic per session over a course of weeks was a preferred method of training for teachers. One stated, ‘if you get all information in one sitting you are confused as to where to start, whereas with this programme you got one strategy or topic per session and the time to implement it, and an opportunity to report back to the enablers if you have had any problems’.

The content of the programme was considered to be ‘useful’ and ‘easily adaptable’ for teachers in terms of their daily practice. Feedback found that participants were particularly interested in how the programme was built upon the idea of turning book reading into a conversation through use of the following strategies; ‘making words sparkle’, ‘expanding children’s understanding of stories’ and ‘encouraging children to use language to think and learn’. On reflection, one participant noted that the Hanen ABC and Beyond™ training was useful compared to other trainings as it concentrated on more relevant areas of practice, ‘training around literacy in infant years focuses a lot on phonics, and language was becoming a real problem with us. Some children are pre-verbal and their basic ability to respond to you is very poor… we needed training like this’.

Teaching aids and materials provided to participants were reported to be ‘very helpful’ in further explaining the programme content in accessible terms, and also as revision tools. One participant explained, ‘we got great notes that really helped as we could revert back to these outside of the training’.

Approach to Delivery The programme’s facilitators were praised by all participants, one of whom commented, ‘the two girls were fantastic, amazing, they were so helpful and so easy- going, no question was regarded as being silly and they answered every one. They just made everybody feel really comfortable’. Their knowledge of, and reference to, the current curriculum used in primary schools when teaching Hanen ABC & Beyond™ strategies was praised by participants who found this to be useful learning aid. One interviewee stated, ‘it felt like the facilitators almost looked at how we teach and explained the Hanen strategies in the language we use every day, it was amazing’.

Similarly, interview participants also noted that facilitators researched the newly

104 introduced Primary School Language Curriculum in order to demonstrate how they could implement the Hanen ABC & Beyond™ strategies in line with this, ‘they also kept an eye on the new language curriculum and explained how we could fit the Hanen strategies into our daily practice’.

The flexibility and support given by facilitators was highlighted on several occasions, ‘anytime you did have a question that they didn’t have the answer to they would come back the next week with the information’. Participants also noted, ‘we had a phone number for them and email contact details and they were more than willing to come and facilitate any queries’.

Enablers of Participation Group Setting Those interviewed commented on the benefits of the supportive group training sessions which encouraged participation and discussion observing that ‘there was such freedom to talk and to share ideas, no one ever talked over each other, it felt like such a safe space for discussion’. The mix of classroom and resource teachers often encouraged rich discussion about speech, language and literacy development in all areas of the primary school setting, ‘having a mix of different backgrounds was really great in terms of sharing our experiences… I could discuss the way I used a particular strategy in my classroom and I could get advice from my peers on how they used it’.

Video Coaching The individual video coaching sessions, which consisted of recording participants using programme strategies with children followed by an opportunity to view and reflect on their interactions, were reported to be vital for successful implementation of strategies whereby ‘you learn so much from watching yourself back with the support of someone saying well done for doing that, or you may need to try this instead’. One teacher highlighted the importance of the video coaching in terms of understanding children’s behaviours and interactions in the classroom, ‘sometimes you are so involved in the story and listening to the kids that you are not seeing the child on the outside, or the first time he/she becomes involved… I really enjoyed seeing that on tape’.

Principal Support The support and flexibility of individual principals was found to be an influencing factor in signing up for the training, and particularly helpful to participants in terms of organising cover for classes. One interview participant stated, ‘we were very lucky to have the encouragement to participate in the programme from a management level’.

Barriers to Participation Cover for Teachers Organising cover in order for teachers to be able to participate in the group training sessions was identified as the greatest barrier to participation, as evidenced by one who noted ‘organising supervision of classes was sometimes difficult, and planning work for the students while I was at the training was time-consuming’.

105 Outcomes Child Benefits Interview participants reported that the implementation of ABC & Beyond™ strategies significantly impacted child learning,‘children are more observant with improved comprehension and knowledge of stories’. Children’s engagement and social interaction skills were reported to have been positively influenced, as teachers explained, ‘children are volunteering and answering more, and picking up on what their peers are saying’. Interviews with local principals reiterated this point and highlighted that children are better able to converse more appropriately with teachers and other students since exposure to the programme strategies. One principal noted, ‘when you speak to them they are able to speak back to you in an appropriate manner and they understand different social situations in a better way’.

Children’s enthusiasm for engaging with books and stories was noted to have increased greatly following the training, ‘now they love story time, they are so engaged and getting used to answering questions about the book’. Children’s ability to understand stories was reported to have improved since the implementation of ABC & Beyond™ strategies. Interview participants regularly referred to children being able to describe the ‘setting’ and ‘characters’ in books since the implementation of specific strategies and subsequent newly-acquired language. One participant explained how encouraging children to think of words with similar meanings when introducing new vocabulary led to a visible expansion of their vocabulary, ‘we asked the children to think of another word for things, now they use a range of vocabulary more often’.

Resource teacher feedback highlighted the benefits ofABC and Beyond™ strategies for children with additional needs, ‘I have used it with boys that are much older but who would have more specific speech and language issues and it has had a very positive effect. They have responded very well to looking at a book in a different way’. In addition, teachers noted that parents commented on the increase of children’s vocabulary in the home.

Impact on Teachers Participation in ABC and Beyond™ was reported to have impacted positively on teachers’ confidence in terms of professional practice and their capacity to understand speech, language and literacy development for young children, ‘we touched on children’s development in our basic teacher-training but we have never been given specific strategies to support or encourage speech and language development’. Improvements in vocabulary and overall communication skills were reported to have resulted in less conflict in the classroom and school yard due to children’s increased abilities to communicate more effectively with one another. One teacher recalled, ‘I have seen huge improvements in how children interact with each other. Children now have the language to verbalise their frustrations rather than using hands or legs as they may have before’. Another teacher described how the ABC and Beyond™ training has been used to inform the development of the infant language and literacy policy in the school, ‘we’re rewriting the infant literacy policy - we’re changing it completely and incorporating Hanen strategies. We’re also giving a small presentation to the rest of the staff’.

106 Recommendations for Improvement Interview participants recommended that the ABC and Beyond™ programme should be made available to all teachers, both in the YK area and nationally. Suggestions of holding ‘refresher training sessions’ were frequently noted throughout interviews. Participants felt that in order to maintain the skills and strategies they have learned then continued training must be facilitated, ‘I have learned so much…I want to keep that level of knowledge so I can implement the strategies in the correct way over time’.

Results from Learning Language and Loving It™ and ABC & Beyond™ Feedback Sheets

Hanen ‘Final Evaluation’ and ‘Session Feedback’ forms were completed by a total of eleven participants following the final sessions of both the HanenABC and Beyond™ and Hanen Learning Language and Loving It™ programmes.

Sources used for this section of the report include: • Final session and feedback forms (n=11).

Thematic analysis of final session and feedback forms resulted in the following themes and sub-themes:

Theme Sub-themes Programme Delivery • Programme facilitators • Hanen strategies • Enablers of participation Outcomes • Impact on professional practice • Benefits to children • Knowledge-acquisition Recommendations for Improvement • Refresher training

Programme Delivery Programme Facilitators The majority of EY educators and primary school teachers reported that both trainings were ‘very well delivered’ and praised the ‘enthusiasm’ and ‘openness’ of the facilitators. Participants found the advice offered by facilitators following video playback was ‘useful’, ‘positively reinforcing’, and ‘confidence building’.

The Hanen Program® Format Quantitative feedback (likert scale results) revealed that the programme delivery approaches and content were ‘useful’ to ‘very useful’.

Enablers of Participation Quantitative feedback (likert scale results) for programme components including ‘group discussions’, ‘videotapes’, and ‘handouts’ scored ‘useful to very useful’. However, ‘roleplays’ scored slightly lower and were regarded by the majority of participants as ‘somewhat useful’.

107 Outcomes Impact on Professional Practice Respondents reported that both programmes had a significantly positive impact on their overall professional practice, ‘I found the course really beneficial and it has improved my practice and how I interact with the children greatly’. EY educators and primary school teachers reported an increased awareness to urge children to lead, encourage increased child interaction, and to listen and give children ample time to speak or respond. A respondent noted ‘the most important thing I took away from the course was to observe, wait, and to give children opportunities to listen and then speak’. In addition, feedback from both groups highlighted that the recommended programme strategies were used on a ‘daily basis’, with one respondent in particular adding, ‘I use them when I engage with the children right throughout the day’.

Benefits to Children Primary school teachers noted the impact that the implementation of the Hanen ABC & Beyond™ programme strategies have had on child learning and engagement. Among the responses were ‘children in my class are more observant and have improved comprehension and knowledge of stories’, ‘children are volunteering and answering more, and picking up on what their peers are saying’, ‘they love story time, they are so engaged and getting used to answering questions about the book’.

Knowledge-Acquisition EY educators identified‘owling’, ‘mirroring’, and ‘listening’ as the main strategies implemented, while primary school teachers recalled their implementation of ‘Strive for 5’, ‘Es & Ps’, ‘Shoot for the SStars’ and ‘Make words Sparkle’. EY educators noted that a particularly useful learning from the programme was to communicate with children at their individual levels instead of the desired level of communication for their age, ‘I learned the most valuable thing ever. Instead of trying to get a/any child to the level they should be for their age, you should just help them at the level they are at’. They also recalled that the training provided information regarding the processes of how young children acquire language and vocabulary, and the integral role of the EY educator in this process. Likewise, primary school teachers reported that completion of the programme has increased their awareness of their role in building children’s literacy.

Teachers reported that the implementation of the programme strategies in their classrooms has impacted positively on child learning, ‘I plan better literacy lessons now as I focus more on vocabulary and not just listening and re-telling, the children have really benefitted from this’, ‘I have begun literacy stations, which allows me to read big books to smaller groups of which are differentiated depending on ability, I can see the improvement this is making already’.

Recommendations for Improvement

EY educators in particular highlighted the need for greater training in the area of child speech and language delay, particularly in terms of how best to support children with such needs. Interview participants stated, ‘additional training on promoting communication with children with needs is badly needed’.

108 3.2.5 Implementation Process of Strategy 2

Table 3.2.6 outlines the implementation of Strategy 2 over the three-year period.

Through examining activities and outcomes across each time point (2015, 2016/17 and 2018), we are able to track the evolution of the strategy from 2015 to 2018 and to assess whether the strategy has achieved its immediate goals (short-term outcomes) and ensured fidelity to its long-term aims.

The 2015 YK Logic Model outlines the strategy’s initial short and long-term outcomes and the main activities proposed in order to achieve these goals. Work Plans from 2016/17 and 2018 allow insight into successful activities, those not achieved, and those yet to be achieved.

109 Table 3.2.6: Strategy 2 Implementation Process, 2015 to 2018

Strategy 2: Speech, Language & Literacy

2015 Logic Model 2016-17 Work Plan 2018 Work Plan (Long-term outcomes not outlined due to uncertainty of YK funding beyond 2018) Short-term Long-term Activity Short-term Long-term Activity Short-term Outcomes Activity Outcomes Outcomes Outcomes Outcomes (2018+) (by 2016) (by 2018)

!School and !Measured !Hanen, PALLL, !HVP: Provide OLO input/ !Improvements in child !Inter-disciplinary IMH !To continue to support !Babbling Babies early years’ improvem- ELKAN e.g. skills to team and families speech, language and HVP training and guidance to the !Junior Infant S&L Ax service ents in child !Provide support in the literacy development from wider YK team !OLO IMH HVP practitioner’s speech, !Practitioner: identification of children birth to six years. !Transition to !OLO consultations

capacity to language Development of at risk/ presenting with SLT !Sustained capacity building Parenthood (TtP) !To continue to deliver within the community implement literacy Hanen and needs and/or other in parents to support early consultations across the YK !Kidscope language develop- Elklan informed developmental concerns. speech and language !Babbling Babies community !Hanen LLLI Training development ent from training for !Facilitation of onward development, in the context and Coaching initiatives is birth to six teachers. referral to services as of the parent-child !Baby Massage !Further integration of the !Hanen ‘ABC & enhanced. approxima- required relationship. strategy within the Infant Beyond’ Training & ting !Services: !TtP: OLO evidence- !Kidscope Health and Well-being Coaching !Sustained capacity building !Parents national Responding to based input. strategy, working to support !Hanen ‘I’m Ready’ among community actively norms. at-risk groups: !BB: Promotion of early !Early Years first relationships with parents Parent Training & practitioners, EY educators engaging in incl. travellers; communication and and caregivers to promote Coaching and primary school teachers, S&L promotion Whole class interaction. !Early Primary School early language development !UCC trainings to support and enhance with children. approach to S&L !Port-of-entry to wider YK S+L Ax !National OLO communication development programme. !To continue to deliver Consultations re: S2 development for children; !KS: OLO input included !Consultation to teachings to undergraduate practice and and to create and enhance !Parents: in YK inter-disciplinary Primary Schools programmes implementation language rich environments. Promotion of S&L input. !Conference during the !Early Primary School Ax: !Encourage accessible lines !Support !EY Educators & Teachers OL submissions and perinatal period; To support and enhance of communication between referral/engagement/ Development training and participation S&L stimulation oral language parents, practitioners and access to statutory coaching !Participate in OL at home; development. mainstream services services Forum community !Capacity building for EY regarding child development !Capacity building for EY !Maximise other awareness re: educators and school outcomes. !Research & educators and school opportunities for local

S&L stimulation. teachers to support oral !Support early identification Evaluation teachers to support oral stakeholders language development in of childhood speech, language development in the classroom and to language and !Community Events the classroom and to create create language rich communication difficulties by language rich environments environments parents and practitioners and !Capacity building of !Engagement within encouraging onward referral OLO to understand !Research: Baseline of community to the appropriate services. and support language profile

!Research: Baseline of !Collaboration with relationship/IMH for

language profile. educational institutes re the S&L development

integration of IMH at

undergraduate level. 110 Evolution of Strategy 2

The 2015 Logic Model (Table 3.2.6) outlines that Strategy 2 of the YK programme initially aimed to implement two core activities:

• To provide training for local Early Years educators and primary school teachers to support language development for young children within their settings; • To support local parents to engage in speech, language and communication promoting activities with their children.

Building capacities of local teachers, EY educators and parents in order to support and enhance SLC development (short-term) and sustain this capacity building (long-term), were proposed outcomes present at all three time points.

During 2015 and early 2016, OLOs developed and implemented a teacher-training programme to support oral language development in the classroom and to create language rich environments. This consisted of group training sessions, the content of which were Hanen and Elklan-informed, and on-site whole classroom coaching for teachers.

Delivery of this model highlighted the need for an individual video coaching component to support implementation for each teacher leading to OLOs completing Learning Language and Loving It™- The Hanen Program® for Early Childhood Educators/Teachers, and ABC and Beyond™ - The Hanen Program® for Building Emergent Literacy in Early Childhood Settings.

In terms of parental capacity building, OLOs developed and implemented Babbling Babies through inter-agency collaboration and partnership working during 2015. BB was developed to provide a prevention and health promotion service to support communication development within the context of the parent-baby relationship. The 2018 Work Plan proposed the introduction of the Hanen I’m Ready! ™ Programme for Building Early Literacy in the Home.

The 2016-17 Work Plan highlights the expansive and evolving nature of this strategy, through the inclusion of the following proposed activities:

Involvement in the YK IMH Inter-disciplinary HVP; • Participation in the proposed Transition to Parenthood Programme (see Section 3.1); • Continued administration of speech and language assessments with Junior Infants pupils in four local primary schools and follow-up consultations; • Continued involvement in research and evaluation; • Continued engagement with the wider community, and; • Collaboration with educational institutes regarding the integration of IMH at an undergraduate level.

Following the appointment of the IMH Specialist IMH-E® to the YK programme in 2016, and the subsequent provision of IMH training and reflective practice supervision, the importance of the role of the parent-baby relationship in supporting speech, language and communication development was subject to greater scrutiny. In consultation with the IMH Specialist IMH-E®, OLOs began to embed IMH principles into their daily practice, including BB. In addition, OLOs joined the YK IMH Inter-disciplinary HVP. The 2018 Work Plan identified an important goal to further integrate Strategy 2 into the 111 Infant Health and Well-being Strategy, to promote early communication development within the context of a baby’s first relationship with parents.

In the 2015 Logic Model, a proposed long-term outcome of the strategy was to see ‘measured improvements in child speech, language and literacy development from birth to six years approximating national norms’. A decision was made to administer The Pre-School Language Scales – Fifth edition (PLS-5), with all junior infant pupils in four local primary schools to collate baseline population data regarding child speech and language development in the YK area.

The 2016/2017 Work Plan documented the decision to continue to administer speech and language assessments to ‘provide support in the identification of children at risk / presenting with SLT needs’. Due to the time-consuming nature of administering PLS-5 in the context of limited resources, a shift in practice was required. Thus, a shorter set of assessment tools were introduced.

In addition, the need to continue to further share the learning from Strategy 2 was highlighted. This was delivered through teaching at a local undergraduate level, engagement with the Oral Language Forum, and increased involvement in national and international conferences.

3.2.6 Key Findings and Learning

Table 3.2.7: Strategy 2 Key Findings

1. 163 babies attended the BB Clinics from October 2015 to December 2017

2. OLOs saw approximately 63% of babies born in the YK catchment area in a two-year period

3. Thirty-two local practitioners completed Hanen Learning Language and Loving It™ and Hanen ABC and Beyond™ language training programmes from April 2015 to December 2017

4. ‘Language and literacy’ in pre-school rooms in seven EY centres increased from a sub-optimal pre-ECERS-3 score of 3.8 to an above average score of 5.3, improving by a score of 1.5.

5. ‘Language and Literacy’ in crèche rooms across the seven EY centres increased from a sub-optimal pre-ITERS-R score of 3.7 to an above average score of 6.3, improving by a score of 2.6.

6. ‘Interaction’ in pre-school rooms across the seven EY centres increased from a sub-optimal score of 4.2 to an above average score of six, improving by a score of 1.8.

7. ‘Interaction’ in crèche rooms across the seven EY centres increased from an average score of 4.9 to a sub-optimal score of six, improving by a score of 1.1

112 Table 3.2.8: Strategy 2 Key Learning

Evidence gathered suggests that implementation of Babbling Babies was aided by the following factors:

1. Inter-agency collaboration and partnership working 2. Parent engagement 3. Innovative nature of BB 4. Embedding of Infant Mental Health principles

Evidence gathered suggests that barriers to the implementation of Babbling Babies included:

1. YK catchment area 2. Staff turnover

Evidence gathered suggests that implementation of Hanen Programs® was aided by the following factors:

1. Facilitator’s approach to delivery 2. Accessible programme content 3. Video coaching component

Evidence gathered suggests that barriers to the implementation of Hanen Programs® included:

1. Availability to release and provide cover for participants 2. Scheduling of programmes

113

3.3 Strategy 3: Early Years Care and Education

115

3.3 Strategy 3: Early Years Care and Education

3.3.1 Overview of Strategy

Strategy 3 of the Young Knocknaheeny (YK) Programme, Early Years Care and Education, involved the delivery of a suite of EY quality improvement measures to all Early Years (EY) centres (both crèche and pre-school rooms) in the YK catchment area. Strategy 3 was co-ordinated by Barnardos Brighter Futures, based in Knocknaheeny. It was guided by an Early Years Co-ordinators Group and was aligned to the National Early Years curriculum and quality frameworks of Aistear and Soilta. The seven EY centres which took part in the strategy were:

• Barnardos Brighter Futures, Knocknaheeny; • Hollyhill/Knocknaheeny Family Centre, Knocknaheeny; • St. Mary’s on the Hill Primary School Early Start and Playlands Crèche, Knocknaheeny; • Before 5 Nursery and Family Centre, Gurranabraher; • Páistí @ No. 3 Pre-school, Churchfield; • Padre Pio National School Early Start, Churchfield; • Stepping Stones Pre-school, Farranree.

The suite of EY quality improvement measures provided to EY staff as part of Strategy 3 included:

1. The Hanen Learning Language and Loving It™ Programme (section 3.2.4) 2. HighScope Curriculum Training 3. Mentoring Programme 4. YK Environmental Enhancement Funding

HighScope, Mentoring and Environmental Enhancement Funding

HighScope is a quality approach to early childhood care and education which has been shaped and developed by research and practice. Identifying and building on children’s strengths, interests and abilities, the curriculum is used internationally in a variety of settings including crèches, playschools and primary schools (HighScope Ireland, 2017). Following a site visit to the Young Ballymun ABC Programme (YB) during the development stages of the YK programme, and on seeing the positive impact of HighScope implementation, a decision was made for the HighScope training to be delivered in EY educators in the YK catchment area. Due to its similar theoretical approach and ethos; focusing on child-led learning and parental and family involvement in children’s early education; HighScope was deemed the most appropriate curriculum training.

In conjunction with HighScope training, the Mentoring Programme was developed to provide assistance to EY centres in light of ERS recommendations and to assist in their

117 participation in the suite of EY quality improvement measures. The on-site EY Specialist Mentor was available weekly to all seven centres throughout the training to assist each one in developing and implementing a tailored plan to enhance quality and child outcomes. Through Environmental Enhancement Funding, YK provided funds to each of the participating centres to upgrade settings and equipment in order to effectively implement the HighScope curriculum.

Environment Rating Scale Assessments

Prior to the strategy’s roll-out, YK contracted independent evaluators, A+ Education8,1 to conduct baseline Environment Rating Scales (ERS) assessments in all seven centres in order to quantitatively measure quality improvement in EY centres before and after the implementation of the strategy’s four quality improvement measures (as detailed above).

ERS are highly regarded research tools used for assessing the quality of EY settings. They provide a structure for recording, improving and evidencing different aspects of the learning environment provided for children. Each scale is grounded in research, is rigorously field tested, and is proven, valid and reliable and continually updated for clarity and to reflect best practice and current research in the early childhood field. ERS evaluate programmes on process quality (what children experience in their environment including various interactions and other features that support those interactions) which is indicative of positive child outcomes.

