Q Exchange
Delivering community paediatrics for Roma/Slovak families in Sheffield
- Winning idea
- 2019
What is the challenge your project is going to address and how does it connect to your chosen theme?
Roma/Slovak children do not regularly access healthcare in Sheffield. These families are predominately based in the North of Sheffield and access to the Children’s Hospital is via two buses and can be expensive. The Was Not Brought rate for Roma children during 2018/19 was approximately 30% compared to the average of 11.7%. Health literacy is low and therefore engagement with families on health issues can be challenging. These families and their children have well-documented genetic health conditions, including ophthalmic and audiological issues, which result in late diagnosis and long-term follow up, leading to significant challenges for the health providers in Sheffield. The aim of this project is to reduce some of these barriers, delivering services that these families are more likely to access for their children and therefore improve health outcomes. It will also give clinicians experience of working with other professions eg. GPs and learn from their approach.
What does your project aim to achieve?
There is currently a health drop in facility at one of the local schools which is run by Health Visitors. This has proved very successful, with many Roma/Slovak families accessing the support and advice at times to suit them via the drop in arrangement. We would therefore like to build on this approach and develop the offering to include paediatric input to these families on the same drop in basis. This provides an opportunistic approach which could potentially identify health issues that might not be prioritised by these families as requiring further investigation. The aim, therefore, is to increase attendance of children at clinics, deliver care to children in a familiar environment ie. their local school, improve the health outcomes for children from the Roma/Slovak community and work alongside vGPs and other professionals to improve children’s services in these deprived areas.
How will the project be delivered?
The project will be delivered by a multi-disciplinary team which will include Consultant Paediatricians and will have a dedicated Improvement Project Manager. The governance of the project will be overseen by Sheffield Children’s Transformation Programme Board which has workstreams for Modernising Outpatients and Partnership working. It will be managed through an evidenced based Project Management methodology with clear lines of responsibility and escalation. We will also use quality improvement tools such as a Microsystems approach, to ensure that those involved have a clear understanding of the project aim and are supported to implement Plan Do Study Act (PDSA) cycles.
We have strong working relationships with other partners across the City including the Children & Young People’s Health and Wellbeing Board and the Sheffield Accountable Care Partnership and there are other existing forums within the voluntary sector eg. Young Healthwatch where this project will report into.
What and how is your project going to share learning throughout?
We anticipate that the learning from this project will be around strategies to engage with Roma communities to improve health literacy, particularly in areas of high deprivation and poverty. In addition, we expect to learn what best practice exists and how it can be deployed in alternative ways, e.g. in schools, community centres and patient homes and how we work with our partners to deliver this.
We have a citywide Childrens Health and Wellbeing Board. This board is made up of many public sector bodies in Sheffield, and the learning from this project will be shared through this forum. In addition, this board is part of a research project, led by the University of Sheffield looking at how children’s services are developed in Sheffield using a systems-based approach. The findings of this research will be shared widely across the country and beyond to help other health organisations to develop more cohesive links and how best to deliver joint services.
How you can contribute
- Any examples of similar ideas, and what they have learned
- Any examples of working with Roma communities, and how they've worked with these families
- Any examples of working with communities in areas of high deprivation, and what they've learned
- Provide challenge on the idea to help improve it
- Act as a champion to encourage others to consider whether similar ideas may work in their own areas
- Generate potential solutions and suggestions for further exploration
Plan timeline
| 29 Feb 2020 | Scoping, recruitment, and SLAs in place |
|---|---|
| 31 Mar 2020 | Mobilisation complete, and Marketing commenced |
| 1 Apr 2020 | First Health Drop In Session |
| 30 Jun 2020 | 3 Month Review to commence |
| 31 Jan 2021 | Evaluation to commence |
| 28 Feb 2021 | Decision of whether to continue drop in to be made. |
| 31 Mar 2021 | Evaluation Complete, Pilot of Q Funded drop in to cease. |
Project updates
31 Aug 2021
Reflections on the Roma Slovak Health Café Sheffield Summer term 2021 – Cath Baker, Community Nurse
Due to the pandemic, we were unable to progress with the Health Café as planned. Therefore, I have been present at the school gates each Thursday morning. The purpose of this was to build relationships, to become a familiar presence, to be able to offer support to families in spite of the Covid restrictions and to establish links with Owler Brook school who are partners in the QBid project.Positive Outcomes
• Staff at Owler Brook School have been very welcoming and supportive while I have been there.They have made their Roma and other language interpreters available whenever possible to assist my engagement with parents.
• Being able to attend weekly so I have become a familiar face and able to build relationships with parents.
• Opportunities for ad hoc conversations with staff regarding a child or family where there are concerns or need for support. Joint working with school.
• Positive outcomes from my engagement so far – one parent reported that they have stopped their child’s dummy use after a discussion about this and several parents expressed appreciation at resources given. Children have registered at the nursery. We now have an evaluation form to use which will help to capture the feedback.
