How easily can two become one?

Jovian Smalley, Engagement Manager
Centre of Excellence for Information 

What does integration really mean – just sharing paperwork or actually being in the same room?

That was the burning question that hung in my mind at the end of the 4Children information sharing seminar I attended last week. Having been piloted successfully since January 2013, the day was designed to explore information sharing preparations for the Integrated Review at Age Two, which will be rolled out nationally this month.

My question was a pertinent one because the review brings together two really important checks for two-year olds that had previously been carried out with little, if any cross-over: the Early Years Foundation Stage (EYFS) progress check at age two, and the Healthy Child Programme (HCP) 2-2½ year health and development review.

At first glance the solution to integrate them would seem to make sense, not just for the services, but for the parents and most importantly, the child. However, delegates at this seminar were clear that there were significant cultural and logistical hurdles to overcome first – before two could become one.

For instance, there is the perennial problem of agencies fearing to share. Islington – one of the five pilot areas – gave an overview of their experience in setting up the Integrated Review at Age Two, and explained how the extent of the workload surprised them. Through creating separate operational and strategic groups to manage the complexity of change, they discovered that training and development was very important to both health and early education professionals. Through doing this, it became clear that a lot of the initial resistance to implementing the combined checks came from a lack of confidence to share information and work collaboratively.

It soon became apparent to Islington that there were lots of cultural issues to be resolved and that reaching compromise would be required by all parties. For instance, nursery nurses and health visitors rarely saw eye-to-eye about developmental delay and couldn’t agree on whether a child should be achieving specific milestones by a certain month, or if all children develop skills and abilities at different times.

However, despite initial concerns that two professionals placed together in a room would not always agree on the best way to support children’s developmental needs, over time, being in that room together did encourage accommodation for other professional viewpoints, and a shared understanding of the importance of consensus from the parents’ perspective.

A raft of logistical questions was posed alongside the airing of fears and concerns about sharing both information and space. At the forefront was when and where the review should actually be held, and later evaluation of the pilots conclude that, where some areas simply didn’t have the resource or venue to hold reviews in one room, conducting the health and early years elements of the checks at different times was an acceptable alternative. In these situations, developing integrated working methods and a consistent approach to sharing information became even more vital.

Many delegates stressed that whilst the Red Book was a recognised method of enabling parents to share information between agencies, there was no guarantee they would remember to bring it to each meeting, and in some cases poor communication meant they didn’t realise the need to attend both parts of the review. In these cases, cultural fears of working together could be further compounded by the lack of a technical solution to sharing information.

Based on their experiences of implementing the Integrated Review at Age Two, a commonly accepted point by delegates was that it did have the full support of parents. Islington was able to point to a wealth of feedback from parents, expressing how much they preferred the integrated review to the separate checks because it gave them a holistic picture of their child’s development; “It was one question, two aspects and I could get the whole picture”. Sharing this feedback then gave the borough’s early years and childcare teams the confidence to push forward with their plans, even when health and early education professionals were less positive.

Graham Allen MP’s 2011 report to the Government on Early Intervention underscored the importance of getting this process right as early as possible, to improve outcomes for children: “A child’s development score at just 22 months can serve as an accurate predictor of educational outcomes at 26 years”, and delegates were rightly united in their efforts to navigate their way through the maze of cultural, technical and logistical barriers to integrating early years support.

I took away these learning points from the day’s discussions:

  • There is no one size fits all solution: information about children’s needs is best shared through mutual understanding and appreciation of what each professional brings into the room.
  • It is important to invest time in the process: rushing integration plans or insisting on using one agency’s preferred method of capturing and sharing information will only serve to alienate another agency, which could lead to confusion about what the review is trying to achieve.
  • There is no point putting a new review process in place that identifies children’s support needs at age two if there isn’t a relevant service provision for parents to access: looking at what happens to the information that is shared at the review and how parents are referred onwards to pathways of support is as important as agreeing how to hold the meeting.
  • As one speaker pointed out, “the essence of partnership is sharing” (Jo Tunnard 1991): partnership working in the early years requires a willingness to share, not just information but power, and make decisions jointly. A delegate commented that the key thing for her was “understanding and respecting each other’s roles”.

And with that, I think I may have just answered the burning question that hung in my mind after the seminar: true integration can never be achieved just by sharing paperwork – and being in the same room is only the first step of many to making it a success.