The ERS assessment tools used to measure the quality of the seven EY settings in the YK catchment area were: • ITERS-R. Infant Toddler Environment Rating Scale. Evaluated EY centre-based provision for children from birth to three years. • ECERS-3. Early Childhood Environment Rating Scale. Evaluated EY centre-based provision for children aged from three to five years.

3.3.2 Evaluation of Strategy 3

The evaluation of Strategy 3 is presented as follows: • ERS Assessments (section 3.3.3); • HighScope Training Programme (section 3.3.4); • Mentoring Programme (section 3.3.5); • Environmental Enhancement Funding (section 3.3.6).

Implementation of the overall strategy is evaluated in the following section: • Implementation Process of Strategy 3 (section 3.3.7).

8 A+ Education are UK-based evaluators who aim to improve children’s outcomes through evidence- informed professional development. Using research-validated observational assessment tools, A+ provide a framework for quality improvement. http://www.aplus-education.co.uk/aplus-about-us/vision-and-values/ 118 Research Questions

Evaluation of Strategy 3 aimed to answer the following questions:

Programme Reach Process Evaluation

1. How many children have ERS Assessments: benefitted from EY educator’s 1. What quality improvements have been involvement in the HighScope recorded in the seven EY centres? Training and Environmental Environmental Enhancement: Enhancement programmes? 1. What improvements have been made to EY 2. How many EY educators have settings and services? participated in the HighScope 2. How have EY staff perceived the benefits Training Programme? of the Environmental Enhancement Programme? Mentoring: 1. What support was provided to EY staff by the on-site EY Specialist Mentor? 2. How have EY staff experienced having an on-site EY specialist mentor? HighScope Training: 1. To what extent do staff believe they have benefitted from the HighScope Training Programme? 2. What enables/acts as a barrier to staff participation in the training? 3. To what extent have EY staff been able to implement HighScope strategies?What enables/acts as a barrier to the implementation of HighScope strategies into practice? Methodology

Data Collection

Programme Reach

The YK administrative database was used to determine the level of engagement with the EY suite of EY quality improvement measures. ERS Assessments. ERS assessments were conducted at each EY site at baseline (pre- intervention, January 2015) and at follow-up (post-intervention, October 2017).

Qualitative Data: • Interviews. Small group interviews and one-to-one interviews were conducted with EY educators (n=9) who took part in the HighScope Training and Mentoring programmes. Interviews were semi-structured and lasted approximately forty-five minutes. • Focus Groups. A focus group (n=5) was conducted with EY service managers in May 2017. The focus group was semi-structured in nature and lasted approximately one hour.

121 • Mentor Feedback Sheets. Feedback sheets (n=23) were completed by the on-site EY Specialist Mentor following weekly visits to individual EY centres.

Consent Consent was obtained prior to all one-to-one interviews and focus groups. All participants were provided with an information sheet and the Research Offi cer’s contact details.

Data Analysis Microsoft Excel was used to generate data from the YK administration database. ERS Assessments. Pre and post ERS assessment scores were analysed and compared by an independent assessor from A+ Education. The assessor assigned a descriptive value, on a scale of 1 to 7 (1 = inadequate and 7= excellent), to describe the quality of specifi c items within the early childhood environment for each of the seven sub-scales. NVivo Pro 11.0 was used to collate qualitative data for thematic analysis. The Framework Method (see section 2.2) was used to guide thematic analyses.

Programme Reach

Figure 3.3.1: No. of Participants in EY Suite of Quality Improvement Measures

EY Practitioner Training

1. Twenty-eight pre-school and crèche staff completed the HighScope Training Programme between April 2015 and December 2017; 2. Ten participants took part in both the HighScope and Learning Language and Loving It™ (see Section 3.2.4) programmes; 3. Approximately 700 children benefi tted from the implementation of language training, curriculum training, mentoring intervention, and environmental enhancements implemented in the seven EY centres.

120 Process Evaluation

3.3.3 Environment Rating Scales Assessments

ERS Assessments took place at two time points: 1. Baseline (pre-intervention) ITERS-R (crèche) and ECERS-3 (pre-school) assessments were conducted in January 2015; 2. Follow-up (post-intervention) ITERS-R (crèche) and ECERS-3 (pre-school) assessments were carried out in October 2017.

Each assessment tool provided a profile of the overall social/cognitive learning environment on a one to seven rating scale. They contained seven sub-scales: programme structure, activities, interaction, listening and talking, space and furnishing, personal care routines, and parents and staff.

Each sub-scale consisted of four to ten items that provided an overall profile of the sub- scale based on observer ratings. The observer assigned a descriptive value, on a scale from one to seven (1 = inadequate and 7= excellent), that describes the quality of the early childhood environment for that sub-scale.

A score of one is considered inadequate, three indicates minimal quality, and five indicates good quality. A score of less than three is generally considered to be unacceptable. An average score of five indicates ‘good’ or ‘developmentally appropriate practice’ whereas a score of seven indicates excellent or enhancements to practice (Community-University Partnership for the Study of Children, Youth, and Families, 2011, p.1).

ERS assessments aimed to answer the following question:

What quality improvements have been recorded in the seven EY centres?

ERS Assessments Results

ECERS-3 (Pre-school Rooms) Figure 3.3.2 shows at baseline (pre-intervention) the overall quality of the pre-school rooms across the seven sites was rated to be an average of 3.5 out of 7 on the ECERS-3 scale, a ‘sub-optimal’ score on the ERS ratings scale. Each of the seven sites were, on average, rated below a score of four out of 7 (Figure 3.3.2), indicating that there was opportunity for improvement in general across all areas of childcare in each of the seven EY centres. Follow-up (post-intervention) ECERS-3 scores revealed significant improvements for ‘programme structure’ (+2.3) and ‘personal care routines’ (+1.8).

121 Figure 3.3.2 Overall Pre and Post ECERS-3 Results by Sub-scale Overall ECERS-3 Results by Subscale

Table 3.3.1 provides a detailed breakdown of each centre’s pre and post ECERS-3 result by sub-scale. ‘Programme Structure’ experienced the greatest impact across six EY centres, three centres in particular recording signifi cant results: Centre A increased from a pre-ECERS-3 score of 1.0 to a post score of 5.4 (+4.4); Centre C increased from a pre-ECERS-3 score of 2.4 to a post score of 5.7 (+3.3); and Centre D increased from a pre-ECERS-3 score of 1.6 to a post score of 5.7 (+4.1).

Table 3.3.1: Overall Pre and Post ECERS-3 Results by Sub-scale Overall ECERS-3 (Pre-school) Results Centre A Centre B Centre C Centre D Centre E Centre F Sub-scale Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post Space and 3.6 5.0 3.5 4.6 2.0 3.9 3.3 5.2 4.0 5.5 3.8 5.2 Furnishings Personal 3.3 5.8 4.3 5.5 4.0 4.3 2.7 5.7 4.5 5.5 3.5 6.0 Care Routines Language 2.6 4.4 5.4 5.8 2.6 5.2 3.3 4.9 4.2 5.4 4.4 5.8 and Literacy Learning 2.1 4.4 1.8 3.3 2.3 2.5 2.2 3.9 2.6 4.2 3.4 5.1 Activities Interaction 3.0 4.6 5.4 6.6 3.2 6.6 3.1 5.3 5.0 6.2 5.2 6.4 Programme 1.0 5.4 3.7 5.7 2.4 5.7 1.6 5.7 6.0 5.0 5.4 6.4 Structure Overall 2.6 5.0 4.1 5.3 2.8 4.7 2.8 5.2 4.4 5.3 4.3 5.9 Childcare Quality

ITERS-R (Crèche Rooms) Figure 3.3.3 shows the overall quality of the crèche rooms across the seven sites at baseline (pre-intervention) was rated to be an average of 3.4 out of 7 on the ITERS-R scale, a ‘sub-optimal’ score on the ERS ratings scale. Follow-up (post-intervention) ITERS-R results show greatest increases in ‘programme structure’ (+3.3) and ‘personal care routines’ (+3.1), followed by ‘learning activities’ (+2.6).

122 Figure 3.3.3: Overall Pre and Post ITERS-R Results by Sub-scale Overall ITERS-R Results by Subscale

Table 3.3.2 provides a detailed breakdown of each centre’s pre and post ITERS-R (crèche) results by sub-scale. ‘Language and Literacy’ and ‘Interaction’ recorded signifi cant results in post ITERS-R assessments (see Section 4.2). ‘Personal Care Routines’ signifi cantly increased in 5 EY centres: Centre 1 increased from a pre-ITERS-R score of 2.6 to a post score of 5.6 (+3); Centre 2 increased from a pre-ITERS-R score of 3.2 to a post score of 7.0 (+3.8); Centre 3 increased from a pre-ITERS-R score of 3.4 to a post score of 5.6 (+2.2); Centre 4 increased from a pre-ITERS-R score of 2.2 to a post score of 6.2 (+4); and Centre 5 increased from a pre-ITERS-R score of 1.6 to a post score of 4.8 (+3.2). ‘Programme Structure’ in three EY centres recorded signifi cant results: Centre 1 increased from a pre-ITERS-R score of 1.7 to a post score of 6.2 (+4.5); Centre 4 increased from a pre-ITERS-R score of 2.4 to a post score of 7.0 (+4.6); and Centre 5 increased from a pre-ITERS-R score of 2.4 to a post score of 5 (+2.6).

Table 3.3.2: Overall Pre and Post-ITERS-R Results by Sub-scale

Overall ITERS-R (Crèche) Results Centre 1 Centre 2 Centre 3 Centre 4 Centre 5 Sub-scale Pre Post Pre Post Pre Post Pre Post Pre Post Space and 3.5 4.4 4.1 5.2 2.2 4.7 4.2 6.4 3.2 4.2 Furnishings Personal 2.6 5.6 3.2 7.0 3.4 5.6 2.2 6.2 1.6 4.8 Care Routines Language 2.7 5.8 5.7 7.0 4.2 6.0 3.7 7.0 3.0 6.0 and Literacy Learning 2.0 5.8 4.3 5.9 2.6 3.9 2.4 6.4 2.8 5.6 Activities Interaction 4.0 6.4 6.5 5.5 5.9 5.0 4.5 7.0 3.8 7.0 Programme 1.7 6.2 3.7 5.5 4.0 6.5 2.4 7.0 2.4 5.0 Structure Overall 2.8 5.8 4.6 6.1 3.8 5.3 3.3 6.7 3.0 5.5 Childcare Quality

123 Table 3.3.3 Overall Childcare Quality Improvement Results Overall Childcare Quality Improvement

ERS TOOL Pre Post Overall Improvement ECERS-3 (PRE-SCHOOL) 3.5 6.0 2.5 ITERS-R (CRÈCHE) 3.5 5.9 2.4

Table 3.3.3 indicates the overall improvement in childcare quality across the seven EY centres following the implementation of the EY suite of capacity building programmes; Learning Language and Loving It™ (see section 3.2.4); HighScope Training; the Mentoring Programme, and Environmental Enhancement Funding.

Pre-ECERS-3 (pre-school) assessments recorded an average score of 3.5. This score was sub-optimal and highlighted significant improvements were needed in EY care and education in the YK community. Post-ECERS-3 assessment recorded an average score of 6.0, thus pre-school rooms across seven EY centres experienced an overall improvement of 2.5 in childcare quality.

Pre-ITERS-R (crèche) assessments recorded an average score of 3.5. Again, this score was sub-optimal and highlighted significant deficiencies in crècheooms. r Post-ITERS-R assessments recorded an average score of 5.9, thus crèche rooms across 7 EY centres experienced an overall improvement of 2.4 in childcare quality.

Significant improvements in such a diverse set of sub-scales, ranging from adult-child interactions to physical environments and settings, within such a short time frame highlights the hard work and dedication of EY educators in the seven centres.

124 Table 3.3.4: Summary of Quality Improvements in EY Centres ECERS-3 & ITERS-R - Overall Evaluation YK Catchment Area 2015-2017

Pre-Analysis Comments Post-Analysis Overview

Space & Furnishings • Reflect on room arrangement for learning • Indoor space is bright, clean and well-maintained, with comfortable across all rooms. furnishings and low shelves with easily accessible materials. • Reflect on your daily schedule, transitions and waiting time opportunities for • Display is relevant to current themes and includes photos of children. learning. Staff use this interactively with children making use of it during routines of • Consider how more areas meeting the the day. definition of interest areas could be created supporting choice and deeper • There are many items of interest displayed where children can see them. learning. • Consider provision of space for children’s personal items.

Personal Care • Reflect on greeting and departing. • Children are greeted warmly by staff in all rooms and departure is well- organised with time to speak to parents. Routines • Consider how staff sanitise the changing area after changing the children. • Handwashing, toileting and health practices were consistently followed.

• Reflect on how you can promote more • Staff are vigilant in their safety practices, reminding children of safe effective health and hygiene procedures procedures and giving reasons why. especially handwashing, and provision of drinking water throughout the session.

Activities • Reflect on availability of wide range of • There are many interesting materials for children to choose in all rooms. resources to support child-initiated learning and engagement. • There is good provision for fine motor development; art, blocks, dramatic • Reflect on provision of alternative role play, sand and water, and science and nature in toddler rooms. activities in toddler rooms, particularly in relation to art. • In pre-schools there are good accessible provisions for fine motor skills; • Reflect on provision of nature science blocks, dramatic role play. Musical instruments are freely accessible. resources and experiences in all rooms. • Reflect on provision for promoting diversity.

125 ECERS-3 & ITERS-R - Overall Evaluation YK Catchment Area 2015-2017 Table 3.3.4: Summary of Quality Improvements in EY Centres Pre-Analysis Comments Post-Analysis Overview

ListeningSpace & Furnishingsand • Reflect on howroom language arrangement can forbe learningadded • StaffIndoor talk space very eais bright,sily to children,clean and both well conversationally-maintained, with and comfortable as part of inacross response all rooms. to children’s communication. theirfurnishings learning. and low shelves with easily accessible materials. Talking • Reflect on rangeyour daily of books schedule, accessible transitions to • • Older children are asked to use their words when communicating with children and opportunities for them to and waiting time opportunities for • othersDisplay socially. is relevant to current themes and includes photos of children. accelearning.ss books supported by staff. Staff use this interactively with children making use of it during routines of • ReflectConsider on how quality more of areastalk outdoors meeting as the • Staffthe day. show older children that print carries meaning by writing down compareddefinition of to interest that indoors. areas could be what they say and reading this back to them.

Reflect on strategies to encourage • created supporting choice and deeper • YoungerThere are children’s many items communication of interest displayed is supported where by children adults whocan seecomment them. children’slearning. emergent writing and on what they are doing and ask simple questions during play and • opportunitiesConsider provision for children of space to observefor children’s staff routines. writingpersonal down items. what children say.

InteractionPersonal Care • Reflect on staffgreeting supervision and departing. of play and • StaffChildren are calm,are greeted kind and warmly warm by in stafftheir ininteractions all rooms and with departure children. is well- learning. organised with time to speak to parents. Routines • ReflectConsider on how children’s staff sanitise need forthe st changingaff to • Staff were fully involved with children throughout the entire session. activelyarea after and changing consistently the children.support • Handwashing, toileting and health practices were consistently followed. children’s self-regulation and behaviour. • Children’s peer interactions are supported, and staff encourage them to • Reflect on how appropriateyou can promote expectations more • playStaff togetherare vigilant and in totheir be safety considerate practices, toward reminding others. children of safe caneffective be matched health and to developmental hygiene procedures age. • Childrenprocedures with and additional giving reasons needs werewhy. seen to be accepted and valued, • Considerespecially if handwashing,more open-ended and provisionplay of staff supported them well. opportunitiesdrinking water could throughout be provided the session. to enable individualised teaching and • Staff show warmth and respect toward children and this is reflected in Activities • learning.Reflect on availability of wide range of • children’sThere are manypositive interesting behaviour. materials for children to choose in all rooms. resources to support child-initiated Programme • Reflectlearning on and the engagement. availability of materials in • ChildrenThere is good spent provision most of theirfor fine time motor in free development; play and there art, are blocks, plenty dramatic of free play and how these could be materials to use Structure • Reflect on provision of alternative role play, sand and water, and science and nature in toddler rooms. enhanced.activities in toddler rooms, particularly in relation to art. • TransitionsIn pre-schools and there routines are are good explained accessible visually provisions and verbally for fine bymotor interactive skills; • Reflect on howprovision free playof nature time scienceand useblocks, of the dramatic timeline role of theplay. session. Musical Children instruments area areactively freely engaged accessible. in the outdoorresources opportunities and experiences could in be all expanded rooms. use of this. • toReflect allow on more provision complex for promotingplay and learning. diversity. • Children had plenty of time to engage in free play. • Reflect on group-size, length and content of all sessions in order to match with • Younger children enjoyed group play activities, and these were flexible

developmental stage. and adjusted to match their age, needs and abilities.

126

3.3.4 HighScope Training Programme

HighScope is a quality approach to early childhood care and education which has been shaped and developed by research and practice over a forty-year period. Identifying and building on children’s strengths, interests and abilities, the curriculum is used internationally in a variety of settings including crèches, playschools and primary schools. The core belief of the HighScope approach is that children construct their own learning by doing and being actively involved in working with materials, people and ideas (Early Childhood Ireland, 2017).

Implemented across seven EY centres in the YK catchment area, HighScope training was delivered during the period of April 2016 to April 2017. Training consisted of: • A workshop at the beginning of each month; • Homework to be completed with the children during the month; • Assistance from an on-site EY Specialist Mentor who visited EY centres on a weekly basis.

Perspectives of the HighScope Training

Evaluation of the processes involved in implementation of the HighScope training programme aimed to answer the following questions:

1. To what extent do EY educators believe they have benefitted from the HighScope Training programme? 2. What enables/acts as a barrier to staff participation in the training? 3. To what extent have EY staff been able to implement HighScope strategies? 4. What enables/acts as a barrier to the implementation of HighScope strategies into practice?

Interviews used for this section of the report include: • One-on-one interviews with EY educators (n=11).

Thematic analysis of EY educator interviews resulted in the following themes and sub-themes:

Theme Sub-themes Programme Delivery • Programme structure and content • HighScope strategies • Enablers of implementation • Barriers to implementation Outcomes • Capacity building • Child outcomes • Quality improvement of EY service provision Collaboration • EY team building • Increased community engagement Recommendations for Improvement • Recognition of the value of EY educator training • Refresher workshops

127 Results Programme Delivery

Structure and Content Analysis of one-to-one and small group interviews with EY educators resulted in the emergence a number of themes. The structure of the programme, delivered via monthly workshops for twelve months and on-site mentoring in between sessions, was well-received by the majority of participants, one of whom reflected, ‘I really liked that way of delivering the training, having the classes and then the mentor to come and help you with actually doing the work with the children was great’. The break between workshops was beneficial to participants who used the time to implement changes and strategies, and to observe the effect of such changes on their individual centres. Another noted, ‘it was great to get the principles, to put them into practice, and to learn and see what works and what doesn’t’. The approach to the training by the workshop facilitator in monthly workshops was complimented by the majority of participants. EY staff commented on the encouragement they received from the workshop facilitator at the beginning of the programme, specifically, ‘she got us motivated and get you thinking, and you start feeling that you can make those changes, that things will work out better when you make them, and it did’.

Programme content was deemed appropriate and useful by all. For centres that had been using a different curriculum or who did not have any specific curriculum in place, the content of the HighScope training was praised as being ‘new’, ‘useful’ and ‘easily adaptable’ to each pre-school or crèche setting. In the EY centre where HighScope was previously in place, staff commented on the innovative content of the updated, YK-delivered HighScope training programme, and its benefits in term of refreshing old concepts. A staff member described how ‘we would be implementing a lot of the strategies already, however I found workshops related to interactions and routine really helpful, it allowed us to recap over those topics’.

HighScope Strategies Conflict resolution and strategies related to the management of children in tense situations was frequently referred to as being the most helpful topic covered in the training whereby, ‘we learned how to talk to the children, how to find out what the problem is and how to deal with it’. In terms of crèche employees, however, it was noted that although it was important to cover this topic for their professional development, it was slightly more difficult to implement the strategies into crèche rooms as children’s language and understanding is less developed. Nonetheless, crèche staff commented on the positive impact the HighScope strategies have had on the smaller children in their centres. One example included, ‘before we would have done everything for them, but now, for example, we are bringing them into the toilet and teaching them to wash their own hands’.

Enablers of Implementation Support and encouragement from EY centre managers to staff participating in the training emerged as the greatest facilitator to participation. Managers were praised for their role in motivating staff to participate and for organising cover for staff. One EY educator pointed out that ‘without our manager we couldn’t have completed the training, she was great’. Equally, the participation of some EY managers in the training appears to have had a significantly positive impact on staff’s experience of the training. 128 One EY educator explained, ‘we were all equal, it was lovely for us all to do it together, it has definitely made our team stronger’. Interview participants commented on a sense of increased support from their superiors and a feeling that all staff were on ‘the same page’ regarding the implementation of HighScope strategies. Furthermore, it was also noted that the greater the number of individuals taking part in the training from each centre, the greater the benefits,‘we were very lucky we all participated, I feel it would be a lot harder if one or two was doing it and you had to come in and explain it to the others’. Finally, the encouragement and support offered by the workshop facilitator and on-site EY Specialist Mentor instilled confidence in participants and was found to be a useful aid to participation, ‘it really kept us going’.

Barriers to Implementation EY educator feedback highlighted that the closure of centres to facilitate training, or the logistics of organising staff cover, was a major challenge for participants. They described the difficulty of having to cancel classes and explain to parent’s the reason for the closure or rearrangements, ‘it was really hard to explain to parents why we had to close’. Time was another major challenge to participation. Due to the limitations of the Early Years sector whereby staff are paid only for classroom hours, many participants took part in the training or completed the required paperwork and observations in their own time. One participant explained, ‘I did most of the paperwork and homework outside of work, that’s the only way I could get it done’. In addition, the time-consuming nature of the homework and assignments was frequently noted as a challenging aspect to participation, namely, ‘on top of all of our other work it was a bit stressful to get it done at times’. Finally, one centre highlighted the challenges they faced due to restrictions on the number of staff allowed to participate in the training and the pressure this put on those who were unable to take part, ‘it was hard on the other staff in the room, we were bringing all of this information back to them and they didn’t know what we were talking about’.

