Early child development transformational change programme

Theory of Change

Based on an in-depth review of the evidence on what is needed to improve early child development, and a range of knowledge and experience of the current system, we have developed a high-level theory of change which identifies the areas we need to address. As we learn more, this theory can be refined further.

If Scotland can make improvements as described in the theory of change we believe a realistic improvement aim is that; we reduce the proportion of children with developmental concerns identified at 27-30 month review by a quarter by 2030 (from 18% to 13.5%). Reducing the proportion by a quarter would result in the lowest levels seen since Public Health Scotland started measuring. Note that child health reviews are designed to pick up concerns so that children can get the support they need, and we would not want to jeopardise this by setting the aim too low.

To achieve this aim, we want to see a reduction in the gap between the most and least deprived areas, and will also track this as one of our programme indicators. Scotland’s policies are globally recognised on many aspects but that is not translating into improved outcomes for all, so we need to further understand what else needs to be done, what can be done better or more reliably and consistently, and what would result in most impact.

From before they are born, all babies and young children experience the nurturing care they need to develop to their full potential.

Aim: To reduce the proportion of children with developmental concerns at 27-30 months by a quarter by 2030 (from 18% to 13.5%).

Impact areas

• Support caregivers' wellbeing & capacity to provide nurturing care*
• Create a culture, environment, economy and society that enhances early child development
• Integrate policies and services, ensuring they are evidence based, family centred and responsive to need

Nurturing care*

• Care givers have the security, time and headspace to provide nurturing care in a calm environment
• Care givers have the knowledge and confidence to provide nurturing care
• People get trusted support at the right time, while needed, including preconception
• Workforce supported to have the knowledge, confidence, resources and wellbeing to support families and caregivers to be able to provide nurturing care

Wider world

• Knowledge about the importance of early child development and the impact of trauma, leads to more supportive behaviours
• People live in places that are baby and family friendly, can have trusted relationships and feel part of the community
• We improve on wider factors affecting early child development, including the economy, poverty, housing, air quality, nutrition, domestic violence, physical environments and racial inequalities

Integrated policies and services

• Investment is optimised to reflect the evidence on primary prevention, addressing needs, inequity and enabling continuity of support
• Policies and services that impact on early child development are integrated through a shared evidence base, common narrative and governance and communication structures
• Learning system enables evidence into practice reliably and consistently, and data are shared and used to link planning, monitoring and improvement
• Local partnerships can break down silos to implement evidence driven policies and apply the GIRFEC principles in ways that reflect local and community needs and lived experience
• Leadership across all public sectors and services understand and champion the importance of ECD, and the need to take a whole system approach

*nutrition & health; play & stimulation; sensitive responsive caregiving; safe from harm

Three key impact areas have been identified below.

Supporting caregivers’ wellbeing and capacity to provide nurturing care (nutrition and health, play and stimulation, sensitive responsive caregiving and safe from harm):

• caregivers have the security, time and headspace to provide nurturing care in a calm environment.
• care givers have the knowledge and confidence to provide nurturing care
• people get trusted support at the right time while needed, including preconception.
• workforce supported to have the knowledge, confidence, resources and wellbeing to support families and caregivers to be able to provide nurturing care.

Create a culture, environment, economy and society that enhances early child development:

• knowledge about the importance of early childhood development and the impact of trauma, leads to more supportive behaviours.
• people live in places that are baby and family friendly, can have trusted relationships and feel part of the community.
• we improve on wider factors affecting early child development, including the economy, poverty, housing, air quality, nutrition, domestic violence, physical environments and racial inequalities.

Integrated policies and services ensuring they are evidence based, family centred and responsive to need:

• investment is optimised to reflect the evidence on primary intervention, addressing needs, inequality and enabling continuity of support.
• policies and services that impact on early child development are integrated through a shared evidenced base, common narrative and governance and communication structures.
• learning system enabled evidence into proactive reliably and consistently, and data are shared and used to link planning, monitoring and improvement.
• local partnerships can break down silos to implement evidence driven policies and apply the GIRFEC principles in ways that reflect local and community needs and lived experience.
• leadership across all public sectors and services understand and champion the importance of Early Childhood Development and the need to take a while system approach.

For more information please contact: prebirthto3@gov.scot