Health and Wellbeing in Schools Project - Final Report

Report of a project to improve Heath & Wellbeing in Schools


2. Impact and outcomes - strategic level

This section highlights the importance of strategic leadership in developing a common vision and common values within the workforce. It emphasises how integrated working improves health outcomes for children and young people by ensuring that the right staff with the right skills deliver care and support in the right place, according to identified health needs.

The section includes illustrations developed during the Open Space events by a graphic facilitator. [15]

2.1 Leadership

No '1 person' can do everything!

The local steering groups at demonstration-site level provided governance for the project and professional leadership and direction strategically and operationally to encourage the development of a shared common vision and common values within multidisciplinary teams. Operational leaders supported and motivated staff through the process of change.

Team leaders (health visitor/school nurse) with the right competences and skills, supported by the steering group and project officer, were crucial to ensuring the new models of working were embedded within each demonstration site. Team leaders were able to influence change in practice innovation, implement new models of integrated working within the workforce, improve working relationships among integrated partners and support staff through the process of change.

Leadership - main learning

While strong strategic leadership is necessary to monitor, support and steer the project locally and nationally, it is equally important to ensure strong clinical leaders to motivate and support staff through the process of change. Clinical team leaders improve links between partner agencies and support staff to deliver effective models of health care to the school-age population.

2.2 Integrated working

Let's have real integrated working!

Part of the project's purpose was to look at new integrated ways of working, building on previous learning from the New Community Schools [16] and Integrated Schools [17] pilot schemes. Each demonstration site held an event with key partners at the onset of the project to establish a common vision and goals. It was recognised that Getting it Right for Every Child principles and practices would support the development of a common vision and a common "language" within the integrated workforce.

An integrated workforce is one that is working effectively together to improve the health outcomes for school-age children and young people within and outside the school. This demands not only a common vision and language, but also good communication with strategic heads of departments in health and education and means to ensure that communication reaches operational staff. At times, achieving this was challenging. Although the project engaged with partners through stakeholder events, focus groups and the dissemination of information posters and leaflets, the information was not always cascaded to operational staff. This sometimes resulted in the spread of misinformation about the project.

However, there were benefits to promoting good integrated working when information cascade worked well. One example is where health staff who had access to the website Glow, [18] the world's first national online community for education that is supporting implementation of Curriculum for Excellence, were able to showcase new models of practice and materials to improve health outcomes for children and young people.

A logic model, outcomes-focused approach was used to provide a framework for integrated planning, delivery, evaluation and performance management of the new models of practice.

Integrated working - main learning

There is a need for good communication with heads of departments in health and education and viable means of cascading information to operational staff. It is unwise to assume that information will automatically reach all staff - a managed process is necessary to ensure it gets where it needs to go. The mechanisms employed by each partner agency to cascade information and highlight best practice should be identified.

Enabling common access to information resources (such as websites) can support the integration of partners into integrated teams.

2.3 Health needs assessment

Early years are so important

Health challenges within the school-age population are influenced by socio-economic status, poverty, and community and social factors. It was therefore necessary to identify strengths and assets within each of the demonstration sites.

A variety of sources, including the School Health Profiling tool [19] and information from community health partnership community profiles and local public health departments, was used to identify health priorities. Direct consultations focusing on perceived health needs and key strengths and assets were held with children, young people and their families. In addition to local focus groups targeting school years, the Young Scot website supported the project in gathering information from young people, and an information leaflet about the project was distributed to all children, young people and their families within each of the demonstration sites.

The common themes emerging from the demonstration sites were concerns about emotional health and well-being, obesity and communication difficulties. It was decided that the project consequently should focus on key transition times (nursery to primary 1 (P1), and primary 7 (P7) to secondary 1 (S1)) by implementing early intervention programmes targeting children, young people and their families.

Health needs assessment - main learning

The paper-based School Health Profiling tool took a considerable amount of staff time to complete. An electronic tool that can be updated regularly would provide health and education staff with quicker access to an up-to-date health profile of the school and help in identifying health priorities.

All schools do not need the same workforce. Identifying health needs and existing assets within each school enables the workforce to be modelled appropriately to meet needs.

2.4 Workforce capacity and capability

We must get the skills right

After local health needs, strengths and assets had been identified, the project was able to consider the composition of the workforce and the skills required to address the needs of children, young people and their families. This provided an opportunity to develop new, integrated, sustainable models of practice.

The workforces within the demonstration sites needed to vary according to the needs and the size of the school populations: a "one-size-fits-all" approach would have been inappropriate.

It was found that the composition of existing healthcare teams did not reflect a balanced skill mix. Additional support workers, a less expensive resource than highly qualified school nurses and others, were therefore recruited within each of the demonstration sites to increase efficiency and productivity and to enhance the workforce and skill base. Their role was supported by the opportunity to undertake the children and young people's health and well-being course at Robert Gordon University. Support workers were able to take on screening and surveillance work previously undertaken by registered practitioners and to act as health links between school and the home. This released registered professional time to focus on early intervention/prevention programmes targeting vulnerable groups of children and young people at key transition stages, rather than providing crisis interventions.

Other health professionals were also recruited to the new health teams, including speech and language therapists (S&LTs), occupational therapists, physiotherapists, and child and adolescent mental health workers, alongside youth workers and education staff (including teachers). The new models of team working enabled professionals to work better and smarter together, adopting a flexible approach that was based on recognition of the skills required to meet defined needs rather than a rigid discipline-specific approach. This increased health care capacity and encouraged partnership working.

Co-location of staff within health board or education premises improved communication between disciplines and the co-ordination of quality-based interventions. Co-location maximised skills within the team without the need for additional resourcing, resulting in a more efficient way of working.

Workforce capacity and capability - main learning

The starting point is to identify health needs, assets and strengths within each area. From there, it is possible to prioritise health needs and determine appropriate workforces.

Different schools and different communities have different health needs and therefore require workforces with different skills and resources. A "one-size-fits-all" approach to meeting the health and well-being needs of school-aged children, young people and their families would not be appropriate.

Staff need to work better and smarter together within integrated teams to build health care capacity. The additional staff the project recruited proved highly effective in increasing capacity to address health and well-being needs and in releasing registered professionals to develop early intervention and prevention programmes at key transition times for vulnerable groups of children and young people. Continuing to seek ways to support staff to work better and smarter and to ensure the right staff with the right skills are delivering the right intervention in the right place would be likely to be beneficial.

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