Outcomes

Capacity Building Capacity building of EY educators was a major theme that emerged from interviews. EY staff recalled how the training educated them on topics such as developmental delays in children, and provided them with a language to identify and discuss such issues, one with which they would not have been familiar. Most staff reported an initial sense of apprehension in terms of the benefits of the proposed changes to their centres. However, immediate visible outcomes observed in children’s behaviour and development motivated them to engage whole-heartedly in the programme. It was stated, ‘we didn’t know what to expect at first and didn’t know how useful the training would be but we saw such an impact to the changes, it was amazing’.

Child Outcomes Interview feedback highlighted the impact of the training on children’s behaviours. EY staff found behaviour in the classroom has improved since their participation in the training, noting, ‘before they would just play all day for you, now a structure has been brought in and they are learning… them being exposed to it [new strategies] has had benefits’. Similarly, EY staff noted the positive impact the HighScope strategies have had on children’s behaviours. ‘Although sessions are more structured now’, it was reported, ‘it is more child-led and there is a lot of freedom for the children which has

129 definitely had a positive impact on their behaviour’. Increased levels of confidence in children was also reported by participants who stated, ‘they are so much more independent now. They love making their own plan and choosing what to do’, ‘when it comes to tidy-up time we were doing it. Because of all the labelling and we have this new approach the children take more responsibility now’. Children’s learning and development was also found to be positively influenced,‘we would have a lot of children with needs and since adopting the HighScope we have seen huge effects; they are better able to communicate what they want to do because we have labels on everything now’. In addition, those interviewed also commented on the overall impact of the suite of quality improvement measures on children’s experience of EY education. One participant summarised, ‘I have been an Early Years worker for nearly twenty-two years and I have never seen children’s experience of pre-school improve so much as I have since our involvement in the HighScope and language training programmes’.

Quality Improvement in EY Centres EY educator interviews documented the impact of the HighScope training on service provision in the YK area. Interview participants described how the programme led to increased structure and routine in classrooms. One EY educator observed, ‘the kids are now able to see the day’s activities on the planning board, to identify their own hangers, and they now know where everything belongs as we have photographs on everything’. Practitioners reported using the strategies and skills learned on a daily basis, ‘we use them day in and day out, every day’. In conveying the benefits of the HighScope training on their individual centres, EY educators commented on how the changes have brought about visible improvements in their understanding of child development and their capabilities as Early Years’ practitioners noting how, ‘the training has completely and utterly changed our approach, it gave us a deeper understanding of what children’s developmental stages are, and more than that how to create an environment to suit their developmental stage’. One EY educator who had over twenty years’ experience in the childcare sector summarised what the training meant for her and the children in her centre, ‘I found my voice, I found how to talk to children and how to solve problems by talking. They have found their voice too, how to solve their own problems. This morning I watched as two children began to fight, they actually apologised to each other… before they would have just thumped each other and walked away’.

Collaboration

EY educators highlighted the professional links developed through the training among the staff from the seven EY centres describing how, ‘we have been working in the same area for years and don’t know each other. It was lovely to get to know everyone and to hear similar stories to ours from their centres’. EY educator feedback also recalled the positive impacts such increased inter-agency working had on the quality of EY care offered to young children in the YK area, ‘if we don’t have room in our centre, or maybe the child has particular needs that we don’t cater for, I give a call down the road and see if they can take the child’.

Recommendations for Improvement

Recognition of the Value of EY Educator Training EY educators noted the importance of capacity building training and felt this should

130 be included in EY educator contracts. As one interview participant stated, ‘recognition of the value of training and upskilling Early Years workers in the EY sector needs to happen’.

Refresher Training EY educators and managers alike frequently mentioned the need for continuous training or upskilling after completion of the HighScope training programme in order to keep their skills up-to-date and to ensure the strategies and skills built during the training continue to be used effectively going forward. ‘Refresher workshops’ or ‘monthly mentor visits’ were among the recommendations voiced.

EY Managers’ Feedback

Sources used for this section of the report include: • One EY service manager focus group (n=4); • One-on-one interview with the strategy 3 lead.

Thematic analysis of EY manager focus group and interviews resulted in the following themes and sub-themes:

Theme Sub-themes Programme Delivery • Background to implementation • Delivery and content Enablers of Implementation • Number of participants • EY managers’ participation • Nature of workshops • Video-taping • Whole-community approach Barriers to Implementation • Releasing staff • Initial obstacles • Homework Outcomes • HighScope impact • Child outcomes • Engagement and collaboration • Overall impact Recommendations for Improvement • Refresher workshops • Scheduling of training • Prioritising of EY staff

Results Programme Delivery

Background to HighScope Implementation EY manager feedback highlighted major gaps in terms of training in the EY sector prior to the development of the YK Programme, pointing out that ‘continuous training was always badly needed in areas like Knocknaheeny. It’s an on-going thing because in this sector, terms and conditions make it very difficult for Early Years staff to avail of continuous development programmes’. One EY manager noted that in the

131 development phases of the Early Year’s strategy, it was found that many centres in the catchment area were not using a specific curriculum,‘we started off not knowing what the centres in question needed exactly, so we asked ourselves let’s see if there is something everyone needs’. Feedback from EY managers highlighted that although some services were guided by a curriculum, others did not have the resources to conduct team training or improve their EY settings in line with such a curriculum with one saying ‘we did not have the funding to provide training to our staff’. On reflection of the opportunity provided by YK, one EY manager noted, ‘we are only a small service and curriculum training was something that we couldn’t achieve on our own, Young Knocknaheeny provided the opportunity and structure for us’.

Delivery and Content The approach to delivery of HighScope Training was praised by EY managers who felt that twelve sessions over the twelve-month period allowed staff to implement strategies in each room, observe changes, and report feedback to the on-site EY Specialist Mentor at monthly mentoring sessions, ‘rather than a week’s training, you would learn a little bit, try the strategies out, and go back in the next session and discuss it’. Conflict resolution was mentioned by EY managers as being one of the more important topics covered and one which had the most impact on child outcomes in their centres.

Enablers of Implementation

Number of Participants EY managers felt that the participation of numerous staff from each EY centre greatly aided HighScope implementation. As one EY centre manager noted, ‘all our staff participated, all in the one room so they were all singing off the same hymn-sheet’. In addition to facilitating information uptake, increased numbers of participants from each centre encouraged a whole-centre approach to adopting the changes, ‘it allowed the entire centre to become more consistent in their approach to the HighScope curriculum, we followed the same routine and on the same level, before the training we probably would have been a bit more sporadic in terms of how centre did things’.

EY Manager Participation EY manager participation in the training was also said to be an aid to programme implementation. Focus group feedback highlighted that due to manager participation they were able to ‘effectively support staff in the implementation of changes’. Furthermore, their taking part resulted in increased relational development between management and staff. One EY manager noted, ‘I did it to support the girls and if they are out I know I can step in anytime. It’s very important from their point of view to see me as well supporting that and actually being with them in the workshop and training with them... we did develop a really tight bond’.

Nature of Workshops The environment created by the HighScope programme facilitator and on-site EY Specialist Mentor was found to be another aid to implementation, ‘it felt like such a safe place to talk and learn’. EY managers noted how participants felt able to freely disclose what did or didn’t work for them and offer each other suggestions on how they might tackle an issue, ‘there was great camaraderie with the other centres and getting to know people from EY centres in the community, we all had the same issues, some maybe more than others, but we were able to discuss them freely’. 132 Video-taping The video-taping aspect of the training by the Mentor was found to be essential for EY educator’s uptake of information and understanding of HighScope concepts and strategies, ‘videos showed staff the areas where they needed to improve. When staff saw themselves doing the strategies and it was being acknowledged they were proud and motivated to keep going’.

Whole-Community Approach One manager noted in previous years their centre had attempted to implement the HighScope Training Programme, however, they faced difficulties being the only centre in the area using this approach to Early Years teaching. EY managers agreed that the whole community approach to change aided implementation which led to an increased quality of EY service provision in the YK catchment area, ‘there is quality and consistency in the area now’.

Barriers to Implementation

Releasing Staff Releasing staff for the training was noted by all EY managers as the most challenging aspect of engaging with the YK Early Years training initiative. Two EY centres found that the only option was to close for the twelve training days over the school year as ‘it was the only way we could enable staff to participate’. One EY manager noted, ‘I had a huge issue around closing the centres in the community, I thought children losing that number of days and in a community like this I felt that was wrong. I think more thought should have gone into setting a budget aside to have appropriate substitution’.

Initial Obstacles EY managers noted several challenges to programme implementation during the initial stages. The implementation of HighScope in one centre was received with apprehension as the pre-school was primarily Montessori. Following a decision that the crèche room staff only would receive the training, the centre also developed a transition programme for children moving from the crèche room into Montessori pre-school rooms. It was observed that ‘once we ironed out that difficulty we were completely behind having as many of our crèche staff trained as possible’. Similarly, two EY managers noted their initial reluctance to participate in the curriculum training as a number of staff were previously trained in HighScope. That said, it was deemed to be very different from previous HighScope training and was complimented for its new approach, ‘those who did HighScope before said this was nothing like the previous High Scope’, ‘it was definitely different to our previous approach… it was like new training, we got a lot from it’.

Homework Homework required as part of the HighScope training, in addition to mandatory daily reports in line with HighScope standards, was regarded as challenging by the majority of EY managers. As EY educators are paid for classroom hours only, homework was regularly completed in staff’s own time which was a concern to managers who explained, ‘they work so hard during the week and to see them bringing work home with them was a concern’.

133 Outcomes

HighScope Impact EY manager feedback highlighted significant positive outcomes in terms of EY educator service provision. The HighScope approach to Early Years education was new to many EY centres, ‘it completely changed our service delivery’, ‘it was definitely different to our previous approach, the girls are so more confident in the capabilities now, they are delighted with themselves’. Where HighScope was already in place, one EY centre manager noted, ‘it tightened and refreshed existing staff’s knowledge of the HighScope curriculum and having a mentor to guide their knowledge and correct any bad habits they had acquired since their last training’.

Child Outcomes Improved child learning and behaviour in EY centres was also noted, ‘the staff report they children are much happier in their environments. They enjoy planning what to do for the day and because of their role in doing this they enjoy tasks more and engage in learning more now’. This child-led approach to EY education appears to have led to marked improvements in child behaviour, ‘children appear more confident… previously a lot of conflict in the class would have stemmed from frustration of not being able to explain what they wanted or needed, now we have labels on everything that frustration has reduced a lot’.

Engagement and Collaboration Increased engagement and collaboration with other EY centre’s staff were found to be a significant outcome of the training. Noted on several occasions by EY managers, the general lack of communication between EY centres prior to the training hindered EY education in the YK area, ‘we have a lot more contact now with the other pre-schools’.

Overall Impact on EY Centres EY managers commented on the benefits of the training on each centre and one noted that ‘I can’t speak highly enough of the training, I have seen notable improvements since we started’. They described how their staff gained a significant amount of knowledge which has positively impacted on their daily practice, in addition to positive outcomes seen in the children, ‘staff are more confident, and children are happier’.

Recommendations for Improvement

Refresher Training Similar to EY educator feedback, EY managers also noted the importance of offering those who took part in the training to undergo a refresher session or masterclass so as to retain and expand on the valuable teachings they learned, ‘it would be great to prevent any loss of skills or as an opportunity for staff to check back in with the HighScope concepts and approach’.

Scheduling Training In a way to overcome the implications of centre closures, EY managers suggested that future roll-outs of HighScope training could be held on altering days of the week observing ‘the fact that training was on the same day meant that children that only come Mondays and Fridays would have lost twelve days which is a lot out of a thirty- seven week year’.

134 Prioritising Staff Another recommendation made by EY managers was to prioritise those who could not participate in the first round of training in future roll-outs. In relation to a staff member who did not receive training, one EY manager stated, ‘I would love if that staff member was trained soon because she’s bought into it as well and has learned so much just from seeing and hearing the staff that did take part’.

3.3.5 Mentoring Programme

Alongside the HighScope Training Programme, the Mentoring Programme consisted of weekly site visits by an on-site EY Specialist Mentor to assist each centre in developing and implementing a tailored plan to enhance quality stemming from the needs highlighted through ERS assessments. The mentor guided EY centres in their spending of environmental enhancement funds; in order to meet the requirements outlined following ERS assessments; and, assisted participants engaged in EY quality improvement trainings. Mentoring sessions afforded EY educators’ the opportunity to enhance their learning through discussing the challenges they encountered in the training. The mentor provided further explanation of HighScope strategies, and offered advice on how to overcome challenges and how best to implement the strategies in each EY site.

Results

Mentor Feedback Forms

During EY centre visits, the mentor sat-in on crèche and pre-school room sessions and observed EY educators, how they worked, their daily routines and their interactions with the children. Following each session, the mentor offered feedback via email to the EY educators participating in training. HighScope topics referred to in the mentor’s feedback included: daily planning; schedules and routines; observation writing; and labelling areas and materials. Each feedback form began by outlining the focus of the training and was followed by a critique of the EY educator’s delivery of each topic.

Evaluation of the Mentoring Programme via Mentor Feedback forms aimed to answer the question:

What support was provided to EY staff by the on-site EY Specialist Mentor?

Sources used for this section of the report include: • Mentor feedback forms (n=23)

Thematic analysis of mentor feedback forms resulted in the following themes and sub- themes:

135 Theme Sub-themes Observations Write-up • Structure • Language Reinforcing HighScope Strategies • Reflection • Planning schedules Managing Challenging Behaviours • Directions for behaviour management • Reinforcing HighScope strategies Developing Appropriate Language

Results

Observations Write-up

Structure A large focus of the feedback was on the topic of anecdote and observation write- up. By examining each participant’s paperwork, the mentor modelled the appropriate approach to observation write-ups by the detailing the correct or suggested edit in bold under the participants observation. The structure of anecdote write-up was encouraged by reinforcing the importance of including a beginning, during and end or outcome sections to their observations.

Language Language used by EY staff to explain their observations was also a large focus of the mentor’s feedback, ensuring the EY educator gave all necessary information through a clear and understandable explanation, for example, ‘During c/t, caregiver observes the child in the Home Area, as she places her hand on a dressing up dress. Caregiver says ‘“M”, you are putting your hand on the dress, would you like to put the dress on? “M” says “Yes”. Caregiver supports “M” in putting on the dress’. The mentor also regularly highlighted the importance of not including judgements or assumptions in EY educator’s observations, focusing solely on giving an account of what a specific child did or said, or the child interactions they observed.

Reinforcing HighScope Strategies

Reflection In addition to examining the write-up of the EY educators’ observations, the mentor used the feedback sheets as an opportunity to reinforce elements of the HighScope approach. In one instance, an EY educator described an incident where one child knocking over another child’s tower of blocks. The mentor asked the EY educator to use a core concept of the HighScope training and to reflect on why this happened,‘Why do you think the child knocked the blocks? Is she younger than the other child? What adult support does this child need?’

Planning Schedules Similarly, after attending a weekly session in one centre whereby the focus was on planning schedules and routines, part of the mentor’s feedback was to make time to sit with the children during snack time, ‘room educators, when the children are having their lunch, join them in having a piece of fruit or a drink’.

136 Managing Challenging Behaviours

Directions for Behaviour Management Clear directions on how to better manage challenging behaviours in the class was also offered in mentor feedback including, ‘these four steps will support each educator when interacting with child/children; name what the child is doing, repeat the words of the child, confirm the child by naming the child’s efforts, and show a good face in positive moments by smiling at the child’. In a more serious case, the mentor offered feedback via a report on a child who had behavioural issues and who regularly disrupted the class. The report offered step-by-step instructions to the EY educator and gave follow-up information on the adult-child interaction after the strategies had been implemented. ‘Over the next few months it was becoming clear that a proper structure and a good atmosphere supported “T’s” learning and development. The room educators supported “T” by: speaking in conversational tones and not always in corrective tones; selecting and confirming “T’s” best emotions; and, when “T” smiled, the room educators mirrored “T” face and built up a longer good moment by having an exchange’.

Reinforcing HighScope Strategies At the end of the report, the mentor used the following example as an opportunity to reinforce the concepts underpinning the incorporated HighScope strategies, ‘it is so important for “T” to see a good face in positive moments. A good face tells the child “I like having you around”. It shows the child that the educator in that positive moment is happy with him. When a child is not managing all he/she sees is that the educator is disappointed in the child. It is important to note here that “T” hugs the room educators quite regularly, building a bond of attachment’. Expanding on the topic further, the mentor stated, ‘when we look at a proper structure for “T”, it is important to also stimulate a child’s own internal structure as well as the structure provided by the external world’, and followed this with an example, ‘when you ask a child to tidy back materials, watch to see that the child can follow. When you see that the child manages with or without support, confirm with the child by name for example, ‘“J” you put the cars back in the basket’. Smile at the child.’

Developing Appropriate Language

The importance of incorporating specific language into EY educator interactions with the children was also reinforced via mentor feedback. In response to one EY centres ‘Schedule and Routines’ write-up, the mentor advised, ‘think about using the word ‘plan’ when coming in to a child’s play, for example if a child moves into the block area and starts to play with the blocks say, ‘”J” I see you are planning to play with the blocks’. Recall was also highlighted as an important element of child-adult interactions, as in the following directions outlined by the mentor, ‘you could mention: ‘during lunch “J”, you played with the blocks during choice time’ - smile, pause and wait for a response or not’.

Mentoring Programme: EY Manager and Educator Feedback

• EY managers focus group and interviews; • One-to-one and small group interviews with EY educators; • One-on-one interview with strategy 3 lead;

137 Thematic analysis of EY manager and educator feedback resulted in the following themes and sub-themes:

Theme Sub-themes Programme Delivery • Approach • Time Outcomes • Skills uptake • Aid to HighScope implementation

Results

Programme Delivery

Approach The on-site mentoring specialist was highly praised by EY staff across the seven centres. The mentor’s approach and dedication to participants over the course of the training was found to be essential for the implementation of HighScope strategies and retention of information. One comment noted ‘the mentor was able to really watch what was happening in the room and make sure it was at that level it was needed to be at and she was great and she really communicated well with everybody’. The encouragement provided by the on-site mentor from the onset was found to be a core motivating factor to participation, ‘she gets you motivated and gets you thinking, and you start feeling that you can make those changes, that things will work out better when you make them, and it did’.

Time

The time and effort given by the mentor to each centre was highlighted on numerous occasions, offering her time above what was required to assist with additional concerns that arose during the training. Those observations included ‘she was very good to me, she stayed back her with me some days, she didn’t have to, she gave her time to me and that was great’, ‘she was very available, sometimes beyond what was required, she put her heart and soul into supporting practitioners on the ground’.

Outcomes

Skills Uptake That delivery of concrete support at weekly site visits, in which the mentor explained and demonstrated the various skills and strategies, was found to be a significant contributor to skills uptake. For example, ‘the workshops were great, but it was having that time in the rooms with the girls that led to real quality improvement’. Centre visits were also found to facilitate intense discussion between mentor and participants regarding the challenges of the training and how best to overcome obstacles, ‘it wasn’t until the mentor saw the girls in action that they were able to identify participants strengths and areas requiring improvement’.

Aid to HighScope Implementation The mentor’s role in assisting with environmental changes taking place alongside the HighScope Training Programme was also found to be vital, ‘someone to overlook the numerous changes taking place and to oversee the changes in the new approach to curriculum was vital. The mentor’s role in terms of the effectiveness of the training and its

138 direct impact on the children was outstanding’. Finally, the mentor was credited by EY managers and educators for participant’s success in completing the programme, ‘the mentor’s role was pivotal and hugely beneficial, she got us over the line’, ‘the training would definitely not work without the mentoring piece’.

3.3.6 Environmental Enhancement Funding

As part of Strategy 3, the Environmental Enhancement Funding provided funds to each of the participating EY centres in order to upgrade their environments and materials in line with their needs arising from pre-ERS assessment results, and in order to effectively implement the HighScope curriculum.

Each one of the seven EY centres was very different in size and layout, and each required different resources (in line with pre-ERS assessment findings, section 3.3.3). Funding gave each EY centre the opportunity, using ERS recommendations and with the guidance of the on-site EY Specialist Mentor, to purchase the necessary resources. The process evaluation of the Environmental Enhancement Funding aspect of Strategy 3 aimed to answer the following questions:

1. What improvements have been made to EY settings and services? 2. How have EY staff perceived the benefits of the environmental enhancement programme?

Sources used for this section of the report include: • EY managers focus group (n=4); • On-site EY Specialist Mentor one-to-one interview; • Strategy 3 lead one-on-one interview.

Thematic analysis of the focus group and interview resulted in the following themes and sub-themes:

Theme Sub-themes Improvements • Resources purchased Aid to HighScope Implementation • Motivating participants Outcomes • Capacity Building • Outdoor spaces • Child outcomes • Overall benefits Results Improvements

Resources Purchased Across the seven sites, EY managers reported purchasing various resources:

• New flooring; • A garden canopy; • A steel outdoor storage unit for children’s bikes and outdoor equipment; • Rain overalls for children; • New tables, chairs and classroom furniture; • New books, stationery, and teaching materials.

139 At the time of the interviews, some centres had not spent all funds allocated to them. EY managers explained that they needed to reflect on how the remainder of funds could be ‘spent most appropriately to ensure HighScope can be implemented effectively going forward’.

Aid to HighScope Implementation

Environmental changes were described by EY educators as being vital for successful implementation of HighScope strategies into each EY setting, and for successful participation in the training programme itself, ‘we couldn’t have participated in the training without the funding’.

Motivating Participants Mentor feedback highlighted the impact of physical changes in terms of acting as a motivational factor to EY educator participation in the training programme, ‘they could see visual improvements very quickly, and they saw how these improvements positively impacted on the children, I think this helped them very much’.