• Ideas generated with staff at school for sessions in nursery when possible to share information re e.g.sleep, oral health, toilet training, healthy eating .
• Resources produced for use at Roma Slovak Health Café and an IPad has been bought to be able to use with parents to access websites, apps, YouTube videos relating to health and well being.
• Opportunities to refer onto other appropriate services.
• Community Paediatrician has sessions planned at school from September 2021.
• Lucky with the weather whilst standing outside school gates!Challenges
• I was not able to find a Slovak interpreter who was able to commit to weekly sessions for the Health Café. The aim was to use the same interpreter every week so they also became a familiar face at the Health Café. I am continuing with this effort to find someone.
• Parents were often in a rush to get home after dropping children off and sometimes hard to engage as a result.
• Language barrier – not always possible to have an interpreter for the language required. It takes time to get an interpreter on the telephone interpreting service and parents were not always able to wait. This will be easier when we are able to have the Health Café indoors for a longer period.
• Covid restrictions and need for self isolation amongst school children and family and staff.
• Pressure on time due to reduced staffing levels in my team making it more difficult to find time to follow up things that have come up, produce resources, etc.All in all, a successful start to the project, despite all the restrictions, and a firm base to build from for September 2021 when the schools return and the health café is up and running again.
20 May 2020
Brief overview:
The project has established a health drop in café at a local school every Thursday morning during and after the school’s breakfast club (8.15am to 12 noon depending on demand). The café is run by Health Visitors and is aimed specifically at Roma/Slovak families to enable them to easily access support and advice at times to suit them via the drop in arrangement. In addition there is consultant paediatric input to these families on the same drop in basis every other week. This provides an opportunistic approach which could potentially identify health issues that might not be prioritised by these families as requiring further investigation and deliver care to children in a familiar environment ie. their local school.
What have we learned so far, either from the successes we have had or from where things haven’t gone to plan?
Due to the situation with the Coronavirus pandemic, the health café is not running at the current time. We ran the one and only session at Owler Brook Primary School in Fir Vale, Sheffield, on Thursday 12 March before the country went into lockdown. The photograph below shows Cath, one of the Health Visitors, setting up for the first session, which was attended by 6 parents (all mums) mainly from Pakistani backgrounds, there were no Roma/Slovak families there that day. There was also an interpreter at the session who interacted with the mums. At the time, there were a few questions regarding Coronavirus and the impact on children, but mainly general conversation about what the health café could offer in the forthcoming weeks.
It was a great start and following a de-brief at the end of the session, we recognised the need for us to reflect and consider how we could engage more Roma families in attending. We also needed to be clear about how and what data would be collected at each session to ensure that there was sufficient information to undertake the evaluation at the end of the project. We were also aware that the Consultant Paediatrician could not be released from her current clinic on a Thursday morning until the end of April, which meant that the café would run without medical input for the next 6 weeks or so. This was not felt to be detrimental to the project as the health visitors could start to develop the sessions and get to know the families better.
What could others learn from our experience of working with a range of stakeholders and collaborating across boundaries (geographical, professional, sector) – what is working well and any challenges we have faced?
The main stakeholders involved so far are the school headteacher and the school’s head of early year’s foundation stage. Both have been eager to help set up the café as they recognise the challenges that this community face. The health visitors have already enjoyed a good relationship with the school and therefore had a foundation on which to build further conversations regarding the set up of the project. Whilst the focus is on Roma/Slovak families, the health café is open to all families attending the school and this was an essential part of the agreement to use the school. Some mornings up to 60 families attend the breakfast club, where free breakfast is provided to the child attending the school, their siblings and their parents. It was therefore an ideal opportunity to use the breakfast club as it was already well established and valued by the community.
We have also received an enquiry from a local GP surgery who we had been in contact with about the project, asking if they could work alongside us to help to build a resilient resource for the Roma Slovak community. We were in the process of inviting them along to attend the meetings as they know the community very well and could help us to raise awareness of the café. Once we are back up and running, we will make contact with the GP surgery to continue these discussions and find out what we could do to work together.
All in all, it was a great start to the project and we will be having discussions over the next few weeks to agree a recovery plan for when the café can start up again. My guess is that this will not be before the Autumn term begins in September.
Comments
Alison Skinner 30 Jan 2020
Hello
I am a Priority Families Engagement Officer for the National Deaf Children's Society and I would like to link up with you as we would like to reach out to Roma families with deaf children. Can we please discuss by email; alison.skinner@ndcs.org.uk thank you
Rebecca Sobey 27 Nov 2019
Hi Jude/Leonie
I am the 0-19 Locality Service Manager for the North of the city, and line manage the Team Leads in Locality B (Shiregreen/Burngreave) I am aware that Louise Wolstenholme has made links with Karen Arnold regarding the initial discussion about this proposal. This successful bid is fantastic news for the families in the locality.
I wonder if it would be beneficial to have further discussion in light of the success of our Health café, and how we could consider working together for greater child and family engagement. My Leaders in the Locality would be completely on board with Joined up/Integrated working.
