Children, especially the youngest, face many transitions in their lives, one of the biggest being the move from the home or early years setting to primary school, normally in the reception year. This can be a stressful time for children and families and it is essential that they are ready for school entry.
Interventions in action
Interventions that focus on the period of transition between early years and school will have an impact, as will specific programmes to improve speech, language, and communication skills. The latter will almost certainly stem from a health review or from ongoing observation in an early years setting. Many areas will take a more collaborative approach, employing programmes that take in more than one area of learning or development. There are simply too many to mention here; nurses and early years professionals will be familiar with those local to them but it is worth researching those used in other areas.
As an example, ‘Initiatives to improve school readiness across the South-East’ has details of the many programmes in use in different local authorities across the South-East of England (Public Health England [PHE], 2019). It would be impossible to mention them all, but this article offers a few examples.
Isle of Wight
On the Isle of Wight, the public health nursing team identified the B4 School Check in New Zealand as having potential for developing school readiness (New Zealand Ministry of Health, 2015; Isle of Wight, 2018; 2020; PHE, 2019). These checks embrace ‘early identification of issues which could impact school readiness and overcome these via partnership working with parents’. Health forms the basis of these checks, which include a hearing and vision test, the National Child Measurement Programme (NCMP) for reception class children, and further school readiness checks. A school readiness passport will also be issued during the term of the child's fourth birthday, providing, ‘information about what a child needs to achieve to be “school ready” and information on the various screening and health and development checks that take place. The passport sets out the journey for the child, parent and school’ (PHE, 2019). Essentially, the check and passport aim to re-establish a relationship between families and health services, building on existing school-based transition arrangements.
The Isle of Wight has put in place training for professionals under the partnership for education, attainment and children's health (PEACH) framework, which is a whole-school framework designed to facilitate improvements in education, attainment and health, encompassing: PSHE, emotional wellbeing and mental health, physical activity, and healthy eating. The programme includes the early years, focusing on supporting school readiness and transition, as well as family health and wellbeing. The PEACH framework is a self-assessment matrix that enables schools to identify areas for improvement or where they are meeting or exceeding expectations. There is a learning and support package that provides resources, including training, evidence, innovation and case studies.
Interventions that focus on the period of transition between early years and school will have an impact, as will specific programmes to improve speech, language, and communication skills.’
‘Each local authority or region has its own strategies and pathways towards promoting school readiness.’
In West Berkshire, the Flying Start programme identified families eligible for 2-year-old funding and those who may be vulnerable (PHE, 2019). Overall, 20 families received a personal invitation to attend the course, with seven attending regularly. The sessions were themed as follows:
- Speech and language
- Personal and social development
- Physical development
- Fun with books
- Exploring resources at the family hub
- Healthy eating
Flying Start helped parents to explore school readiness in terms of their child's learning, health initiatives for all the family, how they could support and extend their child's learning at home and more. None of the parents involved in the Flying Start programme had been offered support or advice about their child starting school prior to the sessions. This may have been because none was on offer, or because they had not known how to access it.
Each local authority or region has its own strategies and pathways towards promoting school readiness. They might include plans to improve outcomes for vulnerable children, early years strategies, health and wellbeing strategies, prevention and early intervention frameworks, school readiness strategies, targeted parenting strategies, training for professionals and so on.
Kent County Council
What should be clear is that the best form of approach is collaborative and multi-agency. For example, Kent County Council (no date) has used The Balanced System (as developed by Better Communication) to bring together ‘all support, training and resources related to speech, language and communication for young children under universal, targeted and specialist levels as delivered by the full range of multi-agency colleagues who support this area of work’ (PHE, 2019). Specialist teachers deliver targeted communication and language training to both early years professionals and speech and language therapists. Workshops include Every Child a Talker (ECaT) and English as a Second Language in the early years, both of which facilitate parental interaction with their children. Makaton training adds to the multi-agency skillset.
East Sussex County Council
East Sussex County Council has developed an early years speech, language and communication pathway involving health, education, the children's integrated therapy service and children's centres (PHE, 2019). The pathway involves the rollout of the ECaT programme, as well as an appointment of speech and language therapy assistants to support early intervention, and multiple levels of support for families, including language checkers and awareness raising tools. Early communication support workers work within children's centres to deliver additional services to families with children who have been identified as needing language support.
The Family Nurse Partnership in Oxfordshire is an example of targeted parenting support in practice (PHE, 2019). Working with parents aged 24 years old and under, this evidence-based programme partners young parents with specially trained family nurses. The family nurse visits the parents regularly from early pregnancy until the child is 2 years old, when links begin with early year settings. The programme includes specific tools around speech and language development as part of the Partners in Parenting Education module and forms part of the 0–5 public health service.
A good example of collaborative working and joined-up thinking was developed in Warwickshire (Warwickshire County Council, 2016a; 2016b), using the Lancaster Model as a starting point.
