This blog is part of the Learning and changing with quality improvement blog series. It explores the role of quality improvement in helping to redesign and enhance the services and systems that support children and families.   

Since 2016, the Centre for Community Child Health has been engaged by the Victorian Department of Education and Training’s Best Start program to maximise participation in Maternal and Child Health and kindergarten services through the use of quality improvement. Together with Best Start facilitators and departmental staff, we continue to learn about how to best adapt this methodology to the community setting and its ability to deliver improvements.

This blog series is authored by Lauren Heery, Acting Manager in the Service Systems Innovation Team at the Centre for Community Child Health.

What we are learning about increasing participation

What works to increase children and families’ participation in key universal services? Best Start facilitators and their partners work together to explore the root causes of low participation, identify possible solutions and then test these through multiple Plan-Do-Study-Act (PSDA) cycles. Solutions that have been tested multiple times and show evidence of improving participation are considered ‘promising practices’.

As part of the Best Start learning program, facilitators came together in February 2021 to reflect on what they are learning about what works to increase participation in kindergarten, Supported Playgroups and the Maternal and Child Health (MCH) service. Through this learning session, the following ten promising practices were identified.

How to increase enrolments

The following change ideas were shared as strong examples of change ideas that improve enrolment numbers in kindergarten and/or Supported Playgroups or scheduling of MCH Key Age and Stage appointments.

1. The development of an online kindergarten central enrolment form enabled referring organisations to complete kindergarten enrolment on behalf of their families. In instances where the child wasn’t yet old enough for kindergarten, the online form allowed referrers to submit an ‘expression of interest’ form, so that the child’s family could be contacted at the relevant time to enrol into kindergarten. This process change has not only increased kindergarten enrolments but has also supported early identification of children eligible for Early Start Kindergarten (ESK). [Best Start Latrobe and Hume]
2. A ‘welcome to playgroup’ book was created by playgroup facilitators and then shared with referring services. Greater referrals and enrolments into supported playgroups (SPG) resulted. Facilitators also created a second version of this book aimed at sharing information about SPG with parents and carers, which gave families an idea of what to expect before attending. [Best Start Wyndham]
3. The team at Ballarat examined their existing processes for identifying children in out-of-home care (OOHC), eligible for ESK & kindergarten, and identified gaps in their existing processes. This gave birth to the idea to collaborate with LOOKOUT to boost identification and enrolment for ESK & kindergarten. The Best Start facilitator:
   • Goes over the list provided by child protection and identifies eligible children,
   • Then contacts central registration to check if the identified children are either registered or attending.
   • Then has a phone conversation with LOOKOUT to ensure that information regarding where the child is registered, or attending is comparable.
   • And if this information is not comparable, or if LOOKOUT does not have this information, LOOKOUT contacts the child’s caseworker (at child protection) to follow-up. [Best Start Ballarat]
4. An agreement was established between the MCH service and Best Start for MCH to share quarterly data with Best Start, identifying all the children/families who attended any KAS visit and were: known to child protection, Aboriginal and Torres Strait Islander, and/or have refugee/asylum seeker status, and therefore were eligible for kinder or ESK. The Best Start facilitator then cross-checks this list with central registration to see if these children are either registered or enrolled for ESK/kindergarten. The families of those identified as eligible, but not enrolled or registered, are then contacted by the Best Start facilitator who discusses eligibility and offers support as required. [Best Start Cardinia]

How to increase attendance

The following change ideas were shared as strong examples of change ideas that improve attendance at kindergarten, Supported Playgroups and/or MCH Key Age and Stage appointments.

1. Messaging apps such as WhatsApp have been used to deliver virtual playgroup sessions and provide one-to-one support to families during COVID-19 restrictions. In some cases, participation in playgroup when delivered virtually has exceeded face-to-face attendance rates. [Best Start Whittlesea]
2. Sending e-reminders for appointments using text message or messaging apps on the day of appointment has increased attendance rates at MCH Key Age and Stage visits. [Best Start Latrobe]
3. Annually surveying families to understand their preferences around kindergarten locations and days/times, and using this information to inform kindergarten scheduling, has led to increased attendance. [Best Start Cardinia]
4. Hand-delivering or posting personalised letters and home learning materials to families who were regularly attending kindergarten during COVID-19 restrictions was found to have a positive impact. Families often replied and continued to stay in contact with the service as a result. [Best Start Casey and Latrobe]
5. Developing a protocol on how to follow-up on missed appointments resulted in more consistent follow-up practice and a higher proportion of missed appointments being rescheduled and subsequently attended. [Best Start Maribyrnong and Latrobe]
6. Collating and analysing attendance data across multiple kindergartens was found to be an efficient way to identify and then follow up children missing multiple sessions, enabling supports to be provided to overcome each child’s barriers to participