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

2. The five ambitions

Children and young people, their parents, carers and families told us what mattered to them through the Children in Scotland survey in 2014 and the open consultation process for this action plan. The five ambitions follow on from the survey and provide the foundations for transformational outcomes for children and young people.

The ambitions are about:

• participation and engagement
• early intervention and prevention
• partnership and integration
• access
• leadership for quality improvement.

Summary diagrams relating to each ambition are presented in the Appendix.

2.1 Participation and engagement

“It may be best to assume that all children of whatever age are capable of contributing to discussions concerning their lives.” (Davis & Watson) ^[13]

Children and young people have a right to be listened to, taken seriously and have their views respected. Adults working with children and young people must ensure this happens consistently: they have a responsibility to do so under the United Nations Convention on the Rights of the Child ^[14] (reinforced by specific duties in the Children and Young People (Scotland) Act 2014), a core principle of which is a commitment to giving children and young people the opportunity to participate in the decisions that affect them and to be agents in their own lives. This is crucial to the successful achievement of well-being outcomes for children and young people: in addition, the GIRFEC practice model and “My World Triangle” ^[15] clearly identify the importance of placing the child at the centre of partnership working.

The Children in Scotland survey and the open consultation process for this plan indicated that children and young people wanted involvement in decision-making about the help they received, and that increased access to information about AHP services would enable them to feel more empowered to get involved. They also suggested that they would welcome opportunities to provide feedback about the services provided by AHPs.

Capability Scotland, in partnership with the Centre for Research on Families and Relationships, recently produced a literature review on empowered and effective decision-making by disabled children and young people. ^[16] The research found the following factors were critical in enabling disabled children and young people’s participation and engagement:

• parents and practitioners having an attitude that disabled children and young people should be involved in decision-making
• being familiar with disabled children and young people, their methods of communication and ways of being can help with interpretation of choices
• having a level of expertise among staff that enables disabled children and young people to communicate their choices well
• ensuring good communication networks between those who care for and support disabled children and young people
• facilitating ongoing training in communication methods and approaches.

AHP services for children and young people will address the challenge of active engagement. They will produce evidence to show that the views of children and young people, particularly those who have disabilities, influence decision-making and that what matters to them is evidenced through their therapy outcomes. We will have compassionate conversations with children and young people and develop participative environments in which they can engage in meaningful ways.

This will require AHPs to find new and innovative ways for children and young people in general, and those with communication difficulties in particular, to make their needs known. We may have to look across the UK and elsewhere for models that would support the development of indicators, such as the work carried out by the Dartington Social Research Unit. ^[17]

Whincup’s research highlighted that “the degree to which children and young people are at the centre of assessment and decision-making in a meaningful manner, depends on the capacity of practitioners, supported by the systems in which they train and work, to form relationships and communicate effectively with them.” ^[18] Staff nevertheless need to be creative about how they engage with children over what may be difficult issues.

We will adapt and change practice to support cultures that enable real participation, eliciting and acting on feedback from children and young people. The impact of changes will be measured through children and young people’s reported experiences of participating and engaging with AHP services.

Ambition
Children and young people’s views will be asked for, listened to and acted upon to improve individual and environmental well-being outcomes and AHP services.

Actions
We aim to achieve the ambition by:

• agreeing participation measures across AHP services for children and young people through implementation of strategies to ensure participation
• committing to demonstrate that children and young people’s and parents’ perceptions of well-being are integral to decisions taken at every stage in their involvement with AHP services
• understanding what well-being measures are currently being used by AHP services for children and young people
• producing evidence of increased similarity between NHS boards in levels of children and young people’s participation in decisions about their care
• focusing as a priority on engagement with young people in decisions that affect their lives
• promoting awareness of children and young people’s rights and participation methods among the AHP children and young people’s and adult services workforces
• using parents’ and children and young people’s stories of their experiences of participation to further upskill AHPs across services for children and young people in Scotland and influence future decisions about our ways of working
• exploring the key skills that enable compassionate communication with children and young people, their parents, carers and families
• creating environments in which participation and participative relationships are possible.

