Organisation submitting example
Tower Hamlets Local Authority
Local authority/local area:
The context and rationale
In collaboration with NHS Tower Hamlets, as part of the Healthy Borough programme, Tower Hamlets Early Years Service designed the Healthy Early Years project (HEY), for children’s centres, early years settings and school nurseries to achieve a healthy early years accreditation. At this time there was a national scheme for schools to achieve healthy schools status and our project was aimed at providing a similar opportunity for early years settings.
In the academic year 2009-2010, 13.3% of Reception aged children in Tower Hamlets were obese (the 3rd highest level in England), along with 23% of year 6 pupils. The White Paper ‘Choosing Health’ (2004) stated that ‘people's patterns of behaviour are often set early in life and influence their health throughout their lives. Infancy, childhood and young adulthood are critical stages in the development of habits that will affect people's health in later years.
The Early Years Foundation Stage framework themes, A Unique Child and Positive Relationships, underline the vital importance of supporting children’s health and wellbeing. Learning and Development places great emphasis on the provision of rich opportunities for physical activity in settings and on healthy eating. Parents and practitioners working together have a positive impact on children’s learning and development. Practitioners in the Early Years are in a unique position in terms of the close relationships and daily contact they have with parents. They are ideally placed to support parents in making healthy lifestyle changes for their children.
The project’s aims were as follows.
• Use early years’ settings to promote healthy diets and healthy food choices for children and their families.
• Promote active play and physical activity both in settings and, through work done in settings, at home, as a key factor in children being healthy, and an important element in their development.
• Support practitioners in promoting children’s emotional wellbeing, both in settings and at home.
• Use early years settings to promote the importance of oral health for young children
A Healthy Early Years coordinator (HEYco) was appointed in April 2010; funded through the Tower Hamlets Healthy Borough programme. 29 settings and schools and two children’s centres enrolled in the project to work towards Healthy Early Years accreditation. They used a locally developed self assessment tool to evaluate their provision and practice around supporting children’s health and well being, and in raising parents’ awareness about the importance of adopting more healthy lifestyles. The settings/schools were required to document the changes they made on the tool and provide evidence.
High quality training was provided on the key aspects of the audit:
• Healthy eating and oral health.
• Emotional wellbeing.
• Physical development.
Settings sent at least one person to each of the training courses provided. The HEY coordinator gave support and advice to settings and schools in improving practice.
Physical development training focused on the importance of developmental movement play. The training was provided over two days. After the first day, each practitioner was given a task to monitor physical activity within their settings and bring back pictures to the second day of children experiencing ‘full bodied and whole hearted physical play’. Settings were also given resources that could be used to set up a developmental movement area. On the second day of the training, practitioners fed back changes they had made to their environment to enable more opportunities for physical play. The HEY coordinator supported some settings with these changes, by helping settings to reduce the number of table and chairs in the rooms and setting up developmental movement areas. Feedback from the training was very positive and practitioners discussed various ways that physical development could be included in their observations of the children.
The Public Health Dietician for children was linked to the project to assess the nutritional value of mealtime menus and food offered as snacks, also offering training and support. Settings submitted their menus to the dietician at the beginning of the project, the menus were assessed and recommendations were given to each setting that needed to make improvements. Settings were given until the end of the project to make relevant changes to their menus.
The oral health promotion team was linked to the project to provide information for parents and children on the importance of oral health. All settings were asked to include a question on their admission forms about registering their child to a dentist. The HEY coordinator gave leaflets and posters of local dentists to settings that did not have the information; they were also signposted to relevant NHS websites.
Practitioners were encouraged to attend the Leuven training provided by the Early Years team on emotional wellbeing. The HEY coordinator supported some settings in using the scales. After using the scales, particularly at meal times, relevant changes were made which enhanced children’s emotional wellbeing.
