The Scottish Government

SURE START SCOTLAND: GUIDANCE (revised June 2000)

This document provides guidance on Sure Start Scotland. It is a revision of guidance issued in December 1998. The Scottish Executive is allocating funding to local authorities for Sure Start Scotland. Local authorities and health bodies and relevant organisations in the voluntary and private sectors are asked to work together to meet the objectives of Sure Start Scotland.

This revised guidance does not deal with submission of information to the Scottish Executive. That is dealt with in a covering letter of 13 June. But as that letter indicates we recommend that future planning for Sure Start Scotland should take place as part of the broader activity of drawing up Children's Services Plans. We therefore expect the next Children's Services Plans to identify how objectives of Sure Start Scotland will continue to be met.

Aims

The aim of the Scottish Executive is to promote social inclusion through a positive start inyoung children's lives. Research (see Annex A) has demonstrated the benefit of directing support to families with very young children to help children fulfil their potential and be in a position to get the most from subsequent opportunities including, most immediately, pre-school education. The initiative is therefore a key element of Ministers' broad programme of action to promote social inclusion.

The focus is the promotion of personal growth and development of the very youngest children (0-3) before they have the opportunity of pre-school education. But the child develops within the family, with the well being and broad skills of parents fundamental to a child's progress. This initiative is therefore aimed at providing community based, family focused resources, including high quality childcare and direct support to parents, which through a variety of mechanisms will strengthen parents' ability to maximise their children's potential.

Objectives

The broad objectives of the initiative are to:

• Improve children's social and emotional development;
• Improve children's health;
• Improve children's ability to learn; and
• Strengthen families and communities.

In meeting these objectives it is recognised that different parents and children will have varying wishes and needs. But provision should:

• encourage parents to identify what will be helpful resources and services and in the light of that to make provision which maximises opportunities for parental involvement and self and group help;
• provide a stimulating environment, in which very young children, through play, have opportunities for physical development, social interaction, personal development and the growth of skills in communication and language;
• offer parents opportunities to assist their child's development and achieve greater satisfaction in their role as parents through playing together and exploring how children develop;
• provide support to parents which will assist in providing a healthy upbringing for their child;
• promote self esteem and personal confidence, as well as communication and decision making skills in both children and parents;
• provide opportunities for parents to acquire skills which lay the basis for more extensive training or subsequent employment;
• provide inclusive support which is both culturally appropriate and sensitive and takes account of any special needs of children and parents;
• provide support targeted to areas of greatest need, including innovative outreach provision to families not otherwise likely or able to seek services.

The Planning Context

Meeting objectives will require joint working between, and the co-operation of, in particular, different Local Authority departments and Health bodies. Joint working will be necessary to:

• identify the specific needs of different communities;
• plan to meet these;
• deliver new or expanded resources and services.

Whether lead responsibility rests with one department or another, it is important to stress that meeting objectives will require a combination of expertise and resources from a number of organisations or departments in order that services can be delivered which satisfy the diverse requirements of families with very young children. We would envisage involvement not only of education and social work staff but also, where appropriate, of economic development units. In health, as discussed further below, it will be appropriate to involve those involved both in health promotion and in more direct delivery of health care, particularly primary care services.

Some voluntary organisations have valuable experience in operating services for families with young children in more deprived communities. Local authorities should consider involving them in the process of planning for the expertise which they can bring to bear.

East Lothian has an established 'Chief Officers' Group which includes Council, Health, Voluntary Organisation and Parent representation. This ensures access to open discussion and decision making at senior level of the multi-agency environment including on Sure Start Scotland.

The aims of the Scottish Executive take local authorities beyond the provision of services already required in connection with their statutory responsibilities for children in need. But it is recognised that some local authorities have already sought to provide a wider service with a more preventative and pro-active approach as is set out in this guidance.

Ministers therefore wish new or expanded provision to take into account and build on, both existing provision already on the ground (e.g. Local Authority and voluntary sector) and existing expertise in working with families with very young children. It will be important to explore the physical and professional resources which are available before developing proposals and models of delivery.