The Lancaster Model is a ‘step-by-step change management solution to drive service improvement forward and transform practice. It provides a validated, systematic approach to assess the needs of individuals and populations, identifying children and young people earlier who would most likely be “under the radar”’ (Lancaster, 2021). It was developed by Kath Lancaster and is a proactive approach based on two elements:
- A sustainable health needs assessment process providing a cyclical approach of staged contacts to evidence the needs of children, young people and their families
- A workforce skill mix strategy that utilises the skills and competencies of the existing workforce, while developing and directing the future workforce.
Warwickshire County Council's (2016a; 2016b) Smart Start Strategy is a good example of putting children and families at the heart of multi-agency working. Smart Start began as a 3-year programme aimed at improving ‘the health and wellbeing of children aged 0–5 years in Warwickshire by giving them the best possible start in life’ (Warwickshire County Council, 2016b). In 2015, 67% of 37 974 children in the county aged from birth to 5 years old achieved a good level of development. Research was conducted with families and frontline staff to understand their experiences. The resulting data were used to inform the Smart Start Strategy and its future work programme. It also resulted in additional investment in family support services, and supported the redesign of 0–5 services in Warwickshire, as well as informing the transformation and re-design process of health visiting.
‘We need more joint working and joining up of expertise, as no one service is going to make the difference to (0–5) children and their families…’
‘It is clear that the best outcomes for children and families are delivered when all key stakeholders work together, including health, care, and education.’
There are a number of interesting quotes from the foundation's project regarding joined-up working, including ‘We need to all work to shared outcomes so we aren't pulling in different directions’ and ‘We need more joint working and joining up of expertise, as no one service is going to make the difference to (0–5) children and their families’ (Warwickshire County Council, 2016b).
Interestingly, given the definitions of school readiness in the first part of this article (Henty, 2020), Smart Start identified the following characteristics in children who are school ready (Sheridan, 1973):
- Recognise numbers and quantities in the everyday environment
- Participate in music activities, such as singing
- Have good oral health
- Are able to take turns, sit, listen and play
- Are able to communicate their needs and have a good vocabulary
- Are able to socialise with peers and form friendships
- Are independent in eating
- Develop motor control and balance for a range of physical activities
- Are independent in getting dressed and going to the toilet
- Have received all childhood immunisations
- Are well nourished and within normal weight for height.
The strategy identified that although Warwickshire was an affluent county, ranking in the top 20% least deprived authorities in England, there were pockets of deprivation, in both urban and rural areas (Warwickshire County Council, 2016a; 2016b). ‘Deprivation and poverty in childhood have a profound impact on educational, health and employment outcomes later in life. This can generally be explained by a lack of financial means to invest in the children, and due to parental factors that are associated with poverty. Poverty and deprivation are linked with lower school readiness meaning that many children from poor backgrounds begin school at a disadvantage’ (Warwickshire County Council, 2016a).
The aim of Smart Start was not only to improve the school readiness for all of Warwickshire's young children, but to co-produce a fully integrated model of early help services. The current Smart Start Strategy Group brings together representatives from health, early years education, social care and the third sector to develop and deliver its strategy. Grants are awarded to projects that meet the following criteria:
- Access to learning activities
- Access to play and learn areas and equipment
- Improving the health and wellbeing of children aged 0–5 years old and their families
- Activities helping to develop parent-child bonding and attachment
- Activities that help children to develop self-help and social skills
- Activities that help parents develop skills to interact with their children and support their development
- Initiatives that support most vulnerable families with 0–5-year-olds, including those with special needs, living in isolation and/or from poorer backgrounds.
The transition to school from the home or early years settings can be a very stressful time in a child and family's life, and school readiness has a substantial impact on children's future life chances. It is clear that the best outcomes for children and families are delivered when all key stakeholders work together, including health, care, and education.
- Better Communication. The Balanced System. No date. https://www.bettercommunication.org.uk/the-balanced-system/
- Department of Education, Department of Health. Families in the foundation years evidence pack. 2011. https://www.gov.uk/government/publications/supporting-families-in-the-foundation-years
- Department for Education. Supporting Families in the Foundation Years. 2011. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/184868/DFE-01001-2011_supporting_families_in_the_foundation_years.pdf
- Home-Start West Berkshire. Home-Start West Berkshire. No date. https://home-startwestberks.org.uk/getting-support/
- Korkodilos Dr M. Improving school readiness Creating a better start for London. Public Health England. 2015. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/781623/improving_school_readiness.pdf
- Ofsted. Are you ready? Good practice in school readiness. 2014. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/418819/Are_you_ready_Good_practice_in_school_readiness.pdf
- Public Health England. Initiatives to improve school readiness across the South East. 2019. https://www.gov.uk/government/publications/improving-school-readiness-initiatives-across-the-south-east (accessed 6 January 2020)
- Public Health England. Child and Maternal Health Statistics. 2020. https://www.gov.uk/government/collections/child-and-maternal-health-statistics
- Public Health England. Public Health Profiles. 2021. https://fingertips.phe.org.uk
- Public Health England. The health and wellbeing of children and young people in London. 2014. https://www.gov.uk/government/publications/health-and-wellbeing-of-children-and-young-people-london-compared-to-4-cities
- Royal College of Nursing. School Readiness. https://www.rcn.org.uk/clinical-topics/public-health/the-role-of-nursing-staff-in-public-health/school-readiness