Outcomes

Capacity Building EY educators felt that environmental improvements allowed for the development of different ‘stations’ in each room which positively impacted on staff’s professional practice, ‘we have a structure in the room now, how to get the most from our setting’.

Outdoor Spaces The increased focus of HighScope on the outdoors and recognition of the outside area as an important element of the classroom was praised by EY educators, one of whom observed that ‘the children are digging and planting flowers now, before they used to just go outside and jump on them, now they know to walk around them, they can see the flowers growing’. Similarly, EY manager feedback also highlighted the importance of funds dedicated to outdoor areas and outdoor play, ‘children are able to play outside due to the purchasing of rain gear, new flooring and furniture in classrooms, increasing the quality of teaching and educational environment overall’. Another EY manager reiterated this, stating, ‘the new improved outdoor area is like an extension, it’s like another room, it’s part of the classroom now’.

Child Outcomes EY educators and managers alike commented on the visible outcomes improvements had on child learning, development and behaviour. EY educators noted how the newly introduced outside learning experience has improved children’s motor development and sensory skills, ‘now they look, feel, and touch and say, ‘that’s hard’ and ‘that’s soft’… they would never have done that before’. Environmental enhancement funding was also credited with facilitating increases in child confidence and independence. Examples offered by EY educators included, children’s increased responsibility in cleaning up after themselves and placing objects in their correct places. Finally, staff from one EY centre summarised the contribution of the funding, ‘we got a new floor, chairs, and tables. We didn’t even have enough chairs at one time. If we weren’t involved in the programme we wouldn’t have these… we really hit the jackpot to be honest’.

140 Overall Benefits EY manager feedback summarised the importance of the funding to local EY centres. In relation to the garden canopy purchased in one centre, the EY manager explained, ‘this was an issue raised by pre-school inspectors in 2008 that the children did not have enough shade in our outside area, this cost €4,000 and was not something that could be easily purchased. When we were offered funding through Young Knocknaheeny it was like Christmas, it was a wish list of stuff we would have never had the chance to buy, it was fantastic’. Similarly, another EY manager commented on the reaction of the wider community to the changes, ‘parents are thrilled, and staff who normally wouldn’t come to this side of the school are popping in to see the changes. We wouldn’t have been able to afford the quality of flooring without the YK programme’.

3.3.7 Implementation Process of Strategy 3

This section of the report outlines the implementation of Strategy 3 over the three-year period. Table 3.3.5 details three columns; activities, short-term outcomes, and long-term outcomes; across each time point (2015, 2016/17 and 2018). From these we can track the evolution of Strategy 3, from 2015 to the end of 2017, and to assess whether the strategy has achieved its immediate goals (short-term outcomes) and ensured fidelity to its initial long-term aims. The 2015 YK logic model outlines the strategy’s initial short and long-term outcomes and the main activities proposed in order to achieve these goals. Work Plans from 2016/17 and 2018 give insight into successful activities, those not achieved, and those yet to be achieved.

Table 3.3.5: Strategy 3 Implementation Process, 2015 to 2018

See overleaf.

141 Table 3.3.5: Strategy 3 Implementation Process, 2015 to 2018

Strategy 3: Early Years Care & Education

2015 Logic Model 2016-17 Work Plan 2018 Work Plan (Long-term outcomes not outlined due to uncertainty of YK funding beyond 2018)

Short-term Long-term Activity Short-term Long-term Activity Short-term Activity Outcomes Outcomes Outcomes Outcomes Outcomes (by 2016) (by 2018) (2018+)

!School and Early !Wide and !Tailored training !To give a snapshot !Services can !Final ECERS & ITERS !Maintenance of !Managers meeting Years’ service imbedded and supports for of the quality of each implement and 2017 quality !Event Celebration practitioner’s awareness of Early Years service/room with use an !SBSRS Questionnaires improvement in !New sites to be capacity to and educators to meet regards to forty internationally Pre and Post the 7 EY settings approached, implement engagement action plan quality recognised, !HighScope Training and incorporation Faranree Early Start, language with early child targets. Services: measurements. !On-site Specialist of a further three Little Hands, Cushing high-quality development services by Engagement Early !EY services to make Mentor identified sites. House initiatives is mainstream curriculum. Years services; changes based on !Hanen LLLI Training !High scope training* enhanced. services, !A child’s Baseline ERS baseline results. !Transition protocols !Hanen LLLI !Increase in the parents and assessment (i.e. !Each room to be transition to between services and !Mentoring numbers of children community. national school taking up free pre- !Early Years ECCERS) of prepared for ERS post schools !Paper Submission at to be school year. settings are services carried assessments. !Promotion of EY conferences such as !Services are open delivering high- out Individual !YK scores will show supported by centres and valuable EECERA, OMEP and to training and quality service action plan for increase in school information. development Early Childhood programme across the each service readiness of pre- opportunities Ireland delivery. areas. !Environment school cohort from !Increase parental !Policy Position paper !Practitioners are improvement Sept to June. Engagement – from YK Evaluation undertaking funds !Staff and managers Services training and on- !Parents: are supported to fully !Environmental going mentoring Awareness and benefit from quality enhancement and are engagement improvement process. !Managers Meetings implementing process for early !A strong cohort of !Staff Supervision programmes. childhood Early Years staff to be !Research/ Policy !Data collection is education trained and able to Paper, OMEP / EECRA

taking place at a local level. !Data collection implement strategies

to impact S&L

development. 142

Activities Achieved (as of Dec 2017)

At the 2015 Logic Model time point, illustrated in Table 3.3.5, Strategy 3 initially aimed to achieve five main activities: • to conduct baseline assessments of the seven EY centres in the area; • to provide resources to each EY centre for centre improvements; • to provide a suite of quality improvement measures to seven sites which would result in the capacity building of EY educators; • to increase parental awareness of, and engagement with, the early childhood education process; and; • to engage in data collection.

The 2016-17 Work Plan highlighted successful implementation of baseline ERS assessments, the environmental enhancement fund, and capacity building in EY educators through HighScope Training and the Hanen Learning Language and Loving It™ Programme. The on-site EY Specialist Mentor assisted EY centres in their implementation of all quality improvement measures.

Data collection was on-going alongside EY educator capacity building programmes. As part of YK’s agreement with the Centre for Effective Services (CES), EY data was collected for the national evaluation via Santa Barbara School Readiness Scale (SBSRS) questionnaires.

Activities to be Achieved

Activities detailed in the 2018 Work Plan show increased efforts to maintain quality improvement across the seven EY centres through continued implementation of quality improvement measures. Recognition of EY centre’s participation in the suite of quality improvement measures and their achievement of such significant ERS follow-up results was proposed through the ‘EY celebration event’.

The 2018 Work Plan also highlights the aim of Strategy 3 to replicate the successful implementation of EY workforce capacity building training and quality improvement measures by extending the offer of training to three new sites located outside the YK catchment area. Additional activities such as ‘the dissemination of Strategy 3 findings and learnings through conference papers and policy papers’ are also noted at this time point.

Activities Not Implemented

Of note, the 2018 Work Plan also highlighted the activities proposed in the 2016-17 Work Plan that were not fully implemented. After initial plans to increase parental awareness and engagement in EY education, it was decided that this was not a no longer a major concern in the area following the introduction of the free pre-school year. EY centres in the YK area filled all available spaces, and many had waiting-lists for registration to the service. Similarly, the proposed 2015 and 2016-17 activity, ‘transition protocols between services and schools’, did not come to fruition. The NCCA was in the process of developing a national EY transition protocol and information-sharing tool, and in discussion with the local managers, it was agreed to wait for the national process rather than develop one specific to our locality that may not be in keeping with this. The National tool will be launched in the autumn 2018.

143 3.3.8 Key Findings and Learning

Table 3.3.6: Strategy 3 Key Findings Key Findings

1. Twenty-eight local EY educators participated in HighScope Training, ten of whom also trained in the Hanen Learning Language and Loving It™ programme (section 3.2.4);

2. Approx. 700 children indirectly benefitted from YK-delivered curriculum and language training programmes;

3. Pre and post ERS assessments showed significant improvements in the quality of EY services in the YK area following participation in YK’s EY quality improvement initiative;

4. Pre-school rooms across the seven EY centres experienced an overall improvement of +2.5 on the ERS scale, and crèche rooms experienced an overall improvement of +2.4.

Table 3.3.7: Strategy 3 Key Learning Key Learning

Feedback gathered suggests that the implementation of quality improvement measures was successful due to the following factors:

1. The buy-in and commitment of local EY educators and service managers; 2. The vital role of the on-site EY Specialist Mentor; 3. The evidence-based HighScope training programme; 4. Resources purchased through YK’s Environmental Enhancement Fund.

Feedback gathered suggests that barriers to the implementation of quality improvement measures included:

1. Difficulty of releasing EY staff for training; 2. Difficulty of EY educators to participate in training due to contract restrictions on CPD and training programmes.

144

3.4 Strategy 4: Pro-social Behaviour and Self-regulation

147

3.4 Strategy 4: Pro-social Behaviour and Self-regulation 3.4.1 Overview of Strategy

Strategy 4 of the Young Knocknaheeny (YK) Programme, Pro-social Behaviour and Self- regulation, involved the implementation of a suite of Incredible Years (IY) programmes through a whole-community approach to training parents and school’s staff in the YK catchment area. Co-ordinated by the Le Cheile School Completion Programme (SCP), the main objective of the strategy was to support the embedding of IY skills locally to reach a wider community of parents, teachers, and practitioners.

As part of Strategy 4, the following programmes are delivered: • IY Basic Parent Leader Programme Training,; • IY Basic Parent Programme (2 to 4 years and 5 to 8 years); • IY Teacher Classroom Management Training (TCM) Programme; • IY Whole Classroom DINA Training (DINA) Programme.

During the development stage of the YK Programme, consultation with the Young Ballymun (YB) ABC Programme resulted in the decision to implement the IY suite of programmes due to their successful implementation in the YB catchment area. The Basic IY Parenting Programme was chosen as the way in which parental support and capacity building would be implemented in the YK community. The Basic IY Parenting Programme aimed to further develop parent competencies around positive communication (Archways.ie, 2007).

The IY TCM and IY Whole Classroom DINA programmes were chosen as practitioner capacity building initiatives to be offered to staff from four primary schools in the YK catchment area. The IY TCM Programme is a prevention programme to strengthen teacher classroom management strategies and promote children’s pro- social behaviour and school readiness (Incredibleyears.com, 2018). Similarly, the IY Whole Classroom DINA Programme is a child training curriculum that strengthens children’s social, emotional and academic competencies such as understanding and communicating feelings, using effective problem-solving strategies, managing anger, practicing friendship and conversational skills, as well as appropriate classroom behaviours (Archways.ie, 2007).

3.4.2 Evaluation of Strategy 4

Implementation processes of the following elements of Strategy 4 are evaluated: 1. Incredible Years Basic Parenting Programme (see section 3.4.3); 2. Incredible Years Teacher Classroom Management Programme (see section 3.4.4).

Development of the overall strategy is evaluated in the following section: 3. Implementation Process of Strategy 4 (see section 3.4.5).

149 3.4.3 Incredible Years Parenting Programme Introduction

The IY Basic Parenting Programme was available to all parents and caregivers, with children aged three to seven years of age, residing in the YK catchment area and registered with the YK Programme. Participation in the programme aimed to develop parent competencies further, particularly in positive communication, for example using praise instead of criticism, limit-setting, as well as problem-solving and anger management (Archways.ie, 2007).

In 2015, the following actions were taken in preparation to deliver the IY Parenting Programme: • Fourteen practitioners from several services and organisations across the YK catchment area were trained in delivering the parenting programme through the IY Basic Parent Programme Leader Training; • An IY Parent Leader Facilitators Peer Group was established to support the roll-out of IY Parenting Programme rounds, to support the promotion of the programme, to assist with referrals to the programme, and to assist with the logistics of the programme’s delivery.

With supports in place, the IY Parenting Programme was rolled out in February 2016. Implementation of the IY Parenting Programme involved: • Weekly workshops held in the community over a fourteen-week period; • Facilitation by one YK team member and one member of staff from the Le Cheile SCP.

Prior to the beginning of each roll-out, facilitators met with parents individually to discuss their children’s and family’s needs, what the programme could offer them, and what they aimed to achieve. Throughout the programme’s duration, facilitators contacted participants regularly by phone, between weekly sessions, to provide support and encouragement in their attempts to implement specific IY strategies. After cessation of the programme, facilitators regularly made follow-up phone calls to participants to see if they require additional assistance or advice implementing IY strategies in the home. Due to the nature of the YK Programme, aimed at improving outcomes for children up to the age of six years, two parenting groups were established from 2015 to 2017 - one catering for parents of children aged three to four years and another for parents of children aged five to seven years. Furthermore, due to the commitment of the YK Programme to provide support and training to all families in the YK catchment area, the IY Parenting Programme was also offered to parents in the home, or alternative community setting, if family circumstances deemed their participation in a group unmanageable.

150 Research Questions Programme Reach Process Evaluation

1. How many parents have 1. What are the specific components taken part in the IY Parenting of the YK-implemented IY Parenting Programme? Programme? 2. How many children live 2. How have parents experienced in families where parents participating in the IY Parenting participated in the IY Parenting programme? Programme? 3. How have parents experienced implementing skills learned in the IY Parenting Programme at home? 4. What are parent’s perspectives of the impact of their involvement in the IY Parenting Programme in their home? Methodology Data Collection Programme Reach The YK administrative database was used to determine the level of engagement with the IY Parenting Programme.

IY Parenting Programme Proformas A quantitative questionnaire (see Appendix A) was developed by the YK research team to look at the support offered to parents participating in the IY Parenting Programme outside of weekly workshops, i.e. duration of consultation, intensity level of family at the time of consultation, referral sources, and supports and IY strategies offered to parents in the consultation. IY Parenting Programme enablers completed a proforma for every consultation with a parent (face-to-face or phone call), outside of the scheduled Parenting Programme workshops. These were conducted over a four-month period between August and November 2017 (n=15 families, 139 consultations).

Qualitative Data

Focus Groups: Two focus groups (n=12) were conducted with parents following the completion of two IY Parenting Programme rounds. Focus group questions were open-ended in nature.

Consent Consent was obtained prior to focus groups. All participants were provided with an information sheet and contact details of the Research Officer.

Data Analysis Microsoft Excel was used to generate data from the YK administration database. Proformas: IBM SPSS (20.0) was used to collate and analyse data from the purposefully developed IY Parenting Programme Proforma database. NVivo Pro 11.0 was used to collate qualitative data for thematic analysis. The Framework Method (see section 2.2) was used to guide thematic analyses.

151 Programme Reach

• A total of fi fty-one parents took part in YK’s IY Parenting Programme between April 2015 and December 2017; • Approximately 150 children in the YK catchment area live in families of those who participated in the YK-implemented IY Parenting Programme.

Figure 3.4.1: IY Parenting Programme Participation, Apr ’15 to Dec ‘17 IY Parenting Programme Participation

Process Evaluation IY Parenting Programme Proformas

This section of the report aims to answer the following question:

What are the specifi c components of the YK-implemented IY Parenting Programme?

Results

• Between August and November 20179,1 fi fteen families were provided with one-to- one support to enable them to participate in the IY parenting programme. • This support took the form of either phone calls or face-to-face consultation.

• A total number of 139 consultations were carried out.

Table 3.4.1: Duration of Consultation

0-30 min 31-60 min 1 - 1.5 hours 1.5 - 2 hrs Total

N % n % n % n % N

Face-to-face 17

Phone call 2 12 7 41 6 35 2 12 122

All 105 86 16 13 1 1 0 0 139 consultations 107 77 23 17 7 5 2 1

9 For the purpose of this research piece, data was collected for a four-month period in order to give a snapshot of the IY Parenting Programme in practice. 152 Source of Referrals The majority of families who received support were referred by either a community worker (7) or YK staff member (5). The remaining families were referred by a Public Health Nurse (1) or a social worker (1), and one family self-referred.

Type of Support Table 3.4.2: Type of Support Offered Concrete Emotional Developmental Advocacy IY Strategies Support Support Support

N % N % N % N % N %

Face-to- 4 27% 15 88% 13 81% 0 0% 17 100% face

Phone call 9 7% 90 74% 47 41% 5 4% 101 84%

All 13 10% 105 76% 60 46% 5 4% 118 86% In total, seventeen face-to-face and 122 telephone consultations were conducted. A further seventy-eight phone calls were attempted but remained unanswered and one was answered but rescheduled. All (fifteen) families received telephone support; thirteen families received face-to-face support. Of the thirteen families who received face-to-face support, eleven received one consultation and the other two received three consultations. Most phone calls (86%) lasted thirty minutes or less, while the majority of face-to-face consultations (76%) lasted between thirty-one minutes and one-and-a-half hours (see table 3.4.1). All face-to-face consultations and the majority (84%) of phone calls offered support to families on the implementation of IY strategies. ‘Emotional support’ was the next most common type of support. This was offered in 88% of face-to-face consultations and 74% of phone calls. ‘Advocacy’ was the least common type of support, offered in 4% of phone calls only. Full details of the type of support offered are outlined in table 3.4.2.

Table 3.4.3: Type of IY Strategy Reports as Used by Parents at Each Consultation Face-to-face Phone call Total

% (n) % (n) % (n)

Special time/play 47% (8) 78% (94) 74% (102)

Social, emotional & 29% (5) 59% (71) 55% (76) persistence coaching

Praise & encouragement 24% (4) 51% (62) 48% (66)

Tangible rewards 18% (3) 36% (43) 33% (46)

Rules, responsibility & 18% (3) 31% (38) 30% (41) routines

Clear limit-setting 12% (2) 23% (28) 22% (30)

Ignoring misbehaviour 12% (2) 20% (24) 19% (26)

Time out to calm down 6% (1) 13% (15) 12% (16)

Other consequences 6% (1) 12% (14) 11% (15)

153

‘Special time/play’ was the most commonly reported IY strategy used by parents, having been reported in 74% of all consultations. Full details of IY strategies used are outlined in table 3.4.3.

Table 3.4.4: Intensity Level at Time of Consultation

Low Medium High

Face-to-face 41% (7) 47% (8) 12% (2)

Phone call 64% (78) 26% (32) 10% (12)

Total 61% (85) 29% (40) 10% (14)

Most consultations were of low intensity (61%) with only 10% of all consultations being of

high intensity (see table 3.4.4).

Parent’s Experience of Participation in the IY Parenting Programme

Interviews used to inform this section of the report include: • Two focus groups (n=12);

The evaluation of parent’s perspectives of participation in the IY Parenting Programme aimed to answer the following question:

1. How have parents experienced participating in the IY Parenting programme? 2. How have parents experienced implementing skills learned in the IY Parenting Programme at home? 3. What are parent’s perspectives of the impact of their involvement in the IY Parenting Programme in their home?

Thematic analysis of focus groups and interview transcripts resulted in the emergence of the following themes and sub-themes:

Theme Sub-themes Programme Implementation • Structure • Delivery • Course content • Reason for participation Enablers of Implementation • Programme facilitators • Safe space for discussion • Programme schedule • IY Strategies Barriers to Implementation • Teaching materials • Buy-in of teachers • Programme name Outcomes • Parent capacity building • Child outcomes • Repairing relationships • Social ties • Impact on parenting and family life

154 Theme Sub-themes Recommendation for Improvement • Increase visibility • Rethink programme name • Scheduling

Results from IY Parenting Programme Focus Groups

Programme Implementation Structure Focus group feedback suggested that the structure of the IY Parenting Programme was well-received by most participants. In terms of the programme’s duration, parents felt that, although fourteen weeks was thought to be quite long when they initially started, that amount of time was needed to trial the strategies with their children at home, to adjust their approach if a strategy was not working, and to successfully complete the course as, ‘you needed that time to try everything, some things took longer than others or you needed to go back and try them again at a later stage’.

Delivery Participants complimented the way in which the programme was delivered in line with the school year as they used the time during school holidays to implement the strategies learned in each session, ‘sometimes trying to implement the strategies after school in the evenings was difficult because my son was tired from the day so having that time while he was on school holidays was great, it gave you a chance to use what you were learning and to try the strategies’.

Course Content The content and information delivered in the workshops was well-received by focus group participants who found the approach to delivery very helpful for information uptake; ‘they explained the topics and strategies really well, they gave good examples that helped us to relate to the information they were teaching us’. The flexible nature of the course material was also described by parents as being ‘very useful’. Parents also noted that if one strategy was proving too difficult to implement, facilitators regularly advised how to adjust the specific strategy to suit individual children or situations. Feedback revealed, ‘if one thing didn’t work in our house, they found a way for us to change it a bit and try other another way of doing it’.

Reason for Participation A wide range of reasons motivated parents to sign up to the programme. Managing children’s challenging behaviour was the most common reason for participation, with one parent pointing out ‘my child was very aggressive toward me and his siblings, so his school suggested the programme’. Other reasons for taking part included parental support with managing child diagnoses such as dyspraxia and autism. One parent offered an example of how her child’s school recommended taking part in the programme due to a marked decrease in his confidence following a dyspraxia diagnosis, ‘his confidence became so low, he couldn’t do normal, everyday things anymore’.

155 Enablers of Implementation Programme Facilitators The support and encouragement provided to participants by the programme’s facilitators throughout the fourteen weeks was reported as being vital for their successful completion of the programme. Comments included how ‘the ladies were brilliant, they were always there for us and very kind and understanding’, ‘I couldn’t put into words how great they were, they were just brilliant’. The availability of facilitators was praised by participants who described being able to contact them anytime if they required help implementing the strategies, ‘They advised me and supported me, they motivated me to stick through it and that it will work’.