Settings arranged various ways to include parents in the HEY project. Some were given a copy of the audit tool in order to add their own comments. Information was given to the parents about healthy eating, physical development etc. Parents were encouraged to participate in the project, active play bags and cameras were given to each setting to help with this. The bags and cameras were loaned out to parents to encourage physical activity at home. Settings introduced the bags in various ways, some made booklets and information packs with the bags. The resources inside the bags were demonstrated in different ways e.g. a local park, parents afternoons/evenings.
The settings that completed and made relevant changes or actions to their tool, were approved by the HEY coordinator to go through to the verification process. The final judgements for the accreditation were made by a team of professionals from both the Primary Care Trust (PCT) and the early years’ team through review of the submitted self assessment tools and verification visits to the settings. At the end of this process 22 settings/schools including the 2 children’s centres were awarded Healthy Early Years accreditation. The remaining settings are on course to receive the accreditation however required more time.
The measurable outcomes were:
Measurable improvement in (healthy eating in children) whilst in settings.
• Number of settings/schools making positive changes to ensure their menus are balanced.
• Number of settings/schools that have developed or updated and implemented their Healthy Eating Policy.
Measurable improvement in amount of physical activity done by children whilst in settings.
• Number of settings/schools that have made changes to the environment to create more opportunities for children to engage in physical activity (developmental movement play areas, free flow indoors/outdoors, reduced numbers of tables and chairs.)
• Number of settings/schools with improved quantity and quality of unplanned observations on individual children’s physical play/development.
Leuven well-being scale provides evidence that children’s emotional well-being is developed.
• Number of settings/schools that have made changes in response to using the well-being scale to assess children’s emotional well-being during different parts of the day e.g. mealtimes, transitions.
Increase of parents from targeted settings who are aware of standards and selected key messages.
• Number of settings/schools where parents report improved knowledge of healthy early years standards and the key messages of the HEY project.
• Number of settings/schools where increased numbers of parents have registered their children with a dentist.
Evidence and evaluation - making a difference to children, young people and families
Twenty two settings achieved the Healthy Early Years accreditation, making links with health professionals and attending training.
Healthy eating in children whilst in settings
• 22 settings/schools made positive changes to ensure their menus now meet the minimum standards. Previously, not all settings had had the opportunity to work with a dietician regarding their menus and when reviewed were found not to be nutritionally balanced. Individualised feedback and actions to be implemented were provided to the settings that needed to amend their menus. Of the 16 settings that had identified changes that needed to be made at the beginning of the project, all completed these actions around family service, and children sitting in key groups.
• 22 settings/schools developed or updated and implemented their Healthy Eating Policy.
Amount of physical activity done by children whilst in settings
• All settings/schools reported that they were more confident in what to observe and note in young children’s physical play and how to support it.
• 17 settings/schools made changes to the environment to create more opportunities for children to engage in physical activity. Most settings did not have enough floor space in the setting to allow the children to enjoy movement play inside. Following training and follow up support from the HEY coordinator, these settings/schools set up their own developmental movement areas. They made good use of their new resources to encourage movement play.
Use of the Leuven well-being scale
• The use of the well-being scale is still being established in schools and settings in the borough. Schools and settings that were confident in using them made changes in response to their assessment of children’s feelings about different parts of the day e.g. mealtimes, transitions. Where individual children or groups had low levels of well-being, practitioners made changes to their practice to make improvements.
• Setting/schools that had not accessed any Leuven training run by the early years team were advised to. 10 attended the training to use the scales in their setting.
