Ready to Act - A transformational plan for Children and young people, their parents, carers and families who require support from allied health professionals (AHPs)

1. Background and context

The policy and legislative landscape in Scotland is an exciting one for children and young people, providing possibilities for the delivery of real change for them, their parents, carers, families, stakeholders and communities. The Scottish Government’s strategy for making Scotland the best place in the world in which to grow up has the potential to truly transform the lives of children and young people.

The Children and Young People (Scotland) Act 2014 ^[7] establishes a legal framework within which services will create new and dynamic partnerships to support children and young people, their parents, carers and families to achieve meaningful well-being outcomes. These outcomes include what has come to be known as the SHANARRI indicators of well-being ^[8] – that is, ensuring that children and young people are Safe, Healthy, Achieving, Nurtured, Active, Respected, Responsible and Included (see Glossary). AHPs play a key role in children and young people achieving well-being outcomes through developing their resilience and creating protective environments to enable participation and self-reliance.

The Act also places in statute key elements of Getting it Right for Every Child ^[9] – known as GIRFEC – which is a major ongoing change management approach that is familiar to all leaders and practitioners working in children and young people’s services in Scotland. The GIRFEC focus is about making a difference for children and young people and this can best be achieved through promoting, supporting and safeguarding well-being and reporting on well-being outcomes.

The need to have well-being as a central focus of this transformational plan is
self-evident. The duties in the Children and Young People (Scotland) Act 2014 require significant shifts in mindsets towards a focus on early intervention and prevention, and highlight the need to develop and deliver accessible services in communities for all children and young people. The Act increases the pace of change and consistency in practice and service quality for every child and young person, by every practitioner, all of the time. This pace of change requires that AHPs challenge the status quo and support implementation of innovative service delivery and design based on improvement methodology.

The Act also highlights the need for “targeted interventions” – that is, AHP specialist-level services (see Glossary). A focus on early intervention and prevention does not diminish or replace the need for children and young people to have access to effective, evidence-based interventions at specialist level, with expertise at different levels being accessible to meet needs at different times. Such an approach has the potential to benefit children and young people’s health and well-being, reducing dependency on services while offering access to direct intervention when required. Many services have (or are developing) universal and targeted approaches, which complement the delivery of specialist-level services.

Towards a Mentally Flourishing Scotland ^[10] set out strategies for infants’ and children and young people’s mental health, clearly articulating new ways of working that are closely aligned to the ambitions outlined in this plan.

A practice shift towards resourcing and developing early and preventative interventions and service delivery across AHP services for children and young people was implicit in the findings of the Commission on the Future Delivery of Public Services in Scotland, ^[11] which called for a radical change in the design and delivery of services, with child-centred service provision, effective partnerships and early intervention and prevention.

The Early Years Collaborative ^[12] has committed to make Scotland the best place in the world in which to grow up by reducing inequalities. The ambitions in this plan must have this aim at their foundation and enable practitioners to make the changes required locally to ensure its achievement.

Significant progress has been made in developing innovative services at universal, targeted and specialist levels (see Box below), with a commitment to partnership working in delivering training and education and developing nurturing environmental change for children and young people at home, nursery, in education settings and the community.

Universal, targeted and specialist levels
Universal level
This is for all children and young people. It recognises that a preventative approach and promoting well-being for children and young people, their parents, carers and families is an essential role for AHPs. AHPs working at universal level will provide information and literature, direct children and young people, parents, carers, families and others to the best evidence-based information available, input to activities and programmes organised by others to improve skills and confidence, work with partners to increase participation, and support the development of nurturing environments.

Targeted level
Services and provision at this level are for children and young people (and their parents, families, carers and other stakeholders) who are more likely to be identified as having well-being needs. Services would include specific advice, programmes, workshops and learning, and support to improve well-being.

Specialist level
This level is for those children and young people whose well-being needs cannot be fully met through universal or targeted provision. It would usually involve episodes of direct or indirect intervention involving parents, carers, families and others, with the ultimate outcome of promoting self-reliance and resilience through an asset-based approach.

The Children and Young People (Scotland) Act 2014 defines universal and targeted differently from the definitions above. Universal and targeted are now collectively referenced as “Universal” in the Act, while specialist is now referred to as “Targeted”. This may cause some confusion initially. In essence, in the Act “Universal” will now have two levels: population activities available for everyone (such as health promotion, prevention and general education) and Level 2 activities developed to support impacts on well-being for children and young people who are more likely to require specific support (such as parents of babies born with Down Syndrome). “Targeted” will be direct specialist-level support with children and young people on caseloads.

AHPs in services for children and young people currently provide evidence-informed interventions across all ages and in different locations. The main aims of these services are to support:

• children, young people, their parents, carers and families to self-manage their concerns and needs
• other individuals involved with the child or young person to promote, support and safeguard well-being.

The plan builds on this strong foundation to support AHPs in children and young people’s services to transform their practice.

Transformed AHP services for children and young people are needed to support the policy and legislative foundation described above. The plan aims to achieve this through ambitious actions and a commitment to ensuring AHPs are supported to deliver quality services. A radical agenda of reviewing and shifting practice across AHP services for children and young people is required, involving collaboration between health, community planning partnerships, social care and third-sector partners. Policy-driven changes will be supported locally by lead AHPs and AHP directors in NHS boards linking to their local children’s services planning processes and deliverables.