I look forward to your response.
Kind Regards
Rebecca Sobey
Leonie Redfern 27 Nov 2019
Hi Rebecca,
Thank you for posting a comment about our successful bid to deliver paediatric care to Roma/Slovak patients. As you know Louise Wolstenholme and Karen Arnold have already made links and I am in the process of pulling together a meeting with them and a few other colleagues to discuss next steps. It would be great to include you and any members of your team in the meeting and, if possible, we would love to come out to the community for the meeting. Please email me with your availability on leonie.redfern@nhs.net and we will take from there. It would be good to get a meeting in before Christmas, but maybe early January would be more realistic! I look forward to working with you on this important project and no doubt we will be in touch soon. Kind Regards.
Leonie Redfern, Improvement Project Manager, Sheffield Children's NHS Trust
Helen Crimlisk 8 Oct 2019
Great project Jude, id be keen to link this with mental health services , especially first episode psychosis which is an issue of high prevalence in this community
Jude Stone 8 Oct 2019
Hi Helen, thanks for the encouragement. I agree with what you're saying, I'd hope that by finding ways to build strong relationships and connections into this community with health that we can identify and support all the needs of the children and young people. As an integrated provider - physical and mental health; acute and community - we should be setup to make the most of this opportunity!
Dan Beale-Cocks 25 Sep 2019
I like this idea. I think you've described strong links across the system. I am pleased to see, in one of your comments, that you have good links with the community and you're doing work to build those further. I'd love to see Roma and Slavak voices used to describe the project to other families, and to describe the need for this kind of healthcare. Good Luck!
Jude Stone 2 Oct 2019
Hi Dan, I think we can only be successful if we work with partners across the city to help communicate the message. We're working with a cultural advisor to the Roma community who has links into various community groups that can help give the message. We've been learning that Health professionals will not have meaningful access into the local communities until the groundwork has been laid by peers in the community.
Aimee Protheroe 27 Jun 2019
Hi Jude. I'm really interested in your idea and would love a bit more information about the paediatric provision / service you mention. Also just wondering about how you'll measure whether your intervention has been a success. Good luck! Aimee
Jude Stone 19 Jul 2019
Hi Aimee,
Thank you for your comment and apologies for the delay in responding. I'm replying on behalf of Jude. Firstly, for more information on what we are currently doing in Sheffield regarding the Roma community, please see this link: https://ihv.org.uk/news-and-views/voices/engaging-the-roma-community-a-health-visiting-case-study/ which describes the brilliant work already being carried out by our Health Visitors. They have already established a successful health café in one of the local schools, Fir Vale, which has a high number of Roma children and families.
We therefore hope to build on this with our bid by establishing a Consultant Paediatrician presence on a regular basis at Fir Vale School to work alongside the Health Visitors to see children with health issues early, treat them and hopefully prevent long term conditions taking hold, particularly around hearing and sight problems which are known to be prevalent amongst this community. In order to measure our success, we would hope to see a decrease in Was Not Brought (WNB) for Roma children from the current 30% to nearer our average WNB of 11%. There will also be wider benefits to delivering this service which might be more difficult to measure, such as experience of delivering clinics in different settings, experience of working alongside our partners eg. schools, local council, learning more about the needs of children from minority backgrounds and deprived areas, all of which help us to improve our service and tailor what we deliver for the most effective health outcomes.
I hope this answers your questions, however, please let me or Jude know if you require any further information. We are now working on our final bid so fingers crossed that we are successful.
Kind Regards,
Leonie Redfern,
Improvement Project Manager, Sheffield Children's
Email: leonie.redfern@nhs.net
Sarah Campbell 26 Jun 2019
What a great start to a compelling idea, Jude. It sounds like you're building on good foundations as well with the health visitor model. Do you have good links with the Roma/Slovak community locally? Their voice will be vital.
I hope you can make links with the other ideas on here, particularly the team looking at 'non-traditional networks' and better access for those groups.
Best of luck and look forward to seeing the idea develop
Jude Stone 19 Jul 2019
HI Sarah,
Many thanks for your comment and apologies for the delay in responding. I am replying on behalf of Jude. With regard to our current links with Roma/Slovak communities, yes, we are building on these and already have strong links in place - please see this link: https://ihv.org.uk/news-and-views/voices/engaging-the-roma-community-a-health-visiting-case-study/ which describes the brilliant work already being carried out by our Health Visitors with Roma families. They have already established a successful health café in one of the local schools, Fir Vale, which has a high number of Roma children and families. We are hoping to develop this approach further by having a Consultant Paediatrician presence to enhance the service we provide. We are currently developing our bid further, so fingers crossed! I hope this provides you with sufficient information, however, please contact me if you would like to know more. Thank you for your interest.
Kind Regards.
Leonie Redfern
Improvement Project Manager, Sheffield Children's
Email: leonie.redfern@nhs.net
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