The HEYco worked with one particular day care setting to improve their lunch time routine. Previously the children receiving the NEG grant were collected half way through lunch. Parents would arrive, and collect their children. Some would stay and wait to for their child to finish lunch, others would take their child in the middle of their lunch. This would cause a lot of disruption and did not provide a good atmosphere for the rest of the children. HEYco asked staff and managers to be reflective of their lunchtimes and measure the children wellbeing by using the Leuven training. HEYco worked with them to implement change in the setting to improve the routine. The times for the children to be collected was changed to after lunch and the staff in the room reflected on their practice. I advised for the staff to measure the children’s well being during lunch times using the Leuven scales. After the change feedback from the staff and parents was very positive. The staff felt lunch times were “less hectic.” They felt they were given more time to interact with the children without being rushed to send them home. Parents said they found lunch times “more of an ease” they felt pressure to rush their child to eat in order for them to leave or to encourage them to finish their food. One parent said: “I have noticed my child eating more. When I collected him he use to stop eating and made excuses not to finish. Now the times have changed I collect him after lunch I do not disrupt the other children and I have been told he eats all his food.”
Parents awareness of standards and selected key messages:
• 20 schools/settings said that their parents reported improved knowledge of healthy early years standards and the key messages of the HEY project.
The HEYco delivered a parents afternoon on healthy eating at a children’s centre. The practitioner who was leading the project recognised a lot of parents lacked basic knowledge on healthy eating. When she gave out a questionnaire at the beginning of the project the responses she received confirmed this. Parents were given some information on healthy eating, portion sizes and the importance of movement play. They were given the opportunity to ask questions.
Nursery school parents:
“ I am thinking more carefully about how I feed my children and have replaced afternoon sweets with fruit on some days”
“we really enjoyed the play sessions in Bob’s Park where we got to be kids again and play with the sports equipment, I forgot how much fun skipping was”
A main aim of the project was involving and encouraging parental engagement. Settings and schools were asked to share information with the parents. Parents were also given resources e.g. journal books and active play bags to encourage them to get involved in the project.
Children centre and setting:
“Parents are using the active play bags & enjoying them”
“Healthy Eating parent’s afternoon – parents found really informative.”
Parents did feel involved in the project. They were given opportunities to provide evidence for the audit tool. When they received their active play bags to encourage them to be physical with their children they took cameras home to record this.
21 settings/schools organised training and held parents afternoons and sessions about health and wellbeing.
The HEYco attended a parent evening at a day care setting to explain the healthy early years project. The importance of being healthy and the rewards of being part of the project was explained to the parents. HEYco and deputy manager demonstrated Jabadao activities and encouraged parents to try them. The parents were enthusiastic in learning more about developmental movement play and were happy the setting was working towards achieving the HEY accreditation.
“I loved participating in the activities!”
“I enjoyed taking the Jabadao bags home”
Increased numbers of parents have registered their children with a dentist
Settings/schools did not generally ask if the children on roll were registered with a dentist. Now all schools and settings include this question on their admission forms. If they are not registered the parents are given information about dentists in their area. Sessions were run for parents, children and staff to make them aware of the importance of good dental care.
Day care setting:
“Parents found the information about the dentists particularly useful. Parents are also happy that we went for the HEY award. Most parents choose this nursery because of our Healthy eating policy, activities that promote self-esteem and physical activity, so this award supports them in knowing that we are evaluating what we do, and always trying to make improvements.”
What now happens differently for the services involved? Have the results changed the way the intervention or related services are delivered?
The HEY coordinator quickly established good working relationships with the early years advisory team. The team supports and advises schools and settings in improving their practice in childcare and education. The HEY coordinator made joint visits to settings where appropriate and linked the audit tool to other development work being undertaken in schools and settings. In this way schools and settings were able to see the project as an integral part of best early years practice rather than something additional. In the second year, the project will continue to strengthen the links between healthy early years’ development work and other development work being undertaken by the early years’ team.
“One of my settings had been struggling with provision for physical play and progress has been very slow. However, they are taking part in the Healthy Early Years Project and I visited there with the project coordinator. The setting is beginning to understand the need for physical play not only in terms of children's physical health, but also in terms of their emotional well-being. The combination of expertise between the HEY project and the early years service is proving to be invaluable in settings like this.”