Linked objectives and policies

A network of 47 Social Inclusion Partnerships (SIPs) are currently targeting the areas of greatest need and socially excluded groups in rural and urban areas across Scotland. Social Inclusion Partnerships are multi-agency partnerships, comprising all relevant local partners such as the Local Authority, Scottish Homes, the LEC, the local health board etc. and representatives from the voluntary and private sectors and the local community. Many of the activities of the various SIPs are centred around young children and families and how their needs can be addressed in the local area. Relevant partners in the SIPs will wish to give ongoing consideration of how continuing developments under the Sure Start Scotland initiative can most effectively support the Partnerships' objectives and vice versa.

In West Lothian multi-agency representation at the Social Inclusion Partnership meetings have ensured that SIP initiatives have been identified from the Children's Services Plan and fit with the Early Years and Childcare Strategy.

The Scottish Executive is already committed to the provision of high quality part-time pre-school education for all 3 and 4 year olds by 2002. In light of this, the longer-term focus of new provision for very young children should be 0-2 year olds. However, a number of issues arise on co-ordination of activity. First, local authorities will want to consider appropriate links between provision for very young children and provision for 3-5 year olds. As in some existing family centres it may be appropriate to provide pre-school education as part of a wider package of activity. Where families have children of varying ages the logistics of delivering one child to one place and a second child to another location can present sufficient difficulty to prevent parents using a service, let alone becoming involved in the provision themselves. Where centres deal with the whole 0-5 age group it is accepted that family support should not be exclusively for parents of very young children but should be extended to parents with children receiving pre-school education.

Pre-school education also offers the potential, at the planning stage, of contacting existing groups of parents and building upon this contact to establish what the families in the area see as their needs for provision for very young children. Those parents, whose children have moved into nursery education, will be able to comment on what would have been helpful when their children were in the 0-2 age band.

New CommunitySchools make integrated provision of a range of services with a view to increasing the attainment of children facing under-achievement. The objectives for these schools have much in common with the objectives in expanding support for families with very young children. Both aim to look at the child within the wider family, taking on board issues of social, emotional and health needs. In both, emphasis is placed on integration or co-ordination of a range of support, on an inter-disciplinary team approach and encouragement of parental involvement. Local authorities will wish to consider whether there is a benefit in linking family centre type provision to New Community Schools, so that parents and children receive the broad support envisaged over a longer time-scale.

Healthy living centres, funded by the New Opportunities Fund may also offer possibilities of linked provision or shared resource opportunities. Healthy living centres are intended to focus upon the wider determinants of health, such as social exclusion, mental health, poor access to services and social and economic aspects of deprivation, encouraging innovative ways of responding to these challenges in order to meet the needs of different communities and groups. Among the projects that may be considered for funding are health screening, food co-operatives, pre and post-natal groups, parenting classes, cafes and art programmes.

Models of Delivery

This guidance does not seek to prescribe either one or a number of models of provision. Provision must meet local needs which, will vary between and within local authority areas. But innovative models and flexible methods of delivery are encouraged. The initiative aims to challenge, as well as extend, the types of existing provision for very young children.

It is also worth repeating that while expansion of provision is first and foremost aimed at the needs of the child, these are unlikely to be satisfied or sustained without significant family support being offered. The support will need to identify and aid the needs of the parent, as an essential ingredient of encouraging and strengthening the relationship between the parent and child. The initiative also recognises the need to provide different families with different support services at different times. Dealing with all these variables will require flexible working methods and a diversity of delivery models throughout Scotland

Centre-based provision should provide a springboard for outreach and peripatetic services. The extent of focus on, or suitability of, centre-based provision will vary with, for example, the nature of families to be supported and density of population. (Delivery in rural areas is discussed further below). There is no presumption of support being provided in purpose built dedicated centres for very young children. Local authorities may wish to exploit and extend existing facilities (family centres, child care facilities, schools, women's centres, health centres or community flats) in order to take advantage of already existing family support networks, information services and wider support services.