Safe Space for Discussion The development of trust and understanding between facilitators and parents was recorded. Focus group participants commented on the openness of facilitators who spoke on occasion of the difficulties they faced as parents and the struggles that they encountered. This enabled participants to speak more openly about their issues without fear of judgement. The group setting being a safe space for discussion was reiterated by focus group participants, ‘we all make mistakes and it was nice to hear they make mistakes as well and we’re not the only ones. They were very supportive’. In summarising the impact that the Parenting Programme had on parents in the area one principal stated, ‘for me the IY Parenting Programme has created very positive relationship between a number of parents who participated and the school… we have noticed that parents interact better with the school, they now come to us looking for advice and guidance, they know we are not there to judge them’.

Programme Schedule The scheduling of the programme, in line with the school year, was imperative for the embedding of strategies into family life and routines. Elaborating on the importance of school breaks, parents explained that holiday periods were not only necessary to implement skills and strategies but were also times when these strategies were required most. As one parent stated, ‘when they are off school for the full week is when you actually need to use them more as you have to constantly keep the kids busy’, ‘when you had more time during the day it gives you the scope to practice and try things out’.

IY Strategies ‘Naming the Praise’ was reported as having a significant impact on children’s behaviours in the home. Parents described this as praising children in the ‘right way’, for example ‘good girl for cleaning your room’ instead of ‘you’re a great girl’. ‘Naming emotions’, encouraging children to identify their emotions, was noted as another useful strategy. One parent commented on the positive effects she experienced after changing the ‘naughty step’ to ‘time-out’, ‘I changed the naughty step to a time- out, it’s still pretty much the same but putting a more positive name on it has made a difference’.

156 Barriers to Implementation

Teaching Materials Focus group feedback suggests that the most challenging aspect of the workshops was the vignettes (video teaching materials) shown to the group. Participants felt that due to their dated nature, they couldn’t relate to video content and this hindered their ability to fully understand the intended message, ‘they were so old… there was a message in them, but we were so distracted by how old they looked… and we couldn’t hear or see them properly’.

Buy-in of Teachers A significant challenge noted by one parent was the lack of understanding by her child’s teacher of the IY Parenting Programme. It was reported that the teacher was unwilling to use the IY strategies being trialled in the home (namely praising and positive reinforcement) with the child in the classroom in order to manage behavioural outbursts. One focus group participant recalled, ‘this really damaged the progress I was making with my son, he would come home upset, it totally went against everything I was learning in the programme’. It is important to note that this child was not attending a primary school within the YK catchment area which was engaged in the IY TCM practitioner capacity building programme (see section 3.4.4). However, such feedback is important in terms of highlighting the impact gaps in communication and understanding between services can have on children and parents. Continuity in approach to behaviour management across all areas of this child’s life was not present, which was found to hinder the impact of the parent’s participation in the IY Parenting Programme.

Programme Name Focus group feedback also highlighted initial concerns about participating in a ‘Parenting Programme’. The programme’s title appears to have dissuaded parents from taking part. Many explained how they were put-off the idea of engaging until the programme’s facilitators explained what the programme entailed. One argued that ‘the whole idea of a ‘parenting class’ threw us a bit… I talked to the facilitators and they filled me in on what we would be covering and what the programme was about’.

Outcomes Parent Capacity Building Capacity building in both parents and children emerged as a significant theme when analysing focus group transcripts. Parents regularly recalled and named strategies and gave background information on how and why the strategies worked, demonstrating their level of understanding. The educational aspect of the Parenting Programme and the practical information given to participants was praised by those who would have not come across the topics and concepts previously. Education on self-regulation and emotional awareness of both parent and child – the ability of their children to be more aware of their emotions and better able to regulate their emotions was an important aspect to participants. One revealed how ‘my little guy used to get frustrated, sometimes he would hurt himself and get angry but now he is more aware and he might come in and say, ‘I feel angry’… instead of screaming and shouting he knows what’s wrong with him’.

157 The challenging aspect of implementing strategies and their sometimes time- consuming, trial-and-error nature required parents to employ a significant amount self-discipline, ‘trying to start something new with a child or trying something different and it doesn’t work, you have to keep at it although it’s hard to keep trying when you are getting knocked back’. The necessary persistence and determination had a significantly positive impact on parents who felt that they were now able to be firm with their children and achieve positive results, ‘some days are easier than others to put the information learned into practice…. However, I am more aware and calm now as a parent’. On a similar note, participants reported being more patient and better able to handle tantrums and challenging experiences.

Parents also reported achieving greater insight into their own emotions, finding better ways to handle their frustration with their children in challenging circumstances, ‘I used to panic before and lash out but now I am not like that’. In line with this, other parents explained how they began to praise themselves more, as well as their children, following the programme, ‘during the day you are counting to ten and thinking to yourself to relax instead of giving out, I am proud of myself by the end of the day’.

Child Outcomes A strong sense of capacity building in children was also recorded. Several focus group participants described how their children have shown increased levels of confidence and self-esteem following the introduction of ‘special time’ into their daily routine. One observed how ‘my daughter really benefitted from special time, she loved it and she really needed it’. This increase in self-esteem has had knock-on effects in terms of children’s behaviour also, ‘since we have become closer, he knows now if he shouts that he will not get his way, so now he has started to speak lower. He is regulating his emotions a lot more now’. Child behaviour and social and emotional development were also found to be positively impacted, ‘my lot are so much calmer now. They actually understand that they can’t behave the way they used to and know why too. I can actually have a conversation with them, explain to them what they have done wrong and they learn from it’.

Repairing Relationships Participation in the Parenting Programme was also found to have a positive impact on repairing relationships, either between the parent and child or between siblings. One parent stated, ‘my house is definitely a lot calmer. I have a child who is really hyper and his only way of expressing himself was by acting out. We are naming this now at home, we use our calm voice’. Most focus group participants noted a positive effect on their approach to parenting since completing the programme. Many felt they had acquired a new set of tools to support and guide them in using the strategies, ‘it’s like I am confident now that I know the right thing to do and how to do it’.

Social Ties The social aspect of the group appears to have been a significant outcome of the Parenting Programme. Participation offered parents the opportunity to form relationships with other parents in the area and to build stronger ties in the community. One parent discussed such benefits outlining how‘we lived so close and didn’t know each other, now we are on a WhatsApp group and meet for coffee’. The nature of the programme, whereby participants shared very personal information about the acts as a barrier they faced to managing their child’s behaviours, resulted in the development of strong bonds throughout the group and the creation of a network of support in their 158 community which would otherwise not have developed, ‘I felt I could say anything. There was no one judging me or laughing at me’. This community interaction and the development of new friendships gave parents peace of mind about the issues and problems that they faced. Parents felt they could use the group as a platform to discuss their children’s issues without judgement as most others in the room had experienced a similar issue or situation previously; ‘everyone has a problem at the end of the day, but you think it’s just you. Until you hear someone else’s opinion and they are going through something as well, so you are not on your own’.

Impact on Parenting and Family Life Participants noted that the new approach to parenting had a visibly positive impact on the family overall. Parent’s ability to better manage challenging behaviours resulted in a more pleasant home environment and increasingly happier children. ‘After a few weeks the whole family seemed to benefit, the house was so much calmer’, claimed one parent. ‘Special time’ was found to be the IY strategy which had the greatest impact in the home, ‘I found special time has improved my relationship with my son. I used to always play with him but during the special time it makes you feel that the child is more important and spending time with him brings you closer as well’. One focus group participant summarised the effects of the group on her overall parenting approach by describing how great it felt in the evening to realise that she had not reacted negatively to her children for an entire day, ‘At bed time I say to myself, I reacted well today and because I reacted well the kids have had a good day, they were in good form because I didn’t give out to them. You feel so good about yourself for not reacting, and because of that the kids didn’t react’. This sense of pride has also been found to positively impact on daily family life, ‘we start the day being positive’. Overall, the benefit of the programme appears to have been significant. One principal commented, ‘a number of parents of children in the school have taken part in the IY Parenting Programme and so in a number of instances we have noticed that the parents themselves are better able to interact with the school’.

Recommendations for Improvement Increased Visibility Stemming from the barriers listed above, focus group feedback suggested that increased communication by the YK team with the YK community is needed to inform prospective parents about the Parenting Programme and its benefits. A number of participants mentioned having no previous knowledge of the Parenting Programme, and some noted not having heard of the YK Programme, ‘I would never had known it was in the community, a neighbour told me to get involved’.

Rethinking Programme Name Furthermore, advertising the programme as a ‘parenting course’ has been found to discourage parents from taking part. Labelling the programme as a parenting course appears to convey that parents are inadequate in this role and require training. One focus group participant suggested that YK use a more positive approach to advertising the Parenting Programme by using a tag line such as ‘making the young years count’ or ‘helping parents to help their children’.

Scheduling Although most participants were happy with the duration of the Programme, some noted that the timing could be changed slightly to tie in with dropping children to 159 school. Workshops started at 9:30 in the community, however, parents felt that as they dropped children to school at 8:50 they had to wait for 40 minutes for the programme to start. Suggestions of a 9am start time were voiced. Focus group participants also suggested that YK could hold top-up workshops for parents who took part, in order to refresh IY concepts and strategies and for parents to check back in with facilitators to discuss the challenges they have encountered since cessation of the programme.

Finally, greater communication between IY Parent Programme facilitators and local primary schools is required. Teachers can play an important role in supporting parents involved in the Parenting Programme by understanding the strategies that are being trialled at home and considering these when engaging with the child in the classroom.

3.4.4 IY Teacher Classroom Management Programme

Introduction

The IY Teacher Classroom Management Programme is a prevention programme to strengthen teacher classroom management strategies and promote children’s pro- social behaviour and school readiness (reading skills) (Incredibleyears.com, 2018). The programme has been shown in control group studies to reduce classroom aggression and non-cooperation, and promote peer interaction, school readiness, and enjoyment with school activities (archways.ie, 2007). It focuses on the ways teachers can effectively collaborate with and support parents’ school involvement while promoting home-to-school consistency (Incredibleyears.com, 2018). The IY TCM was selected for implementation by YK as it was felt that having strategies implemented by teachers and parents through availability of the Parenting Programme and TCM would result in a whole-community shift to incorporate the strengths-based positive approach to helping children regulate their emotions and engage in a positive way in school, at home and in their community.

The IY TCM programme is available to the staff of four local primary schools in the YK catchment area. Training is overseen and co-ordinated by YK’s Strategy 4 lead. Training is delivered by Archways81 facilitators via monthly workshops over a six-month period.

Research Questions

Programme Reach Process Evaluation

1. How many schools’ staff have 1. How have schools’ staff experienced been trained in the IY TCM participating in the IY TCM Programme? Programme? 2. How have schools’ staff experienced 2. How many children were in the implementing IY TCM strategies? classrooms of staff trained in 3. What are teachers’ perspectives of the the IY TCM Programme? impact of their IY TCM training in the classroom?

8 Archways is a national organisation which was developed to promote the roll-out and evaluation of the Incredible Years programme in Ireland. For more information visit http://www.archways.ie 160 Methodology

Data Collection

Programme Reach The YK administrative database was used to determine the level of engagement with the IY TCM Programme.

Qualitative Data Interviews: • Small group interviews and one-to-one interviews were conducted with participants of four rounds of the IY TCM programme (n=10, 8 teachers and 2 principals) • One-to-one interview was conducted with the Strategy 4 Lead • Interviews were semi-structured in nature and lasted approximately forty-fi ve minutes

Consent Consent was obtained in writing from all practitioners prior to each interview and focus group. Participants were given an information sheet detailing the purpose of the interview/focus group which included the Research Offi cer’s contact details.

Data Analysis

Microsoft Excel was used to generate data from the YK administration database. NVivo Pro 11.0 was used to collate qualitative data for thematic analysis. The Framework Method (see section 2.2) was used to guide thematic analyses.

Programme Reach

• Seventy-two schools’ staff participated in four rounds of the IY TCM Programme between April 2015 and December 2017; • Fifty-one teachers, thirteen SNAs, fi ve School Completion Programme workers, two principals, and one Home School Liaison Offi cer have completed the IY TCM training; • Approximately 2,500 children across the four schools have benefi tted from the involvement of teachers, SNAs and principals in the IY TCM Programme.

Figure 3.4.2: IY TCM Programme Practitioner Participation, Jan ‘15 to Dec ‘17

IY TCM Participation by Year

161 Figure 3.4.3: IY TCM Programme Participant Breakdown by Profession, Jan ‘15 to Dec ‘17

IY TCM Participation by Profession

Process Evaluation

Sources used for this section of the report include: • Ten primary school’s staff one-to-one interviews; • Two principal one-to-one interviews.

Thematic analysis of interviews resulted in the following themes and sub-themes:

Theme Sub-themes Programme Implementation • Structure • Course content • IY Strategies Enablers of Implementation • Programme structure • Overall availability of training Barriers to Implementation • Organising staff cover • Homework • Number of participants per roll-out Outcomes • Engagement and interaction • Child outcomes • Impact on practice Recommendations for Improvement • Greater Consideration by Co-ordinators • Information Sheets

Results

Programme Implementation Structure The structure of IY TCM Programme delivery; monthly workshops with three weeks in the interim to trial the suggested strategies and work plans; was well-received by the majority of school’s staff interviewed. One teacher commented, ‘I really liked how the programme was laid out, focusing on one or two topics each week, and being able to trial them for the remainder of the month in class’. On refl ection, participants involved in the fi rst roll-out of the training; which was delivered via six workshops over a six-month period; suggested that the training could have been delivered in fi ve monthly sessions 162 instead of six. On this feedback, the following four roll-outs took place via five workshops over a five-month period. Participants described how the time in between sessions was essential to implement and trial specific strategies as,‘it allowed us to put our work plans in place, to use the strategies learned on the specific group we were working with, and to see what worked and what didn’t’. This structure was compared to other CPD programmes and the importance of having the opportunity to test strategies and report back to the facilitator on their effectiveness or ineffectiveness was highlighted, ‘I much preferred this structure compared to other courses where you get all the information in one go’.

Course Content Each training session focussed on a specific topic. For most participants interviewed, the training was very useful, and the content was easily trialled and delivered in each of the four schools; ‘everything was very useful and practical, and you could apply it easily’. The flexibility of the strategies and their adaptable nature allowed participants to deliver them to a child or group of children in the class. One participant noted, ‘we did out a behavioural plan after the first workshop. We had to choose a particular child or group in the class to work with, some people stuck with the same group but if there was enough of an improvement we could change group or focus if a child presented with behaviours’. For newly-qualified teachers who had recently graduated, much of the content was known and a lot of the strategies were already in place in their classrooms. Interviewees noted, however, that the training was particularly useful as a refresher of behavioural management concepts, ‘everything was very practical, simple and easy to use and you could apply it in the classroom easily. It was definitely worthwhile revisiting the concepts again’.

IY Strategies Strategies such as building relationships through praise and encouragement and being specific about praise by not stating general comments such as‘good girl or good boy’, are reported as being the most useful strategies delivered in the programme. Another useful strategy named was ‘relaxing and reflecting time’for children. This was implemented in a number of classrooms across the four primary schools as a replacement for the ‘time out chair’ and appears to have had a significantly positive impact on children with behavioural issues, ‘the kids use this time now to do something more positive, they may just take a few deep breaths in and out’, ‘those with challenging behaviours actually seem to be using this time to think about things rather than just sit in a huff’. Similarly, sending ‘positive’ notes home to parents detailing the child’s good behaviour in class, and the idea that punishment is the last option after attempting to implement the numerous behaviour management strategies, were additional strategies complimented by interviewees, including one who noted ‘I just think highlighting good behaviours to parents is such a lovely idea’. Similarly, one resource teacher noted the importance of such simple strategies and the impact they can have on the class, ‘I loved easy strategies for my group. Trophy of the Day, whereby a student would receive a trophy at the end of the day to display on their desk the following day, was a very simple and practical idea but was very effective’.

Enablers of Implementation Programme Structure The main aid to implementation noted in participant’s interviews was the structure of the programme. Focusing on one or two topics per week gave participants the 163 opportunity to implement the strategies in their classrooms, ‘you came away from the workshop with the topic clear in your mind, and you’re given ample time to implement the various strategies over the three weeks’.

Overall Availability of Training Principal feedback also highlighted the importance of the number of school’s staff that participated in the training overall and the benefit this can have in terms a whole school approach to adopting and implementing the training, ‘almost every teacher in the school has completed the training. I did the training myself and likewise all the SNAs. So basically, the way we’re looking at it is, if we adapt the Incredible Years program it should permeate right through the whole school and there should be a similar approach from all the teachers and all the SNA’s and all the staff. It has been fantastic’.

Barriers to Implementation Organising Staff Cover The logistics of organising cover or dividing children into groups to be allocated to different classes for the day of training was reported to be ‘time-consuming’ and to have added to staff’s workload, ‘I suppose organising cover and work for the children was the most challenging aspect of taking part’.

Homework Organising time within their schedules to complete homework for each session was reported to be an obstacle to participation, ‘there just wasn’t enough time some months, I felt I was doing it on my lunch break before the workshop’. Furthermore, many interviewees reported completing the required homework in their own time at weekends as they were fearful of not having their homework complete as this was not well-received by facilitators on occasion, ‘I was so afraid of not having it done that I would do it on a Saturday or Sunday’.

Number of Participants per Roll-out Due to the size and capacity of some schools in the YK catchment area compared to others, participants from a larger school noted the difficulty they faced due to the training not being offered to all members of staff, ‘it would have been great if the training was offered to more of the staff so we could implement the strategies at the same time’. One school teacher commented on the extra work which resulted from participation in order to relay the strategies learned in the training to the SNAs in the classroom, ‘I work with two SNAs and I had to come back from the workshop and try to explain the new strategies to them too. I think it would be great if all infant teachers and SNAs could do the programme together and come back to the class with the same levels of enthusiasm’.

Facilitators Those who participated in the first roll-out of the IY TCM Programme commented on the visible tension between the two facilitators who delivered first roll-out of the training. This appears to have hindered the successful uptake of information in many of the sessions as staff reported that the facilitators often offered conflicting methods and advice, ‘they were not approachable. They didn’t seem to have a good relationship’. That said, participants of the remaining three roll-outs did not encounter this.

164 Inclusion of Management Finally, another challenge noted was the difficulty participants faced when management staff (principals and vice principals) took part in the training. Workshops often required staff to discuss difficult or challenging behaviours they have experienced in their classes and the attempts made to manage those behaviours. With management present, participants sometimes felt unable to disclose full information to the group about how they managed such behaviours, ‘I know personally as a young teacher on a temporary contract, it can be very difficult to share feedback of stressful cases as I don’t want it to look like I can’t cope’.

Outcomes Engagement and Interaction Participants noted the benefit of the IY TCM Programme in terms of engaging with other teachers and school staff in the area. Many participants felt that although they worked in close proximity, schools rarely interacted with each other and the programme gave them an opportunity to do this, ‘I think it was a brilliant opportunity to meet junior and senior infant teachers in the area’. This interaction was not only important to make ties and links with other schools but also as a teaching aid as some teachers comment on the usefulness of hearing the experiences of other colleagues and how they faced challenging behaviours and situations, ‘we would share ideas on what strategies worked and what did not, it was great to hear their stories too’. As has been found across many capacity building aspects of the YK Programme, building relationships and creating networks helps to foster communities of continuous learning.

Child Outcomes Participant feedback frequently reported how the children quickly and very naturally adapted to the new strategies delivered in the classroom. It was stated that ‘after a few weeks the kids really bought into the strategies and we could see huge improvements both in the class and playground’. One school teacher described how the children in her class did not previously know what the word ‘concentrating’ meant, and how following the implementation of quiet time and increased use of the word by the teacher, resulted in the children telling each other to ‘concentrate more’ throughout the day. Equally, staff also commented on the effectiveness of using behavioural templates in the class for students with more challenging behaviours, ‘I am a resource teacher and the strategies were just as applicable to that setting as a larger class’.

Impact on Practice Classroom teachers reported using the concepts and strategies learned through the IY TCM Programme on a daily basis, ‘we use the strategies learned in the TCM Programme an awful lot, every day throughout the day’.

Recommendations for Improvement Greater Consideration by Co-ordinators A number of participants interviewed suggested that greater consideration should be given to co-ordinating the IY TCM Programme so that teachers and SNAs who work in the same room can train at the same time. ‘We could implement strategies together, we could assist each other in the learning, but it would also help us to deliver more

165 effective behavioural management strategies to the children’, stated one individual. Participants also felt that greater communication between programme co-ordinators and staff in management roles could take place going forward in relation to the openness of the programme pointing out that, ‘maybe if we could be assured that the workshop is a safe and confident space for discussion’.

Information Sheets Participants felt that more support could be offered to alleviate the pressures on teachers who must return to the classes and educate colleagues on the IY TCM Programme and its strategies. Several classroom teachers suggested providing information sheets for members of classroom staff not able to participate in particular rounds of training, ‘if participation is limited to a number of staff per school, information sheets should be provided to those not taking part in order to understand the strategies being trialled in their classroom and school in general’.

3.4.5 Implementation Process of Strategy 4

Table 3.4.5 outlines the implementation of Strategy 4 over the three-year period. Through examining activities and outcomes across each time point (2015, 2016/17 and 2018), we are able to track the evolution of the strategy from 2015 to 2018 and to assess whether the strategy has achieved its immediate goals (short-term outcomes) and ensured fidelity to its long-term aims. The YK Logic Model (2015) outlines the strategy’s initial short and long-term outcomes and the main activities proposed in order to achieve these goals. Work Plans from 2016/17 and 2018 give insight into successful activities, activities not achieved, and those yet to be achieved as of January 2018.