Senior Public Health Strategist:
“A HEY steering group met on a quarterly basis to discuss progress against objectives and milestones, and how to manage any challenges that arose from the project. The steering group consisted of professionals from Public Health, the PCT and early years enabling cross-sector links to be made for future collaborative work. The potential for working with other professionals and the enhanced positive impact this can have on outcomes has been realised through this group.”
Local authority Early Years Adviser:
“The Healthy Early Years Project has achieved wider impact by raising the profile of health in early years. It has prompted more discussion of health issues by the council’s early years team, for example a session on the new UK Physical Activity Guidelines. In turn this has led to health issues gaining more prominence in managers’ meetings (for school co-ordinators and nursery managers) – where there has been training and discussion around healthy eating and physical activity. The newly formed group which monitors support for schools facing the greatest challenges in the EYFS now includes a health representative and considers health data alongside more conventional educational outcome measures.”
Four colleagues from the early years’ team paired with four from the Primary Care Trust were involved in the verification process. There were three public health coordinators and one dietician from the PCT. They visited settings/schools to verify whether they should receive the Healthy Early Years accreditation. All those involved in the verification process gave positive feedback about the experience for them as professionals. Working alongside a colleague from a different sector to evaluate early years practice was a very valuable shared experience and contributed to their professional development.
“Settings ensured that verifiers had opportunities to look at and discuss a range of evidence and ensured that there was flexibility during visit for verifiers to explore issues that arose during the visit”
Schools and settings are more aware of health professionals roles and services which they can make contact with for practical support and advice(see above).
The feedback received from the settings and schools was that the HEY project provided strong links between health and education. To continue the links, the workforce development team will include the NHS training e.g. breast feeding and nutrition in the early years training directory. This will allow more settings and schools to access the training, make contact with health professionals in the NHS and understand how they can get support from them.
The Dietician supported the project by reviewing the menus provided at all the participating early years settings against the food based standards for children as per Caroline Walker Trust nutritional guidelines for childcare. Food and drink provision at settings were provided either in-house or via external catering services. Most schools and some settings received their meals from Tower Hamlets catering services. It was noticed that the current menu cycles in general were not meeting the food standards. The Dietician worked with the settings to help improve their food and drink provision via individual advice and provision of training on menu planning and child nutrition. Additionally, the HEY coordinator and Dietician made links with Tower Hamlets catering services to make the school menu cycle more suitable for children under 5 yrs as the nutrient requirements for this age group are different to school age children and there are more food restrictions. The current school menu was applicable for school aged children as they followed the school food trust standards which are for children aged 5 -16yrs. Catering services said they were happy to work with us to change the menu on request by the nursery school.
Sustaining and replicating your practice
Every setting in Tower Hamlets is reviewed by the early years’ advisory team termly at settings review meetings. Judgements about the quality of practice and provision are made against a number of criteria, including quality of education and care and parental support and involvement. An additional judgement is now required under a Healthy Early Years heading. The early years’ team are committed to embedding the criteria used in the Healthy Early Years Project assessment tool into their evaluation of the settings.
All 12 of the children’s centres will be involved in the accreditation. The four children’s centres’ teachers will work closely with the HEY coordinator to help the children centres to achieve the accreditation. They will support the play and learning coordinators who run Stay and Play sessions to implement practice following on from training and complete the audit tool with them.
The project will also be extended to childminders and children’s librarians. The audit tool will be adapted and they will receive a certificate stating they achieved the accreditation in their category. Network childminders will attend the training and support child minders to achieve the accreditation.
A new communication aspect is being written for the audit tool to develop and embed the work of the Every Child a Talker (ECaT) programme and to work collaboratively with the Speech and Language Team. This programme focused on raising the communication skills of children in early years settings through the development of practitioners' and parents' skills in supporting young children’s language and communication development. Practitioners will be encouraged to focus on emotional well-being and communication first, because this can be the most challenging area of practice within which to make effective changes and it underpins and enhances the impact of the other aspects of the audit tool.