Orkney Islands Council recognised that with a diverse, and sparse rural population, a centre-based approach was not appropriate, and that locally based solutions would be needed. Their plans include proposals for community based services, outreach provision in families' own homes and the provision of transport to allow families in remote areas to access some services.

Both childcare and opportunities for children to play in the company of their parents should offer a stimulating environment which promote the child's development. But access to these services or resources should also provide a gateway to wider support.

As far as childcare is concerned, funding assumes that childcare will not be provided full time but rather perhaps for three to five half day sessions per week. (Provision of full time places to parents in work or training is considered further below at paragraphs 31). Drop-in facilities or planned parent and toddler sessions, where parents may remain with their children, are also important in providing an opportunity to mix and for playworkers to interact with parent and children.

Childcare can offer the parent some essential respite and/or the opportunity for personal development and contact with other adults, in the knowledge that their child is being well cared for. The availability of childcare also offers the opportunity to take up more specific support, both within a centre and through help in accessing specialist services for child or parent. Centre based support might include individual access to advice (including possibly one to one counselling) and group based support or training. Such group based opportunities are likely to be important as much for building self-esteem and confidence as for specific skills acquired. Both aspects may, however, lay a basis for most extensive training and for future employment. In all cases, if services are to be used and have an impact, it will be important that parents play a large part in determining the shape of provision and activities.

Home based or one to one contact may be necessary in some cases to build confidence and enable families to access wider support available at a central facility. This may extend beyond mere provision of information. Outreach can take many forms, but is generally taken to mean practical support to the family in their own home (or other agreed venue). The help provided to families by the voluntary organisation Home Start is relevant here. Local authorities will want to discuss co-ordination and co-operation where appropriate but specific expectations of activity are not appropriate as Home Start rests on volunteer effort.

There are currently 24 Home Start projects in Scotland, with 2 more due to start within the next few weeks and the organisation anticipates that there will be some 30 projects in place by the end of 2000. Many recently established projects are being supported as part of Sure Start Scotland.

Multi-Disciplinary Working

In providing flexible and innovative family support a range of skills will be needed. Individuals from whatever background will need to work together with a multi-disciplinary approach. Providers will need to consider:

• the extent to which individual centre and outreach workers can, through appropriate training, carry out a range of activities,
• the need for centre staff to have specific skills or qualifications (childcare, social work etc.)
• the need for involvement of professionals whose remit extends beyond the centre in question, such as health visitors, social workers for children with disabilities or sensory impairment, community paediatricians and peripatetic support teachers.

In some instances it will be possible to train centre workers, local community workers or outreach workers in special areas of knowledge or skill (e.g. basic health promotion -for instance nutrition- or counselling skills for working with very young parents). Working with multi-disciplinary teams should give opportunities for shadowing or placement practices, which will help extend individuals' skill base.

There will also be advantage in working closely with, for example, social workers and health visitors who have responsibility for relevant geographical areas or families who could take advantage of centre support. As noted below funding is being allocated specifically to encourage such multi-disciplinary working.

Particular consideration should be given to the person best suited as an initial point of contact, to draw families' attention to support that is available. This could be an appropriate role for midwives, who have contact with a family before and after the birth of a child, or health visitors who also have contact with families soon after birth and in the first years of the child's life.

Health

Integrated support includes addressing health issues. It will be important for Local Authorities to plan provision and delivery of services in co-ordination with relevant health bodies. The main opportunity is likely to be for Sure Start Scotland initiatives to promote healthy living. Practical work might be undertaken either by centre workers after training by health promotion staff or directly by health visitors becoming involved in family centres. Information, advice and support groups on the following issues should be considered:

• Pre-conception and antenatal care - including the reinforcement of key messages on diet, smoking cessation and vitamin intake;
• Breastfeeding - specifically helping to foster a supportive environment for those who have chosen to breastfeed;
• Child diet and healthy eating, including advice on weaning;
• Help in the identification of family problems and potential post-natal depression; and
• Advice on common ailments, accident prevention, first aid and child development.