2.2 Early intervention and prevention

In committing to a systematic shift in culture of practice to embrace early intervention and preventative strategies in service delivery, AHP services for children and young people in Scotland will progress the universal aspects of the Children and Young People (Scotland) Act 2014. Signposting to early intervention and prevention is an important part of the expert reasoning of AHPs and will augment access to direct specialist intervention as and when required.

AHPs need to adopt an enabling approach that promotes self-resilience and allows children and young people, their parents, carers and families to feel confident and competent in self-management, seeking further assistance from AHPs as needed. It is recognised that for many services, however, current systems and models of care make it challenging to shift the balance of care. AHPs will need effective cooperation from, and partnership-working with, universal services (including public health) to realise this ambition.

AHPs will work collaboratively and in partnership with children and young people, parents, carers, families, stakeholders and communities to understand what is needed to improve well-being outcomes, agreeing specific services at universal level. Focused work will be undertaken to support and strengthen early intervention, creating a national approach to support the development of targeted offers.

Socio-economic inequalities and evidence showing poorer outcomes for children and young people and families living in poverty and with low incomes strengthen the need for the development of prevention and early intervention support. AHPs’ contribution to reducing the inequalities gap in Scotland is significant, and their role in this area needs to be promoted and valued.

The focus for all children and young people who access AHP services will be on promoting their well-being and enabling them to self-manage their challenges.

Ambition
Every child will have the best possible start in life, with AHP services using an asset-based approach to aid prevention through universal services and supportive nurturing environments at home, nursery and school.

Actions
We aim to achieve the ambition by:

• ensuring universal services are consistent across Scotland
• scoping the current provision of universal and targeted interventions across AHP children and young people’s services
• increasing appropriate access to interventions at universal and targeted levels of service as needed for improved well-being outcomes
• acknowledging the need to develop new/different measures of quality and performance for AHPs to reflect increased capacity in early intervention and prevention
• directing resources to support changes in environments
• agreeing key messages and specific offers to support early intervention and prevention
• building on, and learning from, what we hear about services from children and young people, parents, carers, families and stakeholders
• supporting children and young people, their parents, carers and families to develop the knowledge and skills to make informed decisions, coordinated and tailored to individual needs
• collaborating with mental health services for children and young people to jointly support early intervention and prevention for those experiencing mental health issues
• acknowledging the place of AHPs in early intervention and prevention with young people at risk of entering the youth justice system.

2.3 Partnerships and integration

Partnership-working needs to be at the heart of everything AHPs do in services for children and young people. AHPs will create mutually beneficial partnerships with children and young people, their parents, carers and families within and between partner organisations.

We will recognise the existing opportunities created by partners in the third sector in local communities, which will enable us to work collaboratively to improve population and individual well-being. Children and young people, their parents, carers and families will be supported to develop knowledge, skills and confidence to more effectively manage and make informed decisions about their health care, which will be coordinated and tailored to individual needs.

Parents, carers and families are crucial partners in delivering children and young people’s well-being outcomes. Parents who responded to the Children in Scotland survey and the open consultation process for this action plan indicated that they wanted to work in partnership with AHPs and felt it important that they be fully informed and included in delivering AHP outcomes. As the people closest to children and young people, parents, carers and families recognise their critical role in achieving well-being outcomes, but also understand that this can be challenging. Acknowledging and communicating their place as partners will be key to delivering the plan’s ambitions.

The Scottish Government’s Guidance on Partnership Working between AHPs and Education document ^[19] outlines the positive impact of good partnership-working on outcomes for children and young people in an education environment. Cooperative strategic support for collaborative working across education, health, community planning partnerships, social care and the third sector is required to develop joint learning initiatives and opportunities that improve inter-agency working.

Research has identified challenges and barriers to partnership-working. These are reflected in AHP services for children and young people locally in relation to engaging and including AHPs in the children and young people’s policy agenda and involving and collaborating with social care colleagues working in local authorities.

