Health and Wellbeing in Schools Project - Final Report

1. Introduction

1.1 The project

The Health and Well-being in Schools project, which ran from September 2008 to March 2011, was a Scottish Government-funded initiative designed to complement the national effort to improve the health and well-being of children and young people in Scotland. It aspired to harness existing skills, develop new roles, expand capacity and work in partnerships with a range of agencies to promote the health and well-being of school-aged children and young people within the Curriculum for Excellence ^[9] cohort (aged 3-18 years) and their families, particularly at key transition stages.

The aim of the project was to increase health care capacity in schools by providing improved health care services designed to meet the needs of individuals, families and communities. It also aimed to develop a range of models and initiatives that could be implemented across Scotland in a safe, efficient and effective manner to support the implementation of Better Health, Better Care^[10] and Equally Well. ^[11]

The project was firmly based in a partnership approach that involved participation from health, education and local authority staff, voluntary organisations, children, young people and their families and communities.

While there was no formal evaluation of the outcomes of the project, it nevertheless generated a wide range of evidence sources that were accessed to demonstrate the impact it had on the health and well-being of children and young people within the demonstration sites. These evidence sources included:

• reports prepared for the national steering group;
• reports prepared for local steering groups;
• intelligence gathered by project officers at local level and the national programme manager nationally;
• reflective diaries maintained by the project officers; and
• the report and source materials emerging from the Open Space series of events. ^[12]

1.2 Why was the project developed?

The Health and Well-being in Schools project was set up in direct response to the Ministerial Task Force on Health Inequalities. Its scope was to develop an integrated school health team to address the needs of the most vulnerable children and young people within their local communities. It was recognised that to achieve this ambition, increasing the health care capacity of those working with school-age children and young people was important.

Equally Well, the report of the Ministerial Task Force on Health Inequalities, contains the following recommendation, which had direct relevance to the project:

Developing a new approach to partnership working between education practitioners, health and other professionals should be a key focus for delivering the health and well-being outcomes within the Curriculum for Excellence. This should include considering how the learning from the forthcoming evaluation of the Health and Well-being demonstration projects can support delivery of Curriculum for Excellence.

The project necessarily had close links with Curriculum for Excellence, which is transforming education in Scotland by providing a coherent, flexible and enriched curriculum for children and young people aged 3-18 years. Its purpose is to enable children and young people to realise their full potential and fulfil the Scottish Government's vision of each child being a confident individual, successful learner, responsible citizen and effective contributor.

The health and well-being component of the curriculum will ensure that children and young people have the knowledge, skills and understanding to follow a positive, healthy lifestyle. New models of integrated health care developed by the Health and Well-being in Schools project will support teachers in meeting the learning outcomes of the health and well-being component of Curriculum for Excellence.

The project also worked alongside established health and well-being initiatives in Scotland, such as the Health Promoting Schools model, Getting It Right for Every Child programme ^[13] and integrated children's services, and complemented and supported a range of national policies.

1.3 How was the project developed?

The project was launched in September 2008. Initial work through to January 2009 focused on developing appropriate models that reflected local needs and on preparing four demonstration sites for launch between January and March 2009. NHS boards were invited to make representations to be part of the project, and sites were selected to ensure the inclusion of school clusters (that is, secondary schools with feeder primaries) and large local authority geographic areas. The selected demonstration sites were:

• NHS Ayrshire & Arran: Belmont school cluster (1 secondary school, 6 primaries and 1 special educational needs school);
• NHS Forth Valley: Clackmannanshire schools (3 secondaries and 19 primaries);
• NHS Grampian: Moray schools (8 secondaries, 48 primaries and 22 nursery schools); and
• NHS Lothian: West Lothian, Armadale school cluster (1 secondary school, 6 feeder primaries).

Governance for the project, which was commissioned by the Chief Nursing Officer Directorate of the Scottish Government Health Directorates, was provided through a national development officer supported by a national steering group consisting of representatives from the Scottish Government, NHSScotland, local authorities, voluntary organisations, Her Majesty's Inspectorate of Education, the Convention of Scottish Local Authorities, the Royal College of Nursing, the School and Public Health Nurses Association and the Royal College of Paediatric and Child Health.

A project officer was appointed in each of the demonstration sites to work two days per week on the project, with the remaining three days being devoted to their normal duties (a school nurse manager, a public health practitioner, a school nurse co-ordinator and a physiotherapist, all working with the school-age population). Working with the national development officer and national steering group, the project officers assumed responsibility in their demonstration sites for:

• promoting an integrated partnership approach to achieving a positive impact on the health and well-being of school-aged children and young people within the Curriculum for Excellence cohort;
• exploring and establishing mechanisms to engage key stakeholders, including children, young people, families and voluntary organisations, in the project;
• identifying health inequalities within the demonstration sites relating to children and young people, their families and the communities in which they lived;
• identifying the workforce, workload and training needs of staff to ensure the provision of appropriately skilled and trained staff within each of the demonstration sites; and
• implementing a range of new, integrated, flexible models of practice within the demonstration sites to support staff in the delivery of preventative, early intervention and treatment programmes aimed at improving health outcomes for children and young people.

1.4 How was project progress monitored?

Steering groups

The national steering group was established to advise, support and monitor the development of different models of increasing health care capacity in schools to address the health and well-being of children and young people in each of the demonstration sites. The steering group was directly responsible to the Chief Nursing Officer and the Minister for Public Health.

Each of the demonstration sites established a local steering group with representatives from health, education and local authority sectors to advise, support and monitor the progress of the project within the area.

Open Space events

A series of Open Space events was held across the four demonstration sites during 2010 to facilitate stakeholders to identify what was working well and what could work better within each of the demonstration sites. A report of these events was published in December 2010. ^[14] In addition, local action plans were developed in response to decisions taken at the Open Space events to reinforce areas of strength and address perceived areas in which performance could be improved.

Project officer activity

Each team member was asked to keep a reflective diary to gather evidence, opinions and feelings about the impact of the new models of working on their practice.

Project officers held monthly meetings with staff in the demonstration sites to capture progress reports on their daily work, gather evidence of how they were engaging with partner agencies and build local health intelligence to influence delivery of new models of practice.

Logic model

Logic modelling is an outcomes-focused approach used to provide a framework for integrated planning, delivery, evaluation and performance management. It was used in the project to map how each of the new models of practice could deliver better health outcomes to children and young people within the demonstration sites.

Logic model work was divided into the following steps:

• defining inputs: identifying what resources were available (workforce, money and equipment);
• defining work programme activities: identifying processes to be followed through the new models of practice;
• defining outputs: identifying what would be delivered through the new models of practice; and
• defining outcomes: identifying short-, medium- and long-term outcomes as a result of the above.

The logic model approach provided a visible way of presenting processes and identifying what each new model aimed to achieve. The demonstration sites regularly monitored the progress of the outcomes identified in the logic models by providing regular reports to local steering groups.