A transformational plan for children and young people requiring 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. The five ambitions follow on from the survey and provide the foundations for transformational outcomes for children and young people.

The ambitions cover:

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

2.1 Access 

Access is broader than service provision and includes:

• access to information (which is not only about information being presented in understandable ways, but also about ensuring children and young people have time to think about and understand it)
• timely services
• 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).

Children and young people need to have responsive services that are appropriate to their needs and which they, their parents, carers and families can access in a timely manner to request assistance to meet their well-being needs. The 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.

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.

Proposals

We aim to achieve the ambition by:

• understanding what is currently available for parents, carers families and stakeholders to meet their needs before they are referred to services
• making access to self-requests for assistance mandatory across all AHP services for children and young people
• developing a national 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
• further developing and testing the concept and use of triage to enable consistent decision-making at the time of requests for assistance
• gathering baseline data from services on their current responses to requests for assistance 
• supporting partners through a comprehensive approach to developing competence, knowledge and skills
• 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 active interventions
• scoping current prioritisation of requests for assistance and moving towards a standard national approach
• testing methods of understanding and responding to children and young people's perceptions of well-being
• sharing and developing new ways of working
• ensuring effective AHP collaboration in mental health services for infants and children and young people and access to AHP services for children and young people experiencing mental health issues
• measuring changes in waiting times and the adoption of national approaches to requests for assistance
• gathering data that supports the value of AHPs' early intervention and prevention activities based on well-being outcomes
• developing IT infrastructure and use of technology across services
• developing shared ambitions with partner agencies
• sharing, testing and disseminating others' successes.

Our questions are:
Are these the right proposals?
What support might AHPs need to deliver these actions?

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. AHPs need to adopt an enabling approach that promotes self-resilience and allows children and young people, parents, carers and families to feel confident and competent in self-management, seeking assistance from AHPs as needed.

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 developing nurturing environments (at universal level).

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 condition(s)/problem(s). Potential outcomes of early intervention and prevention include:

• everybody involved with children and young people changing their behaviour and practice
• resources being redirected to creating nurturing environments for children and young people's well-being at nursery, school and home children and young people, parents, carers, families and stakeholders accessing and using the proposed national foundation AHP resource as and when they need to 
• an increase in schools with nurturing environments influenced by effective collaboration with AHPs, children and young people, parents ,carers and families 
• nursery workers reporting increased confidence in managing well-being concerns 
• more parents, children and young people accessing the early intervention help they need as and when they require it 
• children and young people, parents, carers and families reporting increased confidence and self-reliance in managing their well-being. 

Ambition

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

Proposals

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
• 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 from children and young people, parents, carers, families and stakeholders about services
• ensuring that services deliver focused support for looked-after and accommodated children and young people in line with specific references in the Children and Young People (Scotland) Act 2014
• supporting children and young people and their 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.

Our questions are:
Are these the right proposals?
What support might AHPs need to deliver these actions?

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 families and carers and within and between partner organisations.

We will recognise the existing opportunities created by partners in the third sector within local communities, which will enable us to work collaboratively to improve population and individual well-being. Children and young people and their 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.

The Scottish Government's Guidance on Partnership Working between AHPs and Education document^[12] 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, social care and the third sector is required to develop joint learning initiatives and opportunities that improve interagency 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 (JointWorking) Scotland Act 2014^[13] 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 proposed 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 in the proposed plan. Third sector organisations have well established relationships and partnerships with and in local communities: AHPs working in children and young people's services will utilise these to successfully implement the plan.

Opportunities for joint learning and shared outcomes in relation to children and young people's well-being cannot be missed. A commitment to addressing this inequality is an essential objective of the proposed plan.

Ambition

Children and young people and their 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.

Proposals

We aim to achieve the ambition by:

• sharing good-practice examples of collaboration from areas in which it is working well
• collaborating to develop shared 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
• agreeing key indicators for effective partnership-working
• working with partners in acute paediatric and adult community services to ensure effective transitions for children and young people, parents, carers and families 
• ensuring that AHP reviews and redesigns of services are undertaken in collaboration with parents and stakeholders
• building on existing Early Years 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
• 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 and social care to deliver to the duties of the Children and Young People (Scotland) Act 2014 and implement the plan.

Our questions are:
Are these the right proposals?
What support might AHPs need to deliver these actions?

2.4 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, 2000) ^[14]

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^[15] (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 Getting it Right for Every Child practice model and "My World Triangle"^[16] clearly identify the importance of placing the child at the centre of partnership working. 

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 children and young people is evidenced through their therapy outcomes. We will have compassionate conversations with children and young people and develop participative environments in which can engage in meaningful ways. 

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.

Proposals

We aim to achieve the ambition by:

• committing to produce evidence that children and young people's 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
• agreeing participation measures across 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 workforce
• 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 and participation 
• creating environments in which participation and participative relationships are possible.

Our questions are:
Are these the right proposals?
What support might AHPs need to deliver these actions?

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 proposals 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 for children and young people.

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 creating 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 and their 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, person-centred care.

Proposals

We aim to achieve the ambition by:

• providing training that will help to make quality improvement sustainable across AHP services for children and young people in Scotland
• understanding the need for AHP children and young people's leads to be able to reflect with their peers
• developing AHP children and young people's leads' skills in leading for improvement, in collaboration with NHS Education for Scotland
• producing evidence of quality leadership in service change and activity in relation to implementation of the ambitions of this plan 
• supporting AHP children and young people's leads in effectively representing AHPs for children and young people strategically across partnership agencies
• facilitating NHS board recognition of the AHP children and young people's lead role.

Our questions are:
Are these the right proposals?
What support might AHPs need to deliver these actions?