The Public Bodies (Joint Working) Scotland Act 2014 ^[20] has established a framework for integrating health and social care. Not all local partners have decided to include children and young people’s services at this stage of the integration process, but where integration of children and young people’s services has been included, the ambitions of this plan and its associated actions will be jointly owned by health and social care.

Active and creative collaboration with partners in the third sector will be an essential requirement for the achievement of the ambitions. Third-sector organisations have well established relationships and partnerships with and in local communities: AHPs working in children and young people’s services will need to utilise these to successfully implement the plan.

A key partnership for AHPs will be with people in the Named Person role, as detailed in the Children and Young People (Scotland) Act 2014. AHPs have a duty to collaborate with the Named Person in relation to children and young people’s well-being needs and respond to requests for assistance. There is also a duty on relevant authorities to help the Named Person when requested and provide assistance in relation to the child or young person’s plan.

Opportunities for joint learning and shared outcomes on children and young people’s well-being must be a central focus going forward.

Ambition
Children and young people, their parents, carers and families will have their well-being outcomes met at the most appropriate level through the creation of mutually beneficial, collaborative and supportive partnerships among and within organisations and communities.

Actions
We aim to achieve the ambition by:

• sharing good-practice examples of collaboration from areas in which it is working well
• collaborating to ensure all AHPs deliver to the SHANARRI well-being outcomes in the single child’s plan introduced by the Children and Young People (Scotland) Act 2014
• building on third-sector community relationships to support shared well-being outcomes
• acknowledging the need for more effective transitions for children and young people and the place of effective partnership-working in achieving successful transitions
• agreeing key indicators for effective partnership-working to act as a shared reference point for partnership performance-management
• ensuring that AHP reviews and redesigns of services are undertaken in collaboration with children and young people, parents and stakeholders
• building on existing Early Years Collaborative workstreams locally, using learning to inform practice development in other areas
• reviewing, updating and expanding the Scottish Government Guidance on Partnership Working between AHPs and Education in line with current children and young people’s policy and legislation, including third-sector and social care guidance and involving children and young people and parents
• establishing local cross-agency forums that include children and young people to support implementation of this plan
• utilising the knowledge, skills and established partnerships of third-sector organisations to support implementation of the plan
• developing creative collaborative partnerships with colleagues in health, education and social care to deliver to the duties of the Children and Young People (Scotland) Act 2014 and implement the plan
• upskilling AHPs in community learning and development approaches to community engagement.

2.4 Access

Access in this sense is broader than service provision. It also includes access to:

• information (which is not just about information being presented in understandable ways, but also about ensuring children and young people have time to think about and understand it)
• services in a timeous manner
• provision of support and strategies to promote self-management
• education and skills development for partners
• new ways of organising and delivering services
• flexible working (such as twilight clinics for children who are in school and evening workshops for parents, carers and families) as needed by the local population.

Children and young people require responsive services that are appropriate to their needs and which they, their parents, carers and families can access in a timeous manner to request assistance and support. This requires services to adopt outcomes-focused approaches and move from deficit pathology assessed approaches (“what's the matter?”) to a focus on what matters most and what outcomes an individual wants to achieve. ^[21]

Outcomes discussions should focus on strengths and assets. The New Economics Foundation and Action for Children propose a co-production approach to service delivery. This includes valuing children and young people as assets and enabling them to work out what they are good at and how they are able to influence events and situations. The approach also requires service design and delivery to incorporate children and young people’s assets, such as life experience, knowledge, skills, talents, energy and enthusiasm. ^[22]

Key issues underpinning this ambition include:

• waiting list prioritisation and validation
• prioritisation of requests for assistance and caseloads on the basis of well-being and impact
• adoption of a national approach to requests for assistance
• review and testing of current requests for assistance and access practices
• a mandatory requirement for services to enable self-requests for assistance
• education to promote community understanding of the value of changes in service delivery
• understanding of how people want information to be presented and ensuring that all information is accessible and communication is inclusive.