166 Table 3.4.5: Strategy 4 Implementation Process, 2015 to 2018

Strategy 4: Pro-social Behaviour and Self-regulation (3 to 6 years)

2015 Logic Model 2016-17 Work Plan 2018 Work Plan (Long-term outcomes not outlined due to uncertainty of YK funding beyond 2018) Short-term Long-term Activity Short-term Long-term Activity Short-term Activity Outcomes Outcomes Outcomes (by Outcomes Outcomes (by 2016) 2018) (2018+) !Improvements !Parental-led !Practitioners: ! Children are better ! Children are ! Teacher !Maintain and !Continuation of IY parent in children's activities Incredible able to self-regulate. better able to Classroom continue programme emotional and becoming Years whole !Improvement in self-regulate. Management capacity social mainstreamed class/parent parental skills and (TCM) building of !IY parent programme one- and supported development. programme/cl strategies. !Inter-agency parents and to-one by mainstream working to services. assroom ! Whole school’s !Teachers’ deliver and !Increased management Classroom DINA practitioners in !IY TCM Train the trainer support such teacher and !Parental training/coachi management of the area parental capacity ng/mentoring behaviours aided. programmes ! Basic Parent !IY TCM School capacity to developed to !Services: Improved relations in Group Leader !Informing Implementation support manage be able to numbers of IY schools. !School’s staff Training Policy/Practic routines/behavio engage in practitioners skills and e !IY TCM strategies in urs and service delivery implementing !Marked ! Basic Parenting classroom boundaries. and design. !Programmes: improvements in Programme (IY !IY Dina Programme management. quality children who received PP) !Parents enjoy !Measured standards; parent and teacher !IY Dina Programme their role and !Improvement outcomes for access to classroom !IY Parenting Implementation can meet acts in parental skills children in YK management. as a barrier to assessments and strategies. Programme, one- area are reaching of everyday !Parents: to-one. !Refresher for participants of social, emotional, ! Parent group leader life. Local ! Positive child IY parent Programme educational training: Leaders availability of IY communication ! Data collection norms in line with !Parent /child /parents plus developing set of skills and collation for !Incorporate ways to co- national , problem- relationships parent to support families. the strategy to ordinate/communicate with IY standards solving, and are programme; observe wider city strategy strengthened anger Access to !IY PP: Buy-in to differences in pre management community programme, e.g. and post SDQ !Participate in ABC supports participation, referrals, scores. education learning models support, delivery. community

!Research !Policy position paper to share model and use the evidence from YK evaluation 167

Achievements (as of Dec 2017)

At the 2015 Logic Model time point, illustrated in Table 3.4.5, Strategy 4 of the YK Programme initially aimed to achieve the implementation of three main activities:

• upskilling of local practitioners to deliver high-quality IY Programmes; • the delivery of the IY suite of Programmes; and, • the building of parent capacities in the YK area.

The 2016-17 Work Plan documented the delivery of the IY Teacher Classroom Management (TCM) Programme, the IY Whole Classroom DINA Programme, the IY Basic Parent Group Leader Training, and the IY Basic Parenting Programme. Aims to implement the IY Basic Parenting Programme on a one-to-one level with families was also noted at this time point. Successful implementation of the four IY Programmes to local practitioners and parents over the two-year period marked a fidelity to the initial aims of the strategy.

Tracking short and long-term outcomes gives further insight into the strategy’s expanding nature and the fidelity of the strategy across three time points to its initial design and aims. Initial outcomes of building capacities of local parents to manage their child’s behaviours and routines (short-term) and the strengthening of the parent- child relationship (long-term) were consistent goals throughout the three time points. Equally, increasing teacher capacities to manage challenging behaviours in the classroom setting (short-term) is a proposed outcome indicated across the three years. Collection of child data for the national evaluation also began at the 2016 time point. Initial aims to measure child outcomes in terms of social and emotional norms, as seen in the 2015 Logic Model and 2016-17 Work Plan, was achieved through the completion of formalised and validated Strengths and Difficulties Questionnaires (SDQs). Practitioners who engaged in the IY workforce capacity building programmes were required to complete age-specific SDQs on each child in their classrooms. Data from the CES ‘National Evaluation of the ABC Programme’, to be published in 2018, will provide the necessary information needed to compare child social and emotional development in the YK catchment area with national norms.

Implementation Challenges

Both the 2015 Logic Model and 2016-17 time points highlighted the importance of parental engagement in the implementation and delivery of the IY Parenting Programme training. As parents generally remain living in the YK area, in comparison to practitioners who for the most part live outside the district and who may leave to work in a different location at some point in the future, plans were made to train local parents to support the implementation of the IY Parenting Programme. The Basic Parent Group Leader training was the programme proposed to achieve this. Although parents were given the opportunity to participate, only a limited number completed the training for various reasons, including the intensity level and demands of the programme.

In addition, thirteen local practitioners completed the Basic Parent Group Leader training in 2016 with a view to deliver the IY Parenting Programme. Following the first roll-out of the programme, these practitioners formed a ‘peer-support group’ to assist

168 with the recruitment process for the second roll-out and to offer support to parents who signed up. Initially, the Strategy 4 lead and YK management had hoped that members from this peer-support group would facilitate subsequent rounds of the IY Parenting Programme. For a number of reasons, however, some of which included; staff shortages in workplaces, peer group members leaving to work in other areas, managers unable to release staff to facilitate the group, this did not come to fruition. The demanding nature of facilitating the IY Parenting Programme in terms of time and organisation required the appointment of dedicated IY Parenting Programme facilitators. Thus, in early 2017, one member of the YK team became a dedicated IY Parenting Programme facilitator in addition to a member of the Le Cheile School Completion Programme. Activities to be Implemented

The 2018 Work Plan highlighted aimed to implement the IY TCM ‘Train the Trainer’ Programme and refresher programmes for parents who previously completed IY Basic Parenting Programme. IY TCM and DINA implementation support was also recorded as an activity for future implementation. The 2018 Work Plan also highlighted aims to expand Strategy 4 to create stronger links at a local level with the wider Cork city community and at a national level with participation in the ABC Education Learning Community.

3.4.6 Key Findings and Learning

Table 3.4.6: Strategy 4 Key Findings Key Findings

Evidence gathered suggests that participation in the IY Parenting Programme had a positive impact on parents and children in the YK area in the following ways:

1. Parents are more confident in their approach to parenting and are better able to manage challenging behaviours in the home; 2. Children are better able to self-regulate and a marked decrease in challenging behaviours was noted by parents; 3. Parents report improvement in family quality of life; 4. Local principal’s report observing positive impact of the programme on parent interactions with schools.

Evidence gathered suggests that the IY TCM Programme contributed to positive changes in the service provision of local primary school’s staff in the following ways:

169 1. Teacher’s ability to manage challenging behaviours in the classroom has improved; 2. Tips and strategies have been easily adopted by school’s staff and are used on a daily basis in classrooms; 3. Engagement and networking with other teachers in the area provided links between teachers and greater opportunity for working relations in the future.

Evidence gathered suggests that children have benefitted from school’s staff involvement in the IY TCM Programme in the following ways:

1. Children are better able to self-regulate; 2. Children have welcomed the variety of strategies, particularly more basic, practical strategies.

Table 3.4.7: Strategy 4 Key Learning Key Learning

Evidence gathered suggests that the implementation of the IY Parenting Programme in the YK catchment was aided by the following factors:

1. The flexible and understanding approach to delivery by programme facilitators; 2. Weekly phone calls by facilitators to parents in between workshops offered participants an opportunity to ask advice and supported their implementation of IY strategies at home; 3. The duration of the programme gave participants time to implement IY strategies at home, particularly during school holidays, and to adjust their approach if necessary.

Evidence gathered suggests that barriers to the implementation of the IY Parenting Programme included:

1. The vignettes (video teaching aids) shown to participants during workshops were found to be dated and of poor picture and sound quality.

Evidence gathered suggests that the implementation of the IY TCM Programme was aided by the following factors:

170 1. The course structure; 2. The high number of staff from some schools being given the opportunity to participate resulted in greater benefits to schools in terms of a whole school approach to implementing strategies.

Evidence gathered suggests that barriers to the implementation of the IY TCM Programme included:

1. Tension between facilitators and their unapproachable nature on some rounds of the programme; 2. Pressure on staff to relay information back to colleagues who were not engaged in the programme; 3. Pressure on staff to organise cover and work plans for their class during their time away to participate in the training; 4. Pressure on staff to complete required homework

171

3.5 Programme Level Results

173

3.5 Programme Level Results

3.5.1 Overview

This section of the report provides programme level results regarding rates of participation and the YK Programme’s adherence to its three overarching themes; capacity building, collaboration, and quality improvement. It also provides additional insight into the YK community’s experience of engaging with the Programme. Quantitative information on programme participation is provided first, followed by a summary account of the experiences of local practitioners, service managers and families from the YK catchment area using YK’s three overarching themes.

Research Questions

The programme level evaluation of the YK Programme aimed to answer the following questions:

Programme Reach Process Evaluation

1. How many families have 1. Overall, how have local families engaged with the YK experienced participating in the YK Programme? Programme? 2. How many practitioners 2. Overall, how have local practitioners have engaged with the YK experienced participating in the YK Programme? Programme?

Methodology

Data Collection

Programme Reach The YK administrative database was used to determine the level of engagement with YK activities.

Qualitative Data

Interviews: • One-to-one interviews were conducted with eight YK team members, three local primary school principals, two Home School Liaison Officers (HSLO) and four local PHNs. Interviews were semi-structured in nature and lasted approximately one hour. • Telephone interviews were conducted with five parents involved with the Inter- disciplinary IMH Home Visiting Programme. These were semi-structured in nature and lasted ten to fifteen minutes. • Two case study interviews were conducted with families who participated in three or more aspects of the YK programme. The questions were open-ended in nature and each interview lasted one to 1.5 hours.

175 Focus Groups: An Early Years managers’ focus group (n=5) was conducted. Questions were semi-structured in nature and the focus groups lasted approximately one hour.

Consent Consent was obtained prior to all one-to-one interviews and focus groups. Consent was obtained in writing by a YK team member prior to all parent telephone interviews. All participants were provided with an information sheet and the Research Officer’s contact details.

Data Analysis Microsoft Excel was used to generate data from the YK administration database. NVivo Pro 11.0 was used to collate qualitative data for thematic analysis. The Framework Method (see section 2.2) was used to guide thematic analyses.

3.5.2 YK Programme Reach

Participation Rate Figure 3.5.1: Total Family and Children Participation Rates, Jan ’15 to Dec ‘17

Suite of EY BB Training (d) (i) Programmes 163 Groups (d) (i) 700 Hanen LTWYB (d) 35 Training Peep (d) 29 Programmes Baby Massage (i) 1,200 (d) 23 Total Families and Children 5,450 HVP J.I. S&L Assessments (d) (i) 300 (d) 350

IY TCM IY PP and DINA *(d) direct benefi t (i) 150 Programmes (i) 2,500 (i) indirect benefi t

Figure 3.5.2: Total practitioner participation rates, Jan ‘15 to Dec ‘17

IY TCM Hanen Training 72 Programmes 29

IMH MC HighScope and 300 Total Mentoring IMH NG Practitioners 28 29 539

Peep Training IY DINA 12 18

176 3.5.3 Process Evaluation

As outlined in section 1.5, the YK Programme’s four strategies are connected by three overarching themes. In order to examine the programme’s adherence to these themes, the experiences of local parents, practitioners, and service managers are presented under the following headings: • Capacity building; • Collaboration; • Quality improvement.

Capacity Building

• Parent focus groups and interviews found that YK-implemented parent capacity building programmes were received well by the majority of those who took part. Parents involved with the IY Parenting Programme reported increased levels of confidence in their ability to manage children’s challenging behaviours (section 3.4.3). Parental skills and competencies were found to have further developed through initiatives such as the IMH Inter-disciplinary Home Visiting Programme (section 3.1.4) and Babbling Babies (section 3.2.3). • Practitioner capacity building programmes across the four YK strategies provided new levels of expertise to practitioners working in the YK catchment area in terms of social, emotional and language development of children aged 0-6 years. Feedback from the YK IMH inter-disciplinary team revealed that IMH Training and Coaching facilitated the development of strong relationships with families in the community and delivery of high-quality relational support (section 3.1.4). Feedback from local EY educators found that speech and language training and curriculum training resulted in increased levels of knowledge which in-turn significantly contributed to their daily practice (sections 3.2.4 and 3.3.4). • IMH training and coaching delivered to a wide range of practitioners working within, or linked to, the YK catchment area was reported to have had a significant impact on inter-agency operations in the area (section 3.1.3). Practitioner focus groups and interviews recorded the development of a common language and fluency through which to explain and respond to early social and emotional development alongside increased practitioner confidence (section 3.1.3). • Parent feedback found that the main enabler to implementing parent capacity building programmes was skilled and approachable facilitators. Practitioner feedback found that the main enablers to implementing capacity building initiatives included: innovative, evidence-based training programmes, skilled facilitators, and, a blended learning approach that included a mentoring/ coaching element and an audio/visual component. • Parent and practitioner feedback found that the main barriers to capacity building programme implementation included: difficulties in releasing staff for training, particularly in the Early Years’ sector, accessing hard to reach families due to a historical fear of services in the YK catchment area, scheduling of training, and, completing required homework within working hours in addition to other work.

177 Collaboration

• Interaction and collaboration between parents in the IY Parenting Programme resulted in increased social ties and the development of new support networks for parents within the community (section 3.4.3). • Interviews with members of the YK IMH Inter-disciplinary Team highlighted the importance of increased inter-agency working and collaboration within the YK catchment area in terms of the implementation the YK Programme and the delivery of its many activities (section 3.1.4). • Collaboration between OLOs and local PHNs resulted in the successful development and implementation of Babbling Babies (section 3.2.3), highlighting the importance of a collaborative process to ensure the shift from an impairment- based model of service delivery to a prevention and promotion model. • In-house collaboration between members of the YK IMH Inter-disciplinary Team resulted in a collective approach to IMH Training which led to the successful development and implementation of the Inter-disciplinary IMH Home Visiting Service (section 3.1.4). • Effective inter-agency and partnership working between the YK IMH inter- disciplinary team and local services resulted in successful implementation of the YK IMH Home Visiting Programme and improvements in the quality of services offered to families in the community (section 3.1.4).

Quality Improvement

The various activities in each of YK’s four strategies were enacted to address quality issues, including; curriculum training, formats for building and sustaining workforce capacity, mentoring, environmental enhancement funds, a focussed speech and language programme, management support, and preparation to pilot new community-wide approaches to staff supervision and school transition.

• Feedback from local principals found that practitioner capacity building training in local primary schools resulted in significant quality improvement outcomes, with one noting ‘since the Young Knocknaheeny trainings there is a level of calm around the school, there is no over-reactions to any given situation by the staff and everything is dealt with in a calm way. The children are dealt with calmly and the children are allowed to think and reflect on if they did wrong and what they could do better the next time’, ‘‘I have seen huge improvement in the children, the way they speak, their gestures that they are making, they are making appropriate gestures… ‘when you speak to them they are able to speak back to you in an appropriate manner and they understand different social situations in a better way’. Principal feedback also highlighted that without initiatives like YK, the level of staff capacity building and quality improvements would not have been attainable, ‘It has been very positive, and also very essential. Without Young Knocknaheeny we would not have been able to provide that level of intervention and staff training’. • Local principal and service manager feedback highlighted the success of YK- implemented capacity building on quality improvement in the YK area. A comment pointed out, ‘the IY suite of programmes has seen children being supported at school, at home, and in their communities to express their emotions and to interact with each other more positively. The trust, communication, co-operation and

178 support for children has been the greatest benefit of the trainings’. • EY service manager feedback highlighted the consequences of the EY suite of quality improvement initiatives on EY centres in the YK catchment area (section 3.3.4). Not only have the staff each of the seven assessed EY centres demonstrated how progressive they are in seeking to improve and ensure the quality of early childhood care and education for children, they have also set a strong precedent for other childcare centres in Cork and Ireland to follow their lead and collect this kind of data for quality improvement purposes. • Practitioner interview and focus group feedback found that the main enablers to implementing quality improvement initiatives in the YK catchment area included: inter-agency collaboration and partnership working, evidence-based training programmes that used high-quality, experienced activity facilitators, and the co- operation of local parents. Parent interview feedback highlighted the importance of the YK IMH Inter-disciplinary team’s approach to building strong relationships with local families through a flexible, understanding and non-judgemental approach to service provision. • Practitioner feedback found that the main barriers to implementing quality improvement initiatives included: difficulties releasing staff for training, and staff turnover in the YK area.

179 Parents’ Perspectives of the YK Programme

Case Study 1 I became involved with YK through my PHN. After a few weeks of one-to-one time with the YK worker, me and my daughter took part in ‘Let’s Talk with Your Baby’ and ‘PEEP’. It was so great for us to meet other families and my baby to experience singing, textures and socialising at such a young age. She is so out-going now and I think it is from participating in all of the groups. She does not have the opportunity to interact with children a lot so I was so happy to get involved. I also found the groups great for socialising and developing a support network. Me and the other parents regularly meet for coffee and a chat and we have decided to carry this on even after the group ends. The Home Visiting Programme has been brilliant for the whole family. Our YK worker is amazing, she has helped with sleeping, toilet training, referral forms and other barriers that my daughter has had. My daughter looks forward to her coming. I do too, she’s not just there for my child but for me during the bad days. The Oral Language Officer also visits occasionally and gives advice and tips about improving her language. It’s hard to sum up how it has help us, before YK there wouldn’t have been this type of support in the area. I suppose you could say that my daughter would be a different child if she hadn’t had this in her life.

Case Study 2 Overall I found the YK programme very supportive and valuable. It was just great to have that contact and that person that can guide and help you when you are in troubled waters and you don’t know where to go. I have seen the benefits of it at home hugely, and the home visits have been invaluable. My son has issues with communication and since we started with YK this has improved considerably. We were waiting so long to be seen by Speech and Language therapy. I used to have to communicate for him. With the help of our YK worker and the Speech and Language officer he can do this for himself now. It was great to have that service while we were waiting. From the minute she came in, our YK key worker was so approachable. She was so professional but so open as well and non-judgemental. She connected with my son instantly, when he hears her coming he will run up to her. As well as helping my son, she helped me personally too. When she met me I was lost and now I feel I have some sense of direction. I now have a child that goes to crèche and will stay with other people while I work or do the shopping because he can talk and tell them what he wants, 180 whereas before he wouldn’t stay with anyone. I owe so much to YK. 3.5.4 Key Findings and Learning

Table 3.5.1: Programme Level Findings Key Findings

Evidence gathered suggests the YK Programme was successfully implemented in, and received by, the YK community in the following ways:

1. A significant number of children and families have engaged with and have been involved in several YK initiatives; 2. A significant number of local practitioners have completed YK workforce capacity building programmes; 3. Stakeholders, practitioners and parents report positive experiences of engaging with the YK programme.

Evidence gathered suggests YK contributed to positive changes in local service provision in the following ways:

1. Local practitioners have successfully engaged with, and adapted to, YK training and initiatives. 2. Local practitioners have adopted new, or changed existing, approaches to working following involvement with YK initiatives.

Local practitioners highlighted a number of benefits to local service provision following engagement in YK capacity building programmes, including:

1. Greater inter-agency working in the YK area; 2. Greater co-ordination and planning around family’s/children’s needs in the area; 3. Visible practitioner capacity building and a marked increase in confidence levels.

Local parents identified a number of visible outcomes from engaging with the YK Programme:

1. Parent capacity building; 2. Visible positive child outcomes; 3. Increased social ties and the development of relationships within the YK community.

181 Table 3.5.2: Programme Level Learning Key Learning

Evidence gathered suggests that implementation of the YK Programme was aided by the following factors:

1. The successful buy-in of the local community, stakeholders and local practitioners; 2. Word-of-mouth from families engaged with the programme; 3. The building of strong ties and relationships between the community and the YK team saw increased referrals of families and intensity in their engagement with different YK services; 4. The approach to YK service delivery: flexible, non-judgemental, and supportive.

Evidence gathered suggests that barriers to implementing the YK Programme included:

1. Initial poor visibility of the programme in the area and poor advertising; 2. Difficulties targeting some individuals and families in the YK area due to a fear of services; 3. Unsuccessful buy-in of some local services.

182 Chapter 4: Discussion and Recommendations

183

“Learning Together”: Why these findings matter?

Young Knocknaheeny (YK) aimed to measurably improve the quality of life for children and families living in the catchment area. The programme emerged in 2011, when practitioners across sectors and agencies came together to call for a change in the way in which services for families and children were delivered (from an impairment model to a focus on prevention, earlier intervention and promotion). New ways of collaborative working emerged, creating synergies and an appetite for innovation. This report has provided a transparent evaluation and documentation of the processes involved in establishing a programme of 4 interconnect strategies as a record for all stakeholders and from which we can all learn from.

Government investment in YK was €1.8 million. From January 2015 to December 2017, an accumulated 5,450 families and children participated in the programme, and 539 practitioners completed YK-delivered capacity building and quality improvement programmes. The contribution of local service delivery partners to the YK Programme during this three year period amounted to the equivalent of at least €422,000.

The title of this report “Learning Together” is a reflection of YK itself. The ground-up development of the Programme, with the inclusion of multiple stakeholders in design, implementation and programme participation was a key element in its success. It clearly illustrates the potential for real change that can be realised when funding streams, such as the ABC Programme, engage with and are flexible in response to local priorities.

YK utilised evidence-based programmes across all four strategies. However, these programmes cannot simply be transferred from one context to another - no two communities are the same. This evaluation sought to document the processes and supports required in the local context to ensure the successful delivery of evidence- based approaches. The results from each of the four strategies as well as the over-all Programme results, illustrate that it is the local relationships and attention to contextual enablers and stressors that ultimately determine success.

Recent advances in neuro-science and biology show that early experiences affect brain development with life-long health and social consequences. Early relationships and nurturing environments serve as the foundations from which children develop. Supporting families to enhance nurturing relationships impacts on the child’s social, emotional and language development. Infant Mental Health (IMH) is an evidence- based approach to supporting early relationships and is the framework within which YK works. This report illustrates the effectiveness of IMH as a common language for practitioners and a mechanism for inter-disciplinary working. With appropriate training and on-going mentoring, IMH principles and practices can be integrated into all family support and Early Years services.

