Designing ‘Zone West’, a SP programme for children
The SP programme ‘Zone West’ (ZW) was designed in response to the results of the community consultation, key outcomes of which included the identification of concerns from the WEST and local GP practices about the increasing numbers of children who did not meet threshold for mental health services or special educational needs (SEND) support. These children were experiencing difficulties significant enough to impact their quality of life and wellbeing, resulting in repeat attendance at primary care, and/or impacting on school attendance and attainment. Community consultation also indicated that the existing community partnerships between organisations and sectors, as well as the local community organisations themselves, were considered key strengths of the West End community.
The design of ZW was a collaborative process between NEW and Healthworks, with input from the advisory group. Designed to be a primary prevention initiative, ZW addresses the population health and wellbeing needs found in primary school aged children, and the targeted health needs of children repeatedly attending primary care. Both these groups of children are those who are at greater risk of poor life outcomes due to deprivation, and who are not in receipt of clinical services.
Children recruited to ZW complete a developmental plan with the LW at the start of the programme where key aims and goals for their learning, physical health, social emotional development, and school engagement are defined. This developmental plan is reviewed at regular intervals throughout the ZW programme during 1-1 sessions between the LW and child. ZW children receive weekly individual and group-based therapeutic support with a LW, either in school, GP practice or home, and the LW supports them to attend community assets and meet their pre-defined individual developmental goals. Provision is long-term until developmental goals are achieved. Throughout provision LWs maintain contact with parents/carers, and where appropriate, signpost to external resources if additional needs specific to the parent/carer are identified. This may include welfare rights, housing, adult LW, Early Help, parenting support programmes.
Implementation of Zone West
Implementation of ZW involved ‘buy-in’ from partners across education, health and VCSE sectors through the formation of 3 governance groups: Advisory, Steering and Impact, outlined below:
- Advisory group- included key senior stakeholders from health, local authority, voluntary, mental health and primary care organisations. This group were responsible for overseeing decision making about strategic and funding commitments and met every 3 months.
- Steering group- included colleagues from voluntary sector organisations within the community and the local authority. This group advised the practical implementation of ZW in the community and met every 2 months.
- Impact- included a small group of NEW and health colleagues who led the project at the community level, meeting weekly.
Governance groups take on a hierarchical structure reflecting membership size and involvement perspective of stakeholders, i.e., overarching (Advisory) – place-based (Steering) - community level (Impact). These governance groups ensured ZW was embedded into the wider network of organisations across the region, the network of organisations in the West End of Newcastle, and the community. Feedback and communication between all three groups remained open, frequent, and consistent. The embedded nature of ZW into the existing landscape of community services at these three levels allowed for the outlining of referral pathways into the ZW programme.
Zone West partnerships with other services
The ZW programme and its LWs work in a system and network of other community services for children and families. Crucially ZW defined to existing community services what the aims of ZW were and worked in partnership with the community. This allowed ZW to establish itself amongst existing services for children in the community and specifically alongside the Newcastle Inner West Family and Community Hub, which was fundamental to successful delivery of complimentary models of service provision.
These partnerships and the employment of LWs by Healthworks (a local charitable organisation central to the Family and Community Hub), allowed for the LWs to be embedded into core health, education, and social service groups for families in the community. This included child protection and early help services and allowed for active referrals and signposting for parents/carers. With consent from families, LWs were able to share information about specific children to these wider community services, ensuring efficient support was implemented for the family and/or child, and that support was not duplicated in any way. LWs also provided scaffolding whilst a child/family was waiting for further assessment or specialist intervention, and the outcomes of this scaffolding work were fed back to the specialist services with consent from the child and family. Embedding LWs in the existing network of community services has been an essential component to providing integrated cross-sector support for children and families.
Referral pathways and data sharing
In response to local concerns and needs from the education and health sectors about many children not meeting threshold for clinical services, two referral pathways were developed to identify these children for inclusion into Zone West (Figure 1).
Outlining these referral routes required considerable discussion within the advisory group, whereby differing needs, operational methods, funding streams and outcomes goals from the education and health sectors were identified. The education pathway allowed for a population and long-term approach to SP through the screening of all children in a target age range, i.e., school year groups for appropriate inclusion in ZW. Teacher-completed SDQ’s allowed for the identification of children across multiple year groups who were at-risk of SEMH difficulties, and these results were considered alongside a discussion with education staff to identify appropriate children for inclusion in ZW. This discussion allowed for a broader view of children’s difficulties, considering the dynamics of the child’s school engagement and home circumstance and the potential engagement of the parent/carer to support their child’s inclusion. This process was supported by teachers who appreciated and recognised the benefits of a data-led approach to identification. The education pathway’s identification of children at a year-group level enabled group-based as well as individual SP work with children in school, and long-term provision that transcended school years.
In contrast, GPs see children on an individual basis and mainly observe them in specific contexts and snapshots of time during clinical attendance, therefore it was not possible to screen cohorts of children in the same way as the education pathway, nor was it possible to engage in in-depth discussion with GPs about each child. For these individuals and the GPs involved in ZW, there was a greater need for more rapid and measurable impact that would satisfy the child and family, GP, and funding arrangements. GPs were asked to refer children to ZW who had poorly controlled long-term health conditions or presentations suggestive of emotional distress, who were not in receipt of clinical services. LWs worked with these children primarily in either their GP surgery, at their home or in a community space. In cases where a GP-referred child attended a school which referred children to ZW, the LW was also able to work with that child in their school. Children referred through education, or who attended a ZW referral school, were grouped as ZW ‘Warriors’. Children referred through health who did not attend a ZW school were grouped as ZW ‘Seekers’.
Procedures for sharing data between referring education and health staff, children, families, LWs, community services and the research team, were ethically approved through the Integrated Research Application System (IRAS) and Newcastle University. Data sharing was governed by parental consent at various stages of the referral to recruitment pathway as well as the allocation of unique ID numbers (Figure 1). It was noted when implementing referral pathways that there was a lack of shared knowledge and communication between the education and health sectors, for example many GPs were unaware which school a child attended and vice versa. In addition, there was no infrastructure for schools and GPs to share information about children’s school engagement and health related behaviours even when consent was provided from the child and family. The linkage of this information was however important for the ZW programme to allow LWs to work with children in the most efficient way and location (i.e., their school if their school was taking part in ZW).