Ambition
All children and young people in Scotland will access AHP services as and when they need them at the appropriate level to meet their well-being needs, with services supporting self-resilience through consistent decision-making.

Actions
We aim to achieve the ambition by:

• understanding what is currently available for parents, carers, families and stakeholders to meet their needs
• developing a national foundation AHP resource for all children and young people, their parents, carers and families to be delivered as standard across Scotland to support self-management prior to requests for assistance
• making access to self-requests for assistance mandatory across all AHP services for children and young people
• gathering baseline data from services on their current responses to requests for assistance
• developing parental and workforce competencies in relation to self-requests for assistance from higher-risk groups
• further developing and testing the concept and use of triage to enable consistent child-centred decision-making at the time of requests for assistance (for example, problem-based versus well-being based)
• understanding the differences in numbers of children and young people on AHP active caseloads and the variations in the amount of time they receive in interventions as determined by need and well-being
• scoping current prioritisation of requests for assistance and moving towards a national approach
• sharing and developing new ways of working that can demonstrate desired interim and ultimate outcomes
• ensuring effective AHP collaboration in mental health services for children and young people
• ensuring access to AHP services for children and young people experiencing mental health issues
• ensuring effective access to AHP services for children and young people who are looked after, in the justice system and in youth employment services
• gathering data that supports the impact of AHPs’ early intervention and prevention activities based on well-being outcomes
• supporting the development of IT infrastructures and use of technology across services
• improving access to readily available information
• moving from a service-led to an outcomes-focused approach.

2.5 Leadership for quality improvement

The AHP National Delivery Plan highlighted the importance of strong leadership to drive innovation and the delivery of high-quality responsive services developed around individuals’ needs. Implementation of the actions in this AHP children and young people’s plan will require strong leadership to drive service change and ensure children and young people have access to a national, equitable and sustainable service model.

Action 4.1 of the National Delivery Plan highlighted the requirement for each NHS board to have an identified AHP children and young people’s lead. Most boards now have such a lead in place, although roles and remits vary considerably.

AHP children and young people’s leads must be able to provide strategic leadership and demonstrate the ability to influence a wide range of stakeholders, including AHPs working in children and young people’s services, health, education, justice, social care and the third sector to ensure effective and appropriate utilisation of AHP children and young people’s services. Engagement with the AHP National Lead for Children and Young People and the AHP Children’s Services Forum is a key focus. Leads must also have strong links with their AHP director, who will be accountable for implementation of the transformational plan.

The AHP National Lead for Children and Young People will work jointly with the AHP GIRFEC Implementation Lead at Scottish Government and AHP directors. AHP board leads for children and young people will commit to improving quality and create a local infrastructure to support the sustainability of improvement in practice.

Equity in NHS boards’ commitment to the AHP children and young people’s lead role is essential. Inequalities between boards will impact on the readiness of AHP leaders to play their part in implementing the Children and Young People (Scotland) Act 2014.

Ambition
Children and young people, their parents, carers and families will experience services that are led by AHPs who are committed to a leadership and quality improvement approach that drives innovation and the delivery of high-quality, responsive, child-centred care.

Actions
We aim to achieve the ambition by:

• ensuring commitment to the AHP Children and Young People’s lead role, as determined by the population and demographic needs of the area
• facilitating recognition of the AHP children and young people’s lead role within NHS boards and integrated joint boards, and among planners of children and young people’s services
• supporting AHP children and young people’s leads in effectively representing AHPs for children and young people strategically across partnership agencies
• producing evidence of quality leadership in service change and activity in relation to implementation of the ambitions and actions of this plan
• providing training that will help to make quality improvement sustainable across AHP services for children and young people in Scotland
• developing AHP children and young people’s leads’ skills in leading for improvement, in collaboration with NHS Education for Scotland and Healthcare Improvement Scotland
• collaborating with higher education providers to ensure that practice change and related evidence is embedded in pre- and post-registration curricula.