Outside of the home, childcare services are the setting where young children grow and develop. High-quality services which promote social and emotional well-being are, therefore, essential. The baseline assessment of the Early Years Centres illustrated significant room for quality improvement. Although similar assessments are not available for other areas of the country, it is a fair assumption that childcare in the YK area is on a 185 par with that provided elsewhere. The mentoring, coaching and quality improvement programme resulted in huge gains for the centres, including most importantly the childrens’ experience of the setting. This was due in no small part to the commitment from the practitioners to participate in training and quality improvement initiatives. YK process evaluation findings suggest that increased funding is required for Early Years centres if they are to support optimal developmental outcomes for the children in their care. Funding should incorporate opportunities for continuous professional development to maintain and enhance core skills and competencies.

YK strategies mark a significant shift away from targeted interventions informed by an impairment model of child support, toward a focus on universal, whole-community approaches to prevention, earlier intervention and promotion. The suite of Incredible Years Programmes, implemented with parents, families and schools, provided strategies for enhanced emotional regulation and dealing with challenging behaviours across the whole school population. The availability of local co-ordination and support to individual families who were struggling to participate, ensured that it was indeed a universal programme. This kind of upstream, preventative approach is not only rooted in principles of equity of access, but also has huge potential to prevent emotional regulatory difficulties and behavioural delays in the medium to long-term. This model can be used effectively in other school and community settings.

No one agency, service or practitioner alone can provide optimal support children and families. From the outset there was a very strong belief among YK partners that greater integration and collaboration between the various agencies and services working would improve the quality and consistency of support and result in better outcomes for children.

A recurring theme emerging from the qualitative evaluation it that of families feeling disengaged from services, and providers struggling to reach families that they know can benefit from the service. The report outlines numerous instances of parents feeling isolated and unable to access supports for their children. Conversely, practitioners expressed worry about their ability to reach out to families. It was in this context that the IMH home visiting programme emerged going much further than a mechanism for simply linking families with appropriate services. It became apparent at an early stage, that there was a very significant un-met need for home-based supports to families with young children. Under the supervision of the IMH specialist, a very effective, evidence- based, inter-disciplinary home visiting programme emerged. This is a new service and is the only instance of direct service provision by YK. The value of this service was illustrated by the level of referral from other services, in particular from PHNs, and by the response of parents who had previously felt very isolated. At the same time, this creates a challenge for YK in terms of sustainability and integration of services.

Another key theme emerging from the evaluation is the value of capacity building in enhancing quality service delivery. This was evident across all four strategies for example IMH Masterclasses, Hanen language training, Highscope curriculum training and IY Teacher Classroom Management. Indeed practitioners themselves placed huge value on training. However, training is only the start. On-going mentoring and coaching was the key mechanism for embedding that training into service delivery. In Strategy 1 for example the IMH network groups were highly valued, as was peer-support and facilitated continuous professional development across all strategies. Time constraints were a cross-cutting threat to capacity building. Practitioners expressed concern that

186 managers did not value the time spent in network groups. Schools and Early Years centres experienced difficulty in releasing staff. Again once off training alone will not enhance service quality. There is a need, across all services for children, to consider the value of on-going investment in staff capacity through training, mentoring and coaching. This will require further innovative, interactive ways of building workforce capacity that are not static and lead ultimately to reflective practice for all child and family services.

From the outset YK envisaged evaluation as an integral part of programme development which fed into and enhanced programme delivery. In this context, the CDC Framework for Programme Evaluation in Public Health (CDC, 2013) provided the optimal lens through which to structure the evaluation. Moreover, embedding a researcher in the programme has enabled the documentation of the nuanced processes and relationships essential for effective implementation of community programmes. This also allowed us to capture the emergence and development of innovative practices.

The CDC Framework focuses on the merits and worth of the programme for those who participate and is not solely concerned with the numerical outputs. This again mirrors the approach envisaged by YK. In addition to the many inputs within this evaluation, hearing directly from children themselves as key stakeholders in the implementation of the programme is possible through the CDC framework. A study ‘Including children’s voices in a multiple stakeholder study on a community wide approach to improving quality in early years setting’ was piloted in conjunction with UCC and Barnardos will be available Autumn 2018. This study needs to be expanded to ensure that young childrens’ perspectives on implementation are included. Furthermore as innovative practices which have emerged in this phase of the YK programme are consolidated, there is a need to move toward the evaluation of impact and child-level outcomes.

Funding from the ABC Programme has enabled YK to make significant progress toward realising its key aim of giving every child the best start in life. The language around early childhood development and the value placed on promoting early relationships has changed. There is evidence of quality improvement and greater inter-agency collaboration. This, however, is just a start. The three-year timeframe for the initial funding programme was unrealistic if sustainable change is to be achieved.

Moreover, the time required for recruitment, staff orientation and the logistic aspects of new activities within communities must also be factored into any newly emerging programme. International evidence increasingly demonstrates that short programmes provide insufficient supports for long-term gains for children particularly those who experience adversity. We cannot expect real and lasting change within this timeframe.

This report provides an overview of the achievements and challenges across the four strategies and the YK Programme as a whole through the lens of the CDC Framework. Through the themes that have emerged, several key recommendations can be made for the YK Programme and for policy and practice in services for infants and young children and families.

187

Recommendations

• The science of early childhood development is clear – what happens in the Early Years influences brain development and has a life-long impact. The ABC Programme is a promising start but there needs to be continued long-term strategic and financial investment in prevention and early intervention from pre-birth. The challenging nature of establishing a programme of complexity and rigor takes at least 3 years if not more. There needs to be a commitment beyond the political and budgetary cycles which ensures an inter-generational programme to truly advance sustained change at a local level. Otherwise, the gains which have been made will be lost, partnerships are compromised and the long-term impact reduced.

• The key strength of the YK Programme was in the partnership between agencies and services working with children and families in the area. Community based infant and early childhood prevention and early intervention programmes with a targeted universal approach needs to firmly co-exist and connect with universal, primary, secondary and specialist services. There is a need for further co-ordination locally and nationally with a sustained drive and will to realise the full potential of the collective provision across agencies and services. Enhanced resources for relationships, networks and policy arrangements with service providers such as GPs, Maternity Services, HSE Primary Care and Tusla which is supported at national level would encourage further collaboration for families and shared learning.

• Strategies and programmes that are grounded in local knowledge and build upon local assets are more likely to succeed. Any national programme to support community-based prevention and early intervention programmes should include a strategic ground-up approach and be flexible in response to local priorities. There must also be resources and openness for innovative implementation practice in the local context. There should also be stronger mechanisms whereby experience and learning from local programmes, feed into national long-term policy.

• Infant Mental Health provides a common language and evidence-based relational approaches to promoting social and emotional development in infancy and early childhood. IMH Masterclasses and Network Groups can be replicated as a model for on-going capacity building, reflective practice and inter-agency collaboration for all practitioners working with infants and young children and their families.

• Maintaining a prevention and early intervention focus through capacity building is challenging for YK given the level of immediate demand for programme services such as IMH Home Visitation Programme and parent groups. Consideration must be given to the IMH Home Visiting Model as a successful mechanism for providing appropriate support to families with complex needs. How this service can be replicated and expanded must be explored. • High-quality childcare services are essential to support early childhood development. An evidence-based model of mentoring and coaching and quality improvement for Early Years services is needed across communities and the sector as a whole.

189 • There is limited population level data on children. Census data provides adult- level socio-economic indicators but there is a notable absence of meaningful and routinely collected data on child development. Given the movement towards local and area-based social and health service provision across the country, it is essential to determine appropriate indicators and measures for collection on a routine basis. The Early Development Instrument is a census-level indicator used internationally which could be introduced in Ireland. Outcomes and impact studies are further required for the YK programmes future development and the perspectives of the youngest in the community can be included by the expansion of the collaborative pilot study.

• Finally, YK only came about because the community, services and practitioners wanted to change the way families, infants and young children were being supported and to ensure that every child has the best start in life to benefit their whole life. This is still the ambition of everyone involved in the programme. Successes have been achieved in making best use of the science of early childhood development but in order realise the full potential of YK for all children growing up in the community, further attention, commitment and resources will be required in the long-term.

190 References

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193

Apendices

Appendix A YK-developed Evaluation Tools

YK Inter-disciplinary Home Visiting Programme Proforma P1. YK STRATEGY 1 YK Inter-disciplinary Home Visiting Programme Proforma

Parent ID:

Date of Birth of Key Child

(DD/MM/YY):

Key worker:

Co-worker:

Proforma completed by:

Intensity Level at time of ! visit: ! Low

! Med

High Home Visit/ Phone Call Details:

1. Date (DD/MM/YY)______! ! ! 2. Time duration for home visit ! / phone call : ! 0-30 min ! 31-60 min ! 1-1.5 hrs ! 1.5 -2 hrs DNA Cancelled/Rescheduled

3. Content of this visit included: (Please indicate the focus of this visit, 1 being greatest focus of visit, 6 being least !focus. Only select those options that are applicable to the visit) ! Concrete support

Emotional support

195 YK Inter-disciplinary Home Visiting Programme Proforma P2.

!

! Developmental guidance ! Early Relationship Assessment & Support ! Advocacy Infant-Parent Psychotherapy (IMH Specialist IMH-E® home visits only)

1. Support Mechanisms? a) Has this visit involved consultation with other YK team members (either ! direct involvement with home visit OR advice provision before visit?)! ! OLO ! PHN ! IPS

Infant Mental Health Specialist NO

b) Are there other agencies (statutory/voluntary) also working with the family ! ! prior to this visit?

YES NO

If yes which agency?______! ! c) Has this visit led to onward referral to an external agency?

YES NO

If yes which agency?______! ! d) Has this visit led to an inter-agency meeting/consultation with the above? YES NO If yes which agency?______

196 Strategy 2: Babbling Babies Proforma

Strategy 2: Babbling Babies Proforma

ID Number of Parent/Family:

1.! Parent has indicated an awareness of baby communication development milestones?! !

Yes No uncertain

2. Parent concerns about babi! ! ! es’ speech and language development?

Yes No Don’t know! ! !

!If Yes, concern: Eye contact Babbling Understanding

Other (please state) ______

!3. OLO concerns about baby’s development?! !

Yes No possible! ! !

If Yes, concern: ! Interaction with parent Communication Hearing

Other (please state) ______

4. OLO concerns about possible risk factors for communication development?! ! !

Yes No possib! le ! ! !

If Yes, concern: ! TV/ screen-time Dummy Use Interaction Reading books

Other? ______

5. Specific language advice provided to family! ! !

!Soothers- reduce use Reduce screen-time Increase reading/books

Other?______

6. General language promoting Information provided during clinic?! ! ! ! !

Reading Playing strategies Parent-baby Interaction Talking- babbling/modelling language Singing

!7. Other general advice or information around parent! -child relationship provided during clinic?

Yes No

If Yes, please describe briefly

______

!8. VERBAL CONSE! NT FOR SHORT Post-Babbling Babies interview (15 mins)?

Yes No

197 IY Parenting Programme Proforma

IY Parenting Programme Proforma

Proforma case no.:

(as seen on IY proforma database)

YK ID:

No. of children:

Child/Children DOB:

(DD/MM/YY)

Proforma completed by:

Time point in course: !

! Prior to programme start

! During programme

Intensity level at time of ! After programme

one-on-one/phone call: ! Low ! Med

Referral Pathway (e.g. High teacher, social worker):

Consultation Details

! !

Face-to -face Phone Call Date (DD/MM/YY): ______! ! ! 1. Duration: Outcome: ! 0-30 min ! Attended/answered ! Rescheduled ! 31-60 min ! No answer Cancelled ! 1-1.5 hrs DNA 1.5 -2 hrs

198 IY Parenting Programme Proforma

Consultation content

1. Parent support offered? (Please indicate the focus of support offered: 1 being greatest focus, 5 being least focus. Only select those options that are applicable to the visit)! ! ! Concrete support ! Advocacy ! Emotional support IY strategies

Parent FeedbackDevelopmental guidan ce

2. IY Strategies used by parent/s?! !

! Special time/play Clear limit! -setting

Social, emotional & persistence coaching Ignoring misbehaviour! ! Praise & encouragement Time-out to calm down! ! ! Tangible rewards Other consequences

After Consultation Rules, responsibility & routines

! ! 3. a) Attempt to link with referrer: YES NO ! ! b) !Duration: ! ! 0 - 30 min 1.5 - 2 hrs 31 - 60 min No answer 1 - 1.5 hrs

Additional Comments c) No. of attempts made to referrer: /Notes

199 Appendix B YK Catchment Area

200 Appendix C YK Work Plans

at at .

Tools Tools tool

tools.

capacity of of capacity

y and and y

ngaging in in ngaging ptake of of ptake ing

natal Attendance -

pervision: YK pervision: CUMH, GP, PHN. PHN. CUMH, GP, Su referrals Kidscope Documents ready Documents engagement, HVP: HVP: Research Research HVP: TtP: Parental Parental TtP: BB:

TtP: U TtP:

- e team process. - collected. - - referrals, using team screen for distribution. for Team dissemination to tools: of Suite read are into integrated practice. - and programme to opportunities involved become Indicators - of referrals, analysis engagement, feedback parental etc. - YK team experience, of dev. capacity, ante - clinics

NG: YK NG:

and

designers designers

Admin Admin materials, materials, ’ time.

, and and team team

: PHN, . , admin HN YK team time. YK team External bodies, bodies, External 3 years. time . -

am, tool am, tool aptop. aptop. print developers. e

HVP: YK YK HVP: TtP: P TtP: clinic BB Massage: Baby YK time, KS: OLOs Promotional Promotional TtP: Stakeholders Stakeholders TtP: HVP: IMH MC IMH MC

eam IMHS time, IMHS

Registration leaflets. Registration hours Resources - - PHN & OLO consultation; - time OLOs venue, - time OLOs Materials, venue and - team KS: L - - resources e.g. 0 increased visibility. increased - design Leaflet time. and - Michigan Michigan Programme and YK t development development purchase consultation, supervision, registration documentation. - t External framework. re time bodies venue. organising Facilitators

–

EY: EY:

-

Dec Dec

- – and Dec 2017 Dec

Dec 2017 Dec Dec 2017 Dec

Dec Dec

Dec 2017 Dec Dec 2017. Dec –

- - – –

Dec 2016 for pilot 2016 for Dec -

Feb 2016 2016 Feb Autumn 2016 2016 Autumn Sept April 2016 April

Oct 2015 Oct Sept 2016 Sept HVP: HVP: TtP: BB: to Present Massage: Baby 2017 Sept KS: Ax: School’s August 2016 August 2016 Sept TtP: to Present HVP: Aug 2016 2016 Aug & NG: IMH MC IMH model of service service of model IMH KS:

Time Frame - - 2017 - - 2017 Dec - 2017 - 2015. May/June 2015. Oct/Nov 2016. May/June - - - - supervision: Aug 2016 to Dec Dec Aug 2016 to supervision: 2017 - delivery: present to Dec Dec to present delivery: 2017 IMH Consultations 2017 Dec - -

HV

system system team. team. 9

-

.

team. noting any any noting

istration

disciplinary disciplinary disciplinary and

-

upervision policy. upervision

disciplinary , inter -

birth registration registration birth -

ontent. ontent. offered if appropriate. if offered

work on admin work

Develop s Develop to inter al video coaching sessions. sessions. coaching video al to YK to Set dates for Oct masterclass. Oct for dates Set Develop consultation document document consultation Develop members after next masterclass. next after members

e resources e up clinic. up r approach that may be needed. be needed. may that approach r

NG: NG: eral and pre and eral -

Dissemination. Dissemination. New ogramme.

. and LLLI: Inclusion of OLO c OLO of Inclusion Development of master file, developing of of developing file, master of Development

, purchas hour individu hour Design programme (6 weeks). (6 programme Design Registration Registration Set rota for next semester of clinics. Engage in Engage clinics. in of semester next for rota Set - out pr out - going discussions after clinics clinics after discussions going - x 1 HVP: HVP: PHN invites family to attend after routine 7 routine after attend to family invites PHN BB: by YK OLO classes weekly 5 massage: Baby meeting weekly attend to YK team KS: Hanen Update gen Update HVP: HVP: Consultations: Consultations: Inter - with Sessions Supervision: KS:

TtP:

Implementation Process Implementation - - check month - - - - workshops. hour (2.5) 7 x 4 - documents. documents. visits. Site collected. Registrations etc. tools, design K), buy Eileen with tools Finalise - Promote programme. Promote stakeholders. with discussion in Engage Roll - Policy meetings - policy. - Purchase resources. resources. Purchase IMH MC IMH MC Organise curriculum, dates, invitations, materials, materials, invitations, dates, curriculum, Organise up take to members NG. Support for venue conditions and terms group Have role. facilitator circulated. - on changes in ou in changes Research assistant to assistant Research with consultant. consultation in registrations Bring

e other other e

tion tion and referral referral and Provide Provide based based Provide Provide - clinic.

.

YK will attend attend YK will

f practitioners practitioners f embedding of of embedding

interven

family

and clinic. Integration Integration adapt. evidence 2 per week. x 2 per

and . birth x2 per week and and week x2 per birth - and ent to the programme. the to ent Provide OLO input/ skills skills input/ OLO Provide Intervention model model Intervention re and

OLO OLO Provide a psychological psychological a Provide Sharing experiences and and experiences Sharing birth birth clinic meeting to help help to meeting clinic YK will help provide admin admin provide help YK will - - educators in the wider YK wider the in educators

HVP: HVP: TtP: conversations Starting BB: Increase and maintain maintain and Increase Work in collaboration with collaboration in Work TtP: KS: IMH Consultations: Consultations: IMH HVP: HVP: acilitation of onward of onward acilitation

Aim/objectives - team to of identification in the support with at risk/presenting children and/or SLT needs problem concerns. developmental other F required. as services to - input. - conversations. about early of Promotion registration to programme to registration p from - post partners to develop tools, tools, to develop partners adopt - - compon opportunities for CPD for opportunities o learning initial and area. studies. case - to support post strategies - defined by the use of IMH IMH of use by the defined principles practice into base evidence disciplines. across - base evidence of embedding practice. into Delivery: Service of IMH Model Integration support families. Explor families. support KS support to ways

(NG)

and Model of Model (EY) (TtP) 3 years)

\

- (KS) (KS) (KS) –

elivery. disciplinary

- of Home Home of disciplinary disciplinary

- -

natal

-

Inter IMH Inter Registration in in Registration Suite to Transition Inter Transition to to Transition Babies Babbling Massage Baby Kidscope Years Early School Primary Early IMH Consultations Consultations IMH IMH Masterclass IMH Network Kidscope

- disciplinary D Service Screening Tools. Screening - - (HVP) - with collaboration and CUMH, GPs others. - (TtP) Parenthood Implementation Task Implementation - HVP - Parenthood - (BB) Clinics - - - - Ax - Home Visiting Model Model Visiting Home (pre (Practitioners reflective Fortnightly to supervision practice YK inter Services). team. - (MC) support - -

: :

and h being - Infant Infant Healt Well YK Work Plan 2016 & 2017 YK 2016 Work & Plan 1 Strategy 2 Strategy

YK Work Plan 2016 & 2017 Page 1

201 202

YK Work Plan2016YK Work & 2017 2 Page YK Work Plan 2016 & 2017 Plans Appendix CYKWork Implementation Task Aim/objectives Implementation Process Time Frame Resources Indicators