The joint planning process should also give consideration to community and individual uptake of health services in the local area. There may be opportunities for, and advantages to be gained from, direct delivery of services, such as mother and baby clinics and child development checks, at centres. Centres may, in some circumstances, provide a more accessible location for parents. Some vulnerable parents may attend centres for the services they provide but be poor attenders at clinics. This will be very much for local determination depending on the wider pattern of service delivery. In particular the recent creation of Local Health Care Co-operatives, bringing together groups of GP practices to plan and deliver services for their local population, may provide focal points for contact and co-operation with local authorities in relation to primary care services.

In Glasgow Sure Start Scotland funding has helped to recruit health visitors to be located in family centres.

The Scottish Executive recognises the importance of informing health managers and professionals about the Sure Start Scotland initiative. We have invited health personnel to Sure Start Scotland seminars and seminars have included health service speakers. We have disseminated information about Sure Start Scotland to health service personnel at conferences and seminars and intend further such activity.

In addition to joint working in planning delivery of services there is likely to be a role for individual centres in encouraging co-operation. It may be helpful if individual centres make contact with local health services to enhance understanding of their respective roles and the potential for joint working.

Rural Areas

Although emphasis is seemingly given to a centre-based approach, it has already been noted that this may be less appropriate in some areas. Solutions will need to be devised locally but experience to date has highlighted the following possibilities.

A cluster model might involve only a central management and resource facility providing a base for workers to offer a range of support services to small communities in remote settings. Where there are existing groups of parents meeting on a regular, if not a frequent basis, (e.g. parent and toddler group, playgroup breastfeeding group, nurseries), there may be an opportunity to bring in family support workers (e.g. play workers, childminders, counsellors, health visitors) to provide the kind of family support identified as being required. In addition, even where a centre does exist, these groups may provide a springboard for outreach work with families unable to access the service for what ever reason (transport, other family commitments, confidence issues etc.).

Alternatively, a mobile unit which travels to those families or groups of families who would otherwise have no access to a facility, may be a solution.

Targeting and Access

Funding is being provided for targeted provision as discussed below and with the objective of promoting social inclusion. In determining where to place services local authorities will want to identify concentrations of vulnerable families who would otherwise not receive such support. In terms of individual access, support might be available to all those who live within certain boundaries, similar to a school catchment area. It is recognised, however, that this approach is not without problems. Some outside the agreed area may have greater needs for support. But wholly referral based access may discourage use. An overriding objective is that parents should not be discouraged from using provision because of any stigma attached to services or providers.

It seems likely that providers will need to allow for a mix of open access and referral by social workers, health visitors etc. Ideally the emphasis should be on the former but this brings with it a need to ensure that more dominant individuals or groups do not discourage use by others and that parents' needs are best met by the facility in question rather than being better met elsewhere. It will also be important to encourage access by all main carers (e.g. fathers and grandparents as well as mothers) and to be culturally sensitive including meeting the needs of ethnic minority groups.

Aberdeen City Council propose to expand their services to meet the identified needs of the Cantonese and Bengali Communities and to develop their outreach provision.

The focus of Sure Start Scotland means that services will not be directed in the main to parents in full time employment. Funding is therefore being provided to allow provision of services and resources without charge. However, there may be a case for centres providing more extensive childcare at a charge to parents in employment. This might also have the benefit of increasing the degree of social mix. Charging those in lower paid employment is more practicable with the introduction of the childcare element of the Working Families Tax Credit. It is, however, recognised that parents engaged in training may face particular problems in paying for childcare and local authorities may want to make more extensive childcare available to this group.

