People Group
Integrated Health and Education Reviews
(2-21/2 years)
March 2014
Theresa Bishop
Professional Lead for Health Visiting
People Group
What are the likely benefits of
integrating reviews at age 2 – 2 ½?
• Integrating health and education reviews could give a more
complete picture of the child.
Drawing together the detailed knowledge of how the
child is learning and developing day to day at their
Early Years setting, with the expertise of the child’s
health visiting team at the health review, along with
parents’ views about their child’s progress.
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Aim of the Warwickshire Pilot
To examine:
The appropriateness and effectiveness of combining
the integrated 2 to 2½ year health and education
Effective ways of sharing information and findings
between professionals
The inter-test reliability of the ASQ and ASQ S:E used
by the health visiting team, the Wellcomm Language
Screen and the EYFS 2 year Progress Summary
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Who is involved in the Pilot?
The Professional Lead for Health Visiting, the Lead
Early Years Speech and Language Therapist and the
Senior Officer for Quality, Workforce Development,
Training and Safeguarding developed the outline of the
A Steering Group was established and consisted of key
partners health and the Local Authority including
Health Visitors, Community Nursery Nurses (CNN) and
Early Years Practitioners (EYP) and Childminders;
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Four geographical areas were identified – two in
Leamington, one in Bedworth and one in Nuneaton all
based around children’s centre reach areas;
Four CNNs already familiar with using Ages and Stages
were given further training in screening speech and
language development and in particular using the
Wellcomm Language Screen
All children eligible for the 2 to 2½ year review during
1st September 2012 to 1st December 2012 were
included in the pilot (This was 174 children)
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Methodology cont
 All the Early Years Settings in the pilot areas received a letter explaining
the pilot and asking them to give parents a copy of the Progress
Summary if they were asked for it;
 A letter was sent to all the parents/carers outlining the pilot and its
 Appointments for reviews were arranged by the Health Visiting team on
an individual basis with the child and their parents/carers, in the most
appropriate setting. This included the child’s home, Children’s Centres or
a Health Centre;
 Parents were asked to complete the Ages & Stages Questionnaire
(ASQ) Ages & Stage Questionnaire Social and Emotional
(ASQ:SE) prior to the review and bring it to the appointment;
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The Warwickshire Approach
 In Warwickshire we are using evidence from the CNN
teams, Early Years Practitioners in settings and the
Wellcomm Screening tool.
 The Wellcomm Screening tool is an assessment tool used
to monitor development of a child’s speech, language
and communication. Early Years Practitioners and CNN’s
have been trained to use the monitoring tool.
 Data from the Ages & Stages questionnaires, Progress
Summary and the Wellcomm Screening tool.
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Integrated Review – Results
Number of Reviews
Number of Children –
Wellcomm screen
Number of Children
eligible for EYFS
Progress Checks
Number of children
who attend with
EYFS Progress
28 – Whitnash
22 complete
6 incomplete due to
complex SL difficulties
52 – Bulkington
62 – Sydenham
60 complete
2 incomplete due to
language barriers
32 – Stockingford
Total - 174
Total - 165
Total - 60
Total - 32
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What went well? Not so well?
Lessons learnt?
What went really well?
The Wellcomm Screening Tool as an additional assessment of the
child's speech and language development;
The EYFS summary to give a comparison of what the parents record
on the ASQ's and observations during the assessment
What didn’t go so well?
Parents not bringing the EYFS progress check – setting not
completed or child not in Early Years setting. Language barriers for
some families when using the Wellcomm;
DNAs (did not attend)
Lessons learnt?
Early years settings often assess children 3 months after entering at
2 years of age, the progress check completed after 2 year check;
To consider training for CNN’s and early years settings across all
areas of the process
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Inter-test Operability:
 Able to integrate the Wellcomm Screen with the ASQs when children
were seen individually rather than groups;
 High correlation between the EY Progress Summary and the ASQ;
 Significant number of ASQs that identified child’s language skills as
age appropriate but the Wellcomm Screen and the CNN’s
observation identified as being delayed;
 Both the Progress Summary and the ASQ were at risk of
overestimating children’s language skills;
 The pilot concluded that the Wellcomm Screen was an effective way
of identifying children who may need additional specialist support
for speech, language and communication
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Discussion cont
Physical, Social, Emotional Development (PSED):
 The Pilot suggested less accurate information was being given by the Early
 Progress Summary and that assessment of PSED by the EYPs required
further development;
Other areas:
 No identified means of sharing results of the review with the childcare
 The Early Years Progress Summary correlated well to what parents
recorded on the ASQs and observations by the CNNs suggesting that these
two tools provide the information needed for measuring children’s progress
and the need for addition support
 The joined up approach provides an holistic picture of the child’s skills.
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 The CNNs will see children on an individual basis rather than in
 Identifying a clear pathway for two way information sharing
between the CNN and early years settings;
 Further training and support for EYPs in completing the Progress
Summary accurately;
 The health element of the review will be carried out nearer to 2¼ to
2½ so that more children will be accessing childcare;
 The use of the Wellcomm Screen to enhance the review;
 Clarify which tools should be used by which practitioners and the
necessary training required in order to expand the integrated
 Increase the involvement of parents
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 Phase 2 to begin in the next few weeks;
 Roll out the Wellcomm Screen to all CNNs;
 Use the Wellcomm Screen as per professional judgement and/or parents or
 Develop a leaflet for parents explaining the first stage of the 2.2.1/2year
review which asks them to bring a copy of the Progress summary when
meeting the CNNs (leaflet)
 Improving communication back to the settings (post card)
 Original letter to parents reworded; (new letter) (parents choice)
 Awareness training for all HV teams and EYPs;
 Training in the early years settings regarding the completion of the Progress
 Full roll out county wide from January 2014
People Group
Acknowledgement and thanks
to Community Nursery Nurses
Hayley McKeough
Lisa Touig
Claire Gaffoor
Lynne Reed

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