Integrated Early Years Services – supporting children to achieve a Good Level of Development: East Sussex County Council

East Sussex early years’ service operates as an integrated model, supporting children and families from birth to 19 years. The Health Visiting Service delivers the 0-5 Healthy Child programme via a skill mix team. Some of the interventions which support families are delivered via an integrated model with support from Early Years Practitioners. They offer a range of support mechanisms and interventions that scaffold the mandated contacts of the Healthy Child Programme, to provide better early support for parents which can be targeted at those parents who need it the most. This includes: 

• Helpline service: A duty helpline is available for parents seeking support on areas impacting their child’s development and wellbeing, with frequent queries relating to behaviour and possible neurodivergence. Timely interventions are provided, including further assessments and referrals as needed.
• Parent-Infant Relationship Support: There is increasing focus on supporting parent-infant relationships for children under 2 years, recognising the evidence linking Adverse Childhood Experiences (ACEs) to increased developmental risks. There is a Parent and Child Wellbeing team available to support with a variety of interventions.
• Togetherness (formerly known as Solihull Approach model): A programme designed to provide an integrated framework to enhance emotional health and wellbeing in communities.
• Bookstart packs: Distribution of free backs of books to every baby, to inspire and create a love of reading for children.
• Sunflowers course: A six-week group for parents of children aged 2-5 years delivered by community nursery nurses and early years practitioners which is targeted at families awaiting child development clinic appointments, particularly where neurodivergence is likely.

ASQ at 27 months: The ASQ (Ages and Stages Questionnaire) is used at the 27-month contact. This is the last mandated contact as part of the Healthy Child Programme until a child starts school. All families in East Sussex are offered a face-to-face contact at 27 months, during which practitioners explore the ASQ responses. 

However, the effectiveness of this assessment is often challenged by difficulties in engaging children during the session and the reliance on parental reporting, which can vary widely due to anxiety or reluctance to disclose developmental concerns. This poses ongoing challenges in accurately identifying children’s developmental levels and school readiness.

Workforce development: Following significant losses in health visitors after COVID, East Sussex adopted a ‘grow your own’ approach. Community staff nurses are supported through progression pathways to achieve specialist qualifications in health visiting (Specialist Community Public Health Nursing – health visiting). This skill mix model has proven successful in maintaining service delivery and staffing levels, with the authority now close to fully recruiting the necessary practitioners for its health visiting teams.
Funding: East Sussex received Start for Life funding, enabling significant expansion in perinatal mental health and parent-infant relationship support. However, the short-term and prescriptive nature of this grant presents challenges in sustaining posts and long-term service planning. 

Recommendations for policy: Future funding allocations should prioritise flexibility and longevity, allowing local authorities to design interventions that best meet the needs of their populations rather than adhering strictly to centrally prescribed programmes. The continued sharing of practice, experiences, and challenges with policymakers is crucial to inform more effective, locally responsive approaches to early years health and development.

Rebecca Cottrell, Operations Manager for Public Health at East Sussex Healthcare NHS Trust Email: [email protected]