Providers

Local authorities will need to consider whether to provide support at their own hand or through others, such as relevant voluntary sector organisations or private sector providers. Decisions should take into account which providers are best placed to encourage vulnerable families to take up their services, relevant expertise and experience and cost effectiveness. A number of voluntary organisations in particular have considerable experience in providing support similar to that described in this guidance. We will include information on the relevant experience of different voluntary sector organisations in future issues of the Sure Start Scotland newsletter.

Moray are just one of the local authorities who have produced their development plan jointly with NCH Action for Children, the voluntary sector organisation who are most active in their area.

In practice, the diverse nature of effective family support may demand a service that pools resources from a variety of providers under one umbrella centre or infrastructure. There are, for instance, existing examples of organisations working together combining expertise in provision of childcare and of family support. Existing partners in delivering pre-school education may be able to provide childcare elements of new services.

A new facility in Alness involves Highland Pre-school services in childcare and play activities, NCH Action for Children in activities with parents and Home Start in outreach support.

Monitoring and Evaluation

It will be important that local authorities monitor outputs from spending to meet objectives of Sure Start Scotland. The nature of the Sure Start Scotland initaitive also means that it will be important to be able to assess impact, i.e. whether objectives outlined at paragraph 3 are being achieved. Local authorities will have their own procedures for evaluation for this and other spending and we wish to take these into account in national evaluation. Plans for national evaluation are currently (June 2000) being drawn up and will be discussed with interested parties.

Sharing of Information and Contact Officers

As discussed, meeting the objectives of Sure Start Scotland is likely to involve a number of local authority departments and health bodies. In our discussions with the different bodies involved in delivering the Sure Start Scotland it has been suggested that one of the barriers to developing effective joint working is uncertainty about who is the appropriate contact within a different organisations. It would be helpful therefore if all relevant organisations could provide details of a lead contact. A form for this purpose is attached at Annex B. These will then be circulated to all relevant interests to allow different organisations to identify appropriate contacts to share information and discuss initiatives. We also intend further newsletters and developing a web site for exchange of information

ANNEX A

Cross-Departmental Review of Provision for Young Children

A Cross-Departmental Review of Provision for Young Children was carried out in end 1997/beginning 1998. The main remit of this review was to see if resources devoted to services for children aged 7 and under could be better spent, in particular to see whether a more integrated approach to service provision at the family and community level could tackle (more effectively) the multiple causes of socialexclusion affecting young children.

The Review involved extensive consultation with those involved and interested in such services. A number of key issues were identified:

(1) Effective support for young children is undermined by the current system of service provision, which is driven by vertically separated agencies - each of which deals with a fragment of children's lives - rather than by the needs of children as whole individuals. Fragmentation and lack of co-ordination appears particularly severe for those aged 0-3, when children are most vulnerable but can benefit most from support.

(2) There is a need for changes in existing arrangements, to provide a pattern of services for young children which are free of stigma, but enable effort to be targeted on those children at most risk of becoming socially excluded later in life. Evidence shows that the first year of a child's life is crucial in terms of cognitive development and emotional adjustment: the quality of bonding and attachment in the first year heavily determines subsequent achievement.

(3) In order to benefit those most at risk, a community-based approach to children's services may be needed, providing a universal and open access "gateway" of core services for young children and their families (e.g. childcare, early education and play, health services and family support), beyond which services based on evidence of what works can be targeted on those who need them most.

Effective early interventions were identified:

• 2 generation: involve parents a well as children
• non stigmatising: avoid labelling "problem families"
• multifaceted: target a number of factors, not just e.g. education, health or "parenting"
• persistent: last long enough to make a real difference
• community based: built on consultation and involvement of parents
• culturally appropriate and sensitive to the needs of children and parents

There is no blueprint, but core services were identified as:

childcare / early education, play, health and family support accessible through a single gateway (e.g. open centre, home visitor); effective outreach service to ensure that those in most need get access to appropriate services - it is these parents who are most likely to lack the self confidence to seek support or use facilities on offer.

The review also suggested that to date families with very young children had not been a focus of initiatives to integrate support.