The HEYco is part of the early years’ advisory team that is supporting schools to work more closely with health services around key issues such as obesity, toilet training and oral hygiene.
She now takes part in a strategic meeting held at the beginning of the school year to identify schools facing the greatest challenges. This includes the impact of poor healthy in a school’s catchments area on children’s outcomes. Alongside school consultants and advisory staff, the senior public healthy strategist support is planned in a coordinated way and the HEYco’s knowledge about health services is a valuable contribution to this work.
Twenty-two settings/schools achieved the accreditation:
• The project is being recognised in Ofsted reports; four accredited schools and four accredited settings received outstanding for Healthy/ Healthy outcomes whilst taking part.
• Regular meeting of the HEY steering group ensured that there were good opportunities for different professionals to develop a shared understanding and vision for children’s health and well- being. The meetings ensured the project was well led and supported.
• Carefully planned outcomes which were measurable ensured that we were able to give strong evidence of the impact of the project.
After completing the end of year evaluation forms, 78% of settings/schools found the Healthy Early Years project useful. 56% of settings/schools rated the audit tool very good. Some commented that the tool was quite lengthy and this was reviewed before the second year of the project.
The project cost for year 1 and 2 was £115,410. Matched funding £2,000.
Cost benefit for each setting involved over year 1 and 2 was £3,979.66.
• Training was provided twice to enable settings/schools to send more than one person. This also allowed flexibility for settings and schools to choose a date to attend. There was a good turnout for all the training provided, all settings/schools sent at least one person.
• They used a locally developed self assessment tool to evaluate their provision and practice around supporting children’s health and well-being, and in raising parents’ awareness about the importance of adopting more healthy lifestyles.
“Completing the audit tool really helped us to evaluate what we are doing and to look at where we needed to improve our practice”
“The tool was Excellent in terms of helping us evaluate and develop our practice.”
Children centre and school:
“The audit was a good thinking tool for exploring ideas and practice around health.”
• Training was provided which helped practitioners to reflect on the quality of experience of mealtimes as well as nutrition.
“The planning training overall was very beneficial”
“The advise given around the quantity of foods children should eat, the amount of servings children are expected to have, how to inform parents (sensitively) about the food guidelines was very useful”
All settings/schools made positive changes to their menus and their healthy eating policies. Of the 16 settings who identified changes that needed to be made at the beginning of the project all completed actions around family service, children sitting in key groups.
Training was provided by Julian Grenier, early years adviser to Tower Hamlets.
“An interesting day-very good discussions”
“good insight into children’s emotional wellbeing”
All settings/schools made positive changes to their environments and routines.
Training was delivered by Jabadao on the importance of children’s developmental movement play.
”Amazing sociable and fun”
“Training was eye opening”
“A very relevant, in-depth session”
All settings/schools reported that they were more confident in what to observe and note in young children’s physical play and how to support it. Most settings/schools made changes to the environment to create more opportunities for children to engage in physical activity.
Both practitioners and parents gave their overall evaluations of the project and the impact it had had.
“HEY provides and good link between education and health”
• In discussions at the HEY steering group, it has been planned to include children’s feedback in the next year to help evaluate the project and monitor its impact.
• The early communication and language monitoring tool and the EYFS development matters will be used to measure impact on individual children.
Tips for others:
• Good quality training, support and resources were an incentive for the settings and schools to be involved.
• Settings/schools were reassured that they received support to complete the accreditation from the HEY coordinator.
• EYFS coordinators need to work collaboratively with health colleagues and children’s centres to achieve optimal health and developmental outcomes for children, the HEY project supports this approach.
• Keeping the early years’ advisory team up to date about the progress and the joined up working in particular with settings, has meant they see the value of the project, and are committed to its further development.
• The project spans over the financial year rather than the academic, which made it difficult for some settings and schools to be involved.
Together with children, parents and families
It takes a community to raise a child
Shape up and keep fit
t. 020 7833 6825
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