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What is the commitment to an integrated review?

On18 July 2011, DfE and DH jointly published Supporting Families in the Foundation Years (FitFY) which sets out their vision for the system of services to support parents, children and families in the foundation years starting from pregnancy until a child’s fifth birthday.

FitFY includes a commitment to “explore options for a single integrated review from 2015 when the planned increase in health visitor number should make this possible”, bringing together the Healthy Child Programme review at 2 to 2 ½ and the Early Years progress check at age 2.

Why integrate health and education reviews at age 2?

Age two is an important time for children and their parents. It is a time when problems with language development and behaviour can start to be identified, at an age where interventions can be more effective than they would be for an older child, making a real difference to a child’s future.

This is recognised in the fact that the Healthy Child Programme requires a health review at age 2 – 2 ½, and from September 2012 in the new Early Years Foundation Stage there is a requirement for parents to be provided with a written summary at age 2 of their children’s progress in the EYFS prime areas of learning. However, currently these two opportunities for review of a child’s progress at age 2 – 2 ½ are not integrated together in a coherent way.

Lack of integration can mean that:

  • Parents receive only partial information about their child’s development from a particular professional’s viewpoint;
  • Development needs/areas are not identified as early as they could be;
  • There is confusion further along in the system e.g. in referral to other services about who is best placed to provide any additional support.

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 through drawing together the detailed knowledge of how the child is learning and developing day to day at their educational setting with the expertise of the child’s health visitor at the health review, along with parents’ views and concerns about their child’s progress.

The integrated review will aim to:

  • identify the child’s progress, strengths and needs at this age in order to promote positive outcomes in health and wellbeing, learning and development.
  • facilitate appropriate intervention and support for children and their families, where progress is less than expected.
    generate information which can be used to plan services and contribute to the reduction of inequalities in children’s outcomes. (Integrated Review Development Group, January 2012)

What is the timetable for the Integrated Review?

Our commitment is for the integrated review to be implemented from 2015.

In order for this to happen, we are testing the content and process of the integrated review in 2013.

What is the government doing to develop the integrated review?

The two government departments DH and DfE are working in partnership on the integrated review.

A Development Group of health and education experts along with five Development Sites (taken from Phase 1 Health Visitor Early Implementer Sites) has been in place since Autumn 2011. The group has been considering the complex issues around integration and is working to develop models for testing in 2013.

What will the review include?

The integrated review will cover the development areas in the current Healthy Child Programme 2 year review and the EYFS 2 year progress check, in a coherent, integrated way.

The integrated review is not only about integrating the content of the reviews, but is also about drawing together the different skills and experience of the health and education practitioners working with the child, and will support information sharing and integrated working across health and education to support children’s healthy development.

Will the integrated review supersede theHCP2 year review and the EYFS progress check?

Yes – but building on both of these, and retaining the distinct elements that each offer.

The aim of the integrated review is to provide a fuller picture of a child’s development at age two, and, where appropriate, to identify additional support to promote a child’s future healthy development; bringing the two reviews together in a coherent way will help achieve this.

What is the EYFS progress check?

The EYFS progress check is a written summary of a child’s development which parents can expect to receive from their early years setting from September 2012, and which they can share with other professionals like health visitors. When the integrated review is introduced in 2015 it will draw on the EYFS progress check and bring it together with the HCP 2 -2½ year review in a coherent way.

Does integrating the reviews mean we no longer need to use Health Visitors to deliver this work?

To ensure complete and thorough integrated reviews, the skills and input of both health visitors and early year practitioners will be needed.

Currently, a range of models are used to deliver the Healthy Child Programme 2 – 2 ½ year review. In some areas, early years staff provide the review, overseen by a Health Visitor. Given that the integrated review will retain the elements of the HCP 2 -2 ½ year review, health visitor leadership and clinical skills remain vital.

It will be for local areas to define the best model of delivery suitable to their area. Local areas will be able to engage with and comment on guidance for the integrated review, including in relation to delivery models, during the consultation period, which is expected to take place in 2014.

What will be offered to children who are not in an educational setting at age 2?

Not all children are in an educational setting at age 2. However, the integrated review will be offered universally. This will mean that, as a minimum, children not in an educational setting will receive the same level of service as they currently receive under the HCP 2 – 2 ½ year review.

As the integrated review is developed through its testing phase we will also look at whether educational elements of the integrated review could be offered to those children not yet in a setting, i.e. drawing on parents’ knowledge.

How will the review be developed?

It is planned that a number of sites will pilot a model or models of an integrated review in 2013. Work is ongoing to develop testable models and to work with sites to prepare for testing, supported by an external evaluator.

My team are already working on integration. Should we stop what we are doing and wait for the integrated review model to be available?

The integrated review will not be rolled out until 2015. Putting in place systems in the meantime can help build relationships between health and education sectors locally and offer early benefits for children and families.

Some areas have already put in place more formal arrangements for joint working between early years and health. It is for local areas to determine how professionals can work together to promote the best outcomes for children.

How will the integrated review fit with the new Child Development outcome measure at age 2 which is being developed?

The Department of Health is developing a population measure of child development at age 2 – 2 ½ which it is hoped will be collected during the integrated review. It is expected that, alongside providing national and local population level data for the Public Health Outcomes Framework, the assessment tool used will also offer useful information about the individual child that will feed into the child’s integrated review. Research is underway to decide which tool is most appropriate for the population measure.

My team are working on introducing an evidence-based assessment tool. Will the integrated review include a tool and if so which one?

Using evidence based tools is good practice and the integrated review will involve the use of evidence-based tools to assess children’s development. A single tool will need to be used nationally for the purpose of the age 2 outcome measure so that consistent national and local data can be compiled.

As well as generating data for the outcome measure this tool will need to produce useful information about the individual child that will feed into the child’s integrated review. Other evidence based tools may be used depending on the particular needs of the individual child.

We do not yet know which tool will be used in the integrated review for the age 2 outcome measure, as research is needed to identify and test the most suitable tool for this purpose. This research will report in early 2014.

Before the Integrated Review is introduced, shouldn’t we stop doing either theHCP2 – 2 ½ year review or the EYFS progress check?

It’s a duplication of resources.

No. It is important to continue doing both of these. While they overlap in the broad areas of speech and language, physical development and social and emotional development, theHCPgoes further than the progress check in its coverage of, for example, obesity prevention, checking immunisations are up to date, and informing parents in relation to their child’s hearing, vision and dental checks. The progress check provides a more in-depth look at a child’s learning and draws on the day-to-day experience of the early years providers with the child. The integrated review will draw on both of these reviews to offer a coherent integrated approach.

While both reviews should continue to be carried out ahead of the introduction of the integrated review, it would be valuable to work towards better integration locally, e.g. working to improve information sharing between health and education services.

Links to guidance on theHCPand EYFS reviews at age 2 are below:

HCP2 – 2 ½ year review guidance:

EYFS progress check at age 2 guidance: