Tackling health inequalities has been a long-stated aim of the Scottish Government, yet problems persist. Set up in 2008, the Equally Well test sites were neither supposed to be merely short-term projects nor pilot studies but long-term instruments for change.
The East Lothian test site, Support from the Start, is a partnership approach to reducing health inequalities in the early years of life. It was designed to build on areas of strength already in the locality.
In 2011, Queen Margaret University produced an evaluation called ‘Healthy Happy Bairns’ which reported “significant improvement in health inequalities… through a community empowerment initiative.”
Steven Wray, Health Improvement Officer at East Lothian Council, says being an Equally Well test site broadened their existing knowledge but “it wasn’t something that was going to come to an end because the test site phase came to an end”.
Support from the Start was established as a network to share learning between different professional groups in the region. “What we did was developed a kind of shared learning programme for a group of people who were called champions. They had a particular responsibility for leading in their area, but also sharing learning. What we felt we didn’t do enough of during that test-site phase was involve both ordinary parents and community members. Once the test site ended, we wanted to shift it a little bit. Not to stop all that shared learning going on between different staff members, but to broaden it out to more parents and community members,” says Wray.
Community engagement came naturally to community project First Step in Musselburgh, which started as a parents’ peer support group and has grown into a play centre and support hub. Service champions within Support from the Start, First Step, still enjoy community ownership of projects, reflecting the ethos of the founding members. The National Lottery has just provided First Step with additional funding for five years to support the many extra services they provide, including a respite service for families with special needs, speech therapy and drug and alcohol support for parents.
Project Manager Jane Holden says the project is able to be flexible because it is bottom-led. “How we see it is, every family has problems at some time, so it’s not about saying these are ‘problem families’. We’re saying is, at times, no matter who you are, you have a problem, and we’re here to support you whatever that is,” she says.
Support from the Start funded First Step to try out ‘social marketing’, an evidence-based approach to behaviour change. It uses key concepts and principles from commercial marketing alongside social-science approaches.
The project undertook a survey of the parents to see what they wanted to do as a health issue, and they came up with healthy eating. Eventually, focus groups revealed some participants had no cooking skills whatsoever, so they started to organise community demonstrations and shared cooking classes.
“Within no time, everybody was talking about it. In fact, we’ve continued. We wanted something that would last, because the time parents are in the nursery could only be two years, something that was going to make a legacy, and continue that. They came up with this idea,” says Holden.
The focus group has four generations participating, she says: “We have the gran, her daughter came but she’s working now, but still comes round the project sometimes, and the young mum, and she’s got two children in the project. So there’s four generations there. Gran was saying, ‘my granddaughter cannae cook to save herself’. The granddaughter was saying, ‘my mother can cook but we always just had takeaways and things’. She was eating once a day, and it was either a takeaway or ready meals. That was it. That was her diet. Now she’s cooking. She cooked Christmas dinner. She showed us photographs, and she’s doing absolutely brilliant with her cooking. She knows how far she’s come, and she’s really proud of the fact.”
Support from the Start also helps First Step run a sleep clinic, inviting well respected ‘sleep lady’ Linda Russell to provide sleep therapy to parents in need. In the focus group, “everybody was crying”, according to Holden because of the impact lack of sleep can have on parents.
The sleep clinic is to be extended to another area, Prestonpans, because of the findings of a population-based evaluation for communities, called the Early Development Instrument (EDI), which was created and used in Canada and also successfully used in Australia. The questionnaire is carried out by P1 teachers to assess children’s readiness to learn at age five. Thirty-five East Lothian schools took part in 2012 and will again in 2016.
Steven Wray is looking forward to comparing the findings: “EDI is an ongoing dataset so you’re able to track over time. The really key thing for me is it’s telling us something different. In Scotland, there really isn’t a measure of children’s early development at the moment. There are measures of children’s weight, how many children are breastfed and things like that, but not in terms of development as little people. That’s what EDI gives us. Why I am attracted to it is that parents understand the data and engage with it, and start to think if we did that in our community, it might improve those scores.”
According to Sheila Laing, headteacher of Prestonpans Infant School and chair of the Prestonpans Support from the Start group, the EDI gave them clear areas for development: “We’re developing three projects: one is around sleep, because children’s physical wellbeing is poor and we don’t see them having energy for learning. Another one is around language and communication, and we’re working with speech and language therapists to find ‘the seven great toys’. But one of the big issues for us was working with boys, and with dads in our community.”
To this end, they asked local charity Dadswork to help provide a fathers’ support network and assist in development of local boys. Their launch day, ‘Go Mad With Dad’, brought in 144 fathers with 270 children. Both working dads and non-resident male carers were surveyed with an “overwhelmingly positive” response, according to Laing. “Dads were coming up and saying this is really great. I only see my child on Saturday morning, and I don’t know where to take them,” she says.
Kevin Young, Dadswork project coordinator, says the EDI is inspiring a further project in Musselburgh: “Children who were identified through the nursery had no positive male role models in their family at all, so from that, and through the EDI, Dadswork is looking at a mentoring project with a local high school, looking at S3 and S5s who will gain youth achievement awards mentoring pre-school boys. Through that what we’re looking to do is increase their self-confidence, support their literacy, numeracy and readiness to learn in primary one.”
There are other initiatives rolling out across the region. Baby massage is available across all of East Lothian, and Steven Wray hopes the Parent Early Education Partnership (PEEP) will soon follow.
East Lothian Council has committed £25,000 to a cluster group development fund to allow small groups to develop new ideas, and a network coordinator is in place to administer the network for the next two years, during which time the focus will be on developing local groups to have “deeper roots” and “stronger connections with their communities,” especially ones that have only been going for 18 months, says Wray. The long-term future of the network, however, depends on Support from the Start being constituted, with continued links to the council and the NHS, but community-led as a charity “so it can do more of its own fundraising”, according to Wray: “What the people involved in North Berwick Support from the Start wanted to do was to be able to support those kids that don’t get the same opportunities as their peers. So they started a bursary scheme so that younger children can get access to the ballet classes or the sports classes if they’re on certain benefits or if the health visitor or social worker thinks [that’s appropriate]. We think that can roll out across the whole of East Lothian, but to do that, Support from the Start probably needs to be constituted slightly differently so we can access the funds for it.”
Could support from the start be replicated across Scotland? “I think so. The essential ingredients of it are fairly simple. There needs to be a slightly looser, slightly less risk-averse attitude from managers and senior leadership people. There needs to be a senior commitment to it, and there needs to be a willingness to work at it. To understand it isn’t going to happen in a year or two.
“Support from the Start needs a lot more work done in terms of strengthening its links with communities, getting more people aware of what it is and how it works. The three ingredients, and it’s nothing special, nothing other areas don’t have or can’t do, is getting the leadership right, getting the engagement right and getting the learning right. It’s getting those three ingredients in balance together.”
The EDI too, could be adopted elsewhere. Edinburgh University’s John Frank, one of the designers of East Lothian’s version of the EDI, says at the very least, Scotland should have a uniform, tried and tested way of measuring child development. “Either the EDI, or else an equally well-evaluated instrument, should be the default measure for the Early Years Collaborative’s stated objective of improving early child development in Scotland,” he says.
Wray agrees: “You can’t prove a causal effect, which some people would criticise it for, but it is a population-level measure so you can compare one cohort against another and you can see where the trend is going. Again, it’s about committing to this kind of approach for a long-term thing, rather than thinking you’ve got to fix it in a few years.”