Strategy 1: - RegistrationConsultation into communication- Increase and maintain and interaction. - Update- Primary gen eralSchools: and preIndividual-birth registration SLT Ax. OLOs May/June- August 2017 2016 - Hanen-IMHS time,Training: - KS:- YKDocuments & KS ready Infant collaborationPrimary Schools with Portregistration-of-entry to to programme YK service. documents.available Dissemination. by phone and/or to attend meeting - Hanen- Sept training 2016 from materials,- Promotional OLOs collaboration.for distribution. Health and CUMH,- Oral Language GPs and -from KS: OLO pre- inputbirth x2included per week in YK and inter -Registrationsto discuss collected.school queries. Site visits. September- TtP: Sept 2016-Dec- February 2016 for pilot time,resources EY managers and - HanenTeam Training: dissemination Well-being others.Development Training disciplinarypost-birth x input.2 per week. FinaliseHanen tools ABC with & Beyond: Eileen K), 8 xbuy 1-hour tools, group design etc. 2017.- HVP: Present to Dec 2017 andincreased educators, visibility. Participantsto CUMH, GP, PHN. -and Suite Coaching of Home -- EarlyWork Primary in collaboration School Ax: with To -TtP:training Design sessions. programme (6 weeks). -Research:- IMH model on-going of service decisions venue,- TtP: vStakeholdersideo- completeSuite dof feedback tools: Tools ScreeningReferral/engagement/ Tools. supportpartners and to develop enhance tools, oral language Promote6 x classroom programme.-based coaching sessions for regardingdelivery: evaluation present toprocesses Dec cameratime. Leaflet, laptop, design formsare after read everyy and -access Transition to statutory to development.adopt and adapt. Engageindividual in discussion teachers. with stakeholders. for 2017program me. speakers,and print projector. , workshop;integrated complete into Parenthoodservices. (TtP) -- EYTtP: and Provide Schools a psychological OL Development Roll- outResearch: programme. data collection and entry. - CommunityIMH Consultations events and and stationary.- HVP: External bodies,final practice. evaluation form - InterResearch-disciplinary and trainingcompon andent tocoaching: the programme. Capacity - HVP:- Awareness Development of community of master networkfile, developing groups, of HV networks:supervision: e.g. Bonfire Aug 2016 Night, to Dec School’se.g. 0-3 Ax: years. once-TtP: Programme Uptake of is HomeEvaluation Visiting Model building- HVP: Intervention for EY educators model and Policylocal, purchas eventse and resources engaging, inter with-disciplinary same. Library2017 events. Attendance at AssessmentMichigan tools, compprogrammelete. Focus andgroup (pre- Community-natal – 3 Events years) schooldefined teachers by the use to support of IMH oral meetingsIMH Masterclass,. Oral- IMHLanguage MC & Forum. NG: Aug March 2016 – teacher,Programme principal, designers results.opportunities to (HVP)- Capacity of OLO to languageprinciples development and interven tionin the - Consultations:IMH Network Develop Group, consultation document 2016Dec-Dec 2017 2017 . OLOsand time.developers. - SLTbecome Ax results involved - . -understand IMH Inter- and classroomstrategies. and Integration to create and language policy.IMH Supervision, - KS: Sept 2016 – Dec 2017 - Research:YK team, tool OLOs, YK Rate- ofHVP: existing engagement, and disciplinarysupport \Model of richembedding environments. of evidence base - Supervision:Inter-disciplinary Sessions team with meetings Inter-disciplinary and audit. team. teamdevelopment and and newreferrals, referrals capacityto SLT of Servicerelationship/IMH Delivery. for -into Engagement practice. within community. Purchase resources. Develop supervision policy. researcherspurchase, time. serviceteam. Record using of -S&L IMH developm Consultationsent -IMH Research: Model Baselineof Service of Delivery:language IMH MC and NG: Set dates for Oct masterclass. Communityconsultation, events: enquiries.screen ing tools. (Practitioners and profile.Integration and embedding of Organise curriculum, dates, invitations, materials, OLOs,supervision, YK team’s Community- Supervision: events: YK Services). -evidence Provide supportbase into in practice identification venue for NG. Support members to take up timeregistration and materials. Impactteam on e registration.ngaging in Fortnightly reflective ofacross children disciplines. at risk/presenting with facilitator role. Have group terms and conditions documentation. Increasedprocess. awareness practice supervision to communication- IMH Consultations: needs Provide and/or othercirculated. New members after next masterclass. - IMH MC and NG: YK of YK- .Kidscope referrals YK inter-disciplinary developmentalopportunities for conc CPDerns. and Support - KS: Set rota for next semester of clinics. Engage in team time, materials, - OLOcollected. knowledge and team. andinitial encouragement learning of practitioners of onward on-going discussions after clinics and noting any framework. External upskilling. - IMH Masterclass referrals.and educators in the wider YK changes in our approach that may be needed. bodies time re (MC) area. Sharing experiences and Research assistant to work on administration system organising venue. Strategy 3 - IMHFinal NetworkECERS & (NG)ITERS -case To give studies. a snapshot of the quality in consultation- Detailed reports with consultant. from each site to be - ECERS & ITERS final - ECRSFacilitators assessments:’ time. - Higher scores on -2 017Kidscope (KS) of- KS: each YK service/roomwill help provide with admin regards Bringanalysed registrations by mentor/manager to inter-disciplinary with bulletteam. assessments: June 2017 or EYKS: staff, Laptop. mentor, Admin ECERS & ITERS 2017. support- SBSRS tosupport forty quality to clinic. measurements. YK will attend points of areas to be looked at by each team, Sept 2017. To be agreed with facilitatorhours. YK time. team A+ time. Staff awareness of Questionnaires Pre -post Teams-clinic need meeting to make to helpchanges list of changes made regularly. stand leaders. EducationRegistration leaflets. quality improvements. and Post basedsupport on families. baseline Explor resultse fromother - Site visit schedule to be agreed. - SBSRS Questionnaires: Sept Forms and time. - SBSRS results to - HighScope Training ECERSways to and support ITERS KS(Oct clinic.-Nov 2015). - Forms to be distributed and collected by 2016 – June 2017. Use of this - Research team show increase in Strategy 2 - InterOn-site-disciplinary Specialist -- EachHVP: roomProvide to beOLO prepared input/ skills for - HVP:research Inclusion team of accordingOLO content. to schedule. on-gong- HVP: to Feb be 2016agreed. – Dec 2017 time- HVP: YK team school- HVP: readiness Research HVPMentor ECERSto team and and ITERS family post. Provide assessments. - PHN- Staff invites free family to attend to attend a day afterof training routine with 7-9 - HighScope- TtP: Autumn Training: 2016 Final – Dec 6 - HighScope- TtP: PHN admin betweenanalysis pre of and referrals, post - TransitionHannen ‘Learning to -support YK scores in thewill identificationshow increase of in monthtime check and -supportup clinic. to complete assignment. days2017 of training Sept – Feb processesPHN & OLO demonstratingengagement, the ParenthoodLanguage & Loving(TtP) It’ schoolchildren readiness at risk/presenting of pre-school with - BB:- HanenRegistration LLLI training to YK offered sessions, if appropriate.room visits and 2017- BB: – dates Oct 2015 agreed. – Dec 2017 - Hanen:consultation; OLOs time. impactparental of service feedback on -Training Babbling Babies cohortproblem from SLT Sept needs to and/orJune. - Babyvide massage:o feedback. 5 weekly classes by YK OLO - Hanen- Baby LLLI: Massage: 1 course Present to end to - YK- BB team, clinic : PHN, child.etc. Clinics- Transition (BB) protocols -other Service developmental are able to implement concerns. and - KS:- YKMeeting team to2016 attend (Sept) weekly to agree meeting shared,. DecDec 2016, 2017 managersvenue, OLOs’ time. time - HighScope- TtP: Parental to be -between Baby Massage services and useFacilitation an internationally of onward recognised, referral - HanenStakeholders, LLLI: Protocol. 1 course- KS: Sept 2017. 2017 - Dec - - EY: - Baby Massage: adaptedexperience, and used YK team -schools Kidscope (KS) highto services-quality as curriculum. required. 7 x (2.5)Policy. hour workshops. May/June2017 April 2017 2016 -Dec 2017. Materials, OLOs time withcapacity, fidelity in dev. sites of - EarlyPromotion Years of(EY) EY -- STtP:taff OLOand managersevidence- basedare supported 4 x 1 -hour individual video coaching sessions. - School’s Ax: and venue whoante agreed-natal to tooltrain -centres Early Primary and valuable School toinput. fully benefit from quality May/June 2015. - KS: OLOs time, YK and -use BB: this Attendance at Axdevelopment improvement- BB: Starting conversationsprocess. Oct/Nov 2015. team curriculum.clinics opportunities -about A strong conversations. cohort of Early Year staff May/June 2016. - Increase in S&L toPromotion be trained of and early able to milestones, recognition of when Appendix C YK Work Plans

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Implementation Task Implementation - with collaboration and CUMH, GPs others. - Tools. Screening - (TtP) Parenthood - Model Visiting Home (pre (HVP) - disciplinary D Service - (Practitioners Services). reflective Fortnightly to supervision practice YK inter team. - (MC) - - support - HVP - Parenthood - (BB) Clinics - - - - Ax

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YK Work Plan 2016 & 2017 YK 2016 Work & Plan 1 Strategy Infant Healt Well 2 Strategy

YK Work Plan 2016 & 2017 Page 3

203 204 YK Work Plan2018YK Work 1 Page Plans Appendix CYKWork YK Work Plan 2018 Strategy 1: Activity Target audience Timeframe Resources

Infant Health Direct Work Pre-birth preparation for Expectant parents over 30 On-going Screening tool & Well-being parenthood home screen weeks pregnancy Inter-disciplinary team member Referring agency Onward referrals when required IMH Home visiting Programme Parents and caregivers of On-going Inter-disciplinary team and process infants 0-3 years Operational policy Inter-agency partnerships Groups PEEP Parents and children (1-4) On-going two groups IPS in partnership with Barnardos and supporting other consecutively Barnardos organisations where requested. IPS direct delivery of service in NICHE Lets talk with Your Baby (Elkan) Parents and Infants 0-1 On-going 2 IPS staff available Input from OLO’s Venues across community Baby Massage Parents and Infants 0-9 On-going in partnership One trained YK worker to deliver on rotational basis months with partner agencies (shared list) Refresher training and one more fully trained YK worker. Consultation Targeted Transition to Partnership with AMH 2018 onward MOU between partners and support parenthood research and services and UCC Applied Programme design implementation strategy Psychology Research methods Expectant Parents of AMH Allocation of agreed YK time to support the development services

IMH Inter-agency Consultation Providing Inter-agency On-going IMH Specialist IMH-E® with IPS to engage with inter- practitioners framework agency practitioners (build capacity of existing and support to engage with practitioners, where our services are not involved). families in the 0-3 period of child development Kidscope, admin support, Kidscope clinic, Thursdays in NICHE and bi- Allocation of 1 pt clinic administrator 1 day per week. administrative description, clinic stakeholders and review annual review meetings Write-up of admin role, functions and processes. meetings/review meetings group Capacity IMH Masterclasses Inter-agency practitioners March/Autumn 2018 local Co-facilitator M.C. Building Jan 2018 ABC Site? Venue May 2018 In-house CUMH Materials Cork City Child Care Administration/recruitment Company TBC Evaluation Materials

YK/YB Strategy for ABC ABC Managers and inter- Into 2018 IMH Specialist IMH-E® time to engage with continuation agency partners of working group to finalise strategy and MOU Liaise with ABC Managers to communicate the strategy and co-ordinate buy-in Appendix C YK Work Plans

disciplinary -

team trainings and IMH and trainings team

as an Expert to Programme Expert an as and stakeholders and

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2 FT equiv.); Infant Parent Support Worker (4FT Worker Support Parent Infant 2 FT equiv.); -

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Liaise w/ Liaise materials preparation/ Teaching Budget to attend WAIMH Conference x2 people x2 WAIMH Conference attend to Budget

avel to clinics. to avel

Resources 2 X OLOs. 6 X PHNs. space. room Clinic supplies. stationary and Photocopying Tr including assessment per child per 1hour (approximately 2 X OLOs scoring). schools. in of assessments administration for Room/space supplies. stationary and Photocopying schools. to Travel inter weekly at attendance (including OLOs 1.6 FT equiv. meetings). team at seen be to not prefer would if they families see to Room/space home.

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June) basis basis

- going going going - - Feb 2018 Feb 2018 March 1 Feb/2 TBC - On in agreed dates calendar and training for advance supports WAIMH June 2018 June WAIMH agreed To be Timeframe 6 Approximately per PHN clinics - on an on month going year per 3 months (April July entry Data data Interpreting research for an on purposes on an on required As on

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ych house house mplementation of Operational Policy, Reflective supervision, inter supervision, Reflective Policy, of Operational mplementation elopment Worker (unfilled); Oral Language Officers (1.6 Officers Language Oral (unfilled); elopment Worker i -

IMH Specialist IMH Specialist CCC SLT Dept. CCC SLT Dept.

and Nurture Nurture and ly Years Studies & Studies Years ly uding

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D.W. upporting In upporting Key staff of CUMH CUMH of staff Key S of provision network, process. referral training, UCC Ear Midwifery and Nursing Ps Clinical UCC and in consortium and YK team UCCwith partnership representatives YK Manager/ IMH Management Target audience babies of Parents/caregivers 7 aged check PHN developmental appointment. up (with pupils Infants Junior All attending consent) parental four and/or parents to Feedback if and on request, teachers present. are difficulties P with Liaison YKwith registered Families service visiting home IMH for week, per families (av.2 new) or existing process incl process

approx. 4 masterclasses approx.

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based speech speech based - day

Programme

facilitator facilitator - being -

IMH partnership YK/CUMH IMH partnership Teachings and submissions Conference participation bbling Babies Clinics Babies bbling Informing the HSE Nurture Health Health HSE Nurture the Informing Well and Activity Ba school Infant Junior assessments language and and/or visiting home IMH OLO consultations national expertise / consultation provided by provided / consultation expertise national

Continued consolidation of Inter of consolidation Continued meetings PHN review Monthly Inter co IMH Masterclass group consultation/advisory level of High establishment and Development Service Review process Review Service

     Policy Informing

Staff composition: Infant Mental Health Specialist (FT); Child Health Dev Health Child (FT); Specialist Health Mental Infant composition: Staff (1 Administrator Kidscope equiv.); Supporting elements/structures elements/structures Supporting Work Direct

2: Strategy Speech, & Language Literacy

YK Work Plan 2018 Page 2

205 206 YK Work Plan2018YK Work 3 Page Plans Appendix CYKWork Capacity Hanen ‘Learning Language & Primary target: Early Years 7 group training 2 X OLOs (approximately 130 hours). Building Loving It’ training and coaching (EY Educators. sessions per Room/space for facilitation of group. Sector) Secondary: All children month plus 4 Photocopying and stationary supplies. attending these Early Years individual video Tea & biscuits. Educator’s crèche and pre- coaching sessions Engagement of EY services incl. Faranree and co-ordinators group school settings. per participant. Travel to group sessions and individual video sessions. January to June Names through Strategy 3 lead 2018 Hanen ‘ABC & Beyond’ training and Primary target: Primary 4 group training 2 X OLOs (approximately 60 hours). coaching (teachers working with school teachers (Junior sessions plus 2 Room/space for facilitation of group. children 3-5) Infant teachers, resource and individual video Photocopying and stationary supplies. learning support teachers). coaching sessions Tea and biscuits. Secondary: All children in per participant. Travel to group sessions and individual video sessions. these teacher’s Feb-May 2018 Convene a group of principals (Ingrid and Grace) classes/accessing resource/learning support with these teachers. Hanen ‘I’m Ready’ parent training Parents of children aged 3-5 6 training sessions Cost of training course for OLO. and coaching to support emergent literacy ad individual 2 X OLOs (approximately 60 hours). skills video coaching Room/space for facilitation of group. Aligned with other initiatives such sessions per Photocopying and stationary supplies. as One book one community participant Tea and biscuits. ABC and Beyond, Training in Feb Travel to group sessions and individual video sessions. Read Aloud implementation from March 2018.

UCC trainings UCC SLT As requested in UCC OT line with resources Consultation Kidscope review meetings Families attending Kidscope Rota 1 per month 2 X OLOs involved in rota to attend the weekly review meeting which that will be registered with to attend the lasts for approximately 1 X hour. YK. weekly review Medical students. meeting which lasts for approximately 1 X hour. Term time Community /national OLO Primary Schools As requested OLO time, materials consultations EY Centres Other ABC sites Informing Conference submissions and WAIMH; IASLT; As they emerge OLO time/UCC links/ Policy/practice participation Appendix C YK Work Plans

.

emination s

numbers. on

€1,500 each participant participant each €1,500

s, books, materials s, books, ordination/writer/available ordination/writer/available , policy level etc level , policy - venue, catering, speakers, speakers, catering, venue, Resources * None participants committee?? Organising be to Ecers ccc, with In conjunction High/Scope, completed, Approx. depending OLO per week. days 2 for Budget - support/co and allocation Budget . group research from ordination Co dis design, evidence,

strategy 4 lead 4 strategy

PCCC, and Dept. meetings, development of review review of development meetings, Dept. PCCC, and

OLO time/UCC links/ time/UCC OLO to activities. andcontribute appropriate as attend to YK OLO’s olos, hsl, Principals, going - Timeframe needed as and Jan Early Jan Early Now 2018 2018 June to Jan time 2018 term on 2018 Summer

and new new and

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receive previously receive stakeholders

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WAIMH; IASLT; IASLT; WAIMH; CPD Forum Language Oral Event Slts. ABC of Role wider and SLTS OLOS, stakeholders literacy Schools, etc programmes

Target audience Target centres existing All members board and staff All boards and Managers sites andnew get it, didn’t who staff existing All didn’t who staff Existing staff participants All practitioners contributing and Lead EY and group Research

2018 and incorporate representation of YK on various groupings; FT staff grade oral language officer language oral grade FT staff groupings; various of YK on representation incorporate 2018 and - ing elebration

LLLI

w Hanen Programme w Hanen Conference submissions and and submissions Conference participation Language Oral the in Participate Forum for opportunities other Maximise stakeholders local Activity meeting Managers C Event approached, to be sites New little Start, Early Faranree house Cushing hands, training* scope high Hanen Mentor at Submission Paper EECERA,as such conferences Childhood Early and OMEP Ireland from YK paper Position Policy Evaluation

in in ne

Policy Building Capacity Capacity Informing Informing nference presentations, evaluation, oral language forum, IMH network group, reflective practice supervision, Supervision with Supervision supervision, practice reflective group, network IMH forum, language oral evaluation, presentations, nference Informing Informing Policy/practice elements/structures Supporting Co 1. Strategy of as part strategy of integration future and OLOs for Training Composition: Staff FT post to role senior Expand

Care & Care & Education Strategy 3: Strategy Early Childhood Early Childhood

YK Work Plan 2018 Page 4

207 Appendix C YK Work Plans

GW,

-

for each each for

to link with link to

(Sinead/Monica)

ormas/data entry/record entry/record ormas/data Resources Enablers entry Proformas/data Refreshments Venue Stationary deliver) to supports (wider Facilitator Prof keeping of development Further framework identified 4 people wales to Travel packs and resource Materials schools, for framework a Develop through anticipated but trainers” “train of implementation and schools with consultation and school whole existing within practice Venue Enablers Materials Entry Data SDQ’s and Archways Enablers Location Participation materials and Puppets school to provide to Archways Refresher ports. Strategy lead lead Strategy ports.

18

from January from

Dec 2018 Dec –

going going - - e to YK, management group re group management YK, e to Timeframe 2018 June to January Sept above As 2018 Spring On 20 Autumn 2018 TBC January On TBC s

8 cannot 8 who -

3 -

Target audience Target children Parents 3 children Parents group access round 2 per schools primary all Teachers 4 x school Whole (new schools primary all Teacher teachers) teacher Junior/infant workers Project 4 schools trainees and Managers

to line manage and support Mentor. Monthly report, centrali report, Monthly Mentor. support and manage line to

?

Strategy lead Strategy

- Activity programme of IY parent Continuation 1 to 1 programme IY parent trainer the Train IY TCM Implementation School IY TCM support IY TCM Programme IY Dina Implementation Programme IY Dina IY parent of participants for Refresher Programme

on a regular basis to ensure linkage across strategies. strategies. across linkage ensure to basis regular a on Partnership Direct Work in in Work Direct Capacity Building Capacity and IOR and IOR , , Supporting elements/structures Supporting CM

social social - regulation - Pro Strategy 4: Strategy Behaviour & Self

YK Work Plan 2018 Page 5

208

Further Information Young Knocknaheeny Consortium Members • Dr Margaret Curtin YK Chairperson 2017-2018 / UCC School of Nursing and Midwifery * • Dr Pat Corbett YK Chairperson, 2011-2017’ / Independent* • Ms. Ailbhe Creedon HSE Cork North Speech and Language Dept. • Ms. Anne Horgan HSE Cork North Speech and Language Dept. * • Dr Aileen Malone UCC Dept of Medicine and Child Health/ Kidscope • Dr Louise Gibson UCC Dept of Medicine and Child Health/ Kidscope • Ms. Eileen Kearney HSE North Cork Sector 4 Public Health Nursing Dept. • Mr. Ger Donovan St. Mary on the Hill National School, Knocknaheeny • Ms. June Hamil Before 5 Family Centre, Gurranabraher • Ms. Ingrid O’ Riordan Tusla Le Cheile School Completion Programme* • Ms. Angela Kalaitzake Hollyhill-Knocknaheeny Family Centre, Knocknaheeny • Ms. Jenna Russell Barnardos Brighter Future Centre*, Knocknaheeny • Ms. Nuala Stewart Cork City Council /Cork Northwest Regeneration* • Ms. Denise Cahill Cork Healthy Cities • Ms. Liz Horgan Sundays Well Girls National School • Mr. Dave Cashman Sundays Well Boys National School *YK management group members

Current YK Team • Katherine Harford Programme Manager • Emily Harrington Programme Administrator • Lynn Buckley Programme Officer • Catherine Maguire (s) Infant Mental Health Specialist IMH-E® • Grace Walsh (s) Senior Oral Language Development Officer • Sally O’Sullivan Oral Language Development Officer • Tracie Lane Infant Parent Support Worker • Maeve Donegan Infant Parent Support Worker • Roisin Bradley Infant Parent Support Worker • Suzanne Rigby Infant Parent Support Worker • Sinead Donovan Infant Parent Support Worker (IY Programme) (s) Secondment Contractors • Jenna Russell Consortium Member / Early Years Strategy Co-ordinator

• Ingrid O’ Riordan Consortium Member / Incredible Years Strategy Co-ordinator

• Lucy Connelly Independent Early Years Quality Improvement Mentor

• Mairead Carolan IMH Masterclass Trainer

• Dr Debbie Weatherston Michigan Association of Infant Mental Health, USA

• A+ Education Early Years ERS Assessments

• Archways Incredible Years training and mentoring

• Early Years Highscope training 210 Service Delivery Partners

NICHE Tusla/ Springboard HSE Cork North Speech HSE Sector 4 Public Health and Language Dept Nursing ABC Programme ABC Managers ABC Evaluation Tusla/ North Lee Social Tusla /School Completion HSE Cork North Community Work Department Programme Work Dept Northside GP’s Cork City Council /City Kidscope Northwest Regeneration Hollyhill Library A Plus Education Archways Foroige Youthlinks HSE Cork University UCC Department of Maternity Hospital Epidemiology and Public Health UCC Department of UCC Department of UCC Department of Applied Social Studies Medicine and Child Health Psychology UCC Department of Barnardos; Brighter Futures Before 5 Family Centre Nursing and Midwifery Centre Padre Pio Early Start Hollyhill Knocknaheeny St Marys on the Hill Family Centre Playlands Crèche Paisti @ no. 3 Preschool Cork City Childcare Sundays Well Girls National and Crèche Company School St Mary on the Hill National Sundays Well Boys National Scoil Padre Pio School School North Cork Infant Mental HSE Primary Care, Child Health Network Adolescent and Family Psychology.

NICHE Health Project (Cork) CLG is the lead agency

Young Knocknaheeny is part of the Area Based Childhood Programme funded by the Department of Children and Youth Affairs and Atlantic Philanthropies. Pobal and Centre for Effective Services are the Programme Managers for the Area Based Childhood Programme.

For more information: www.youngknocknaheeny.ie facebook/youngknockhaneeny [email protected]

211 Notes Notes Notes

Photos: P44, 46 Shutterstock All other photos © Young Knocknaheeny Design: [email protected] Young Knocknaheeny, HSE Building, Harbourview Road, Knocknaheeny, Cork

021 601 0656 [email protected] youngknocknaheeny www.youngknocknaheeny.ie funded by: managed by: lead agency: Area Based Childhood Programme

consortium members: Knocknaheeny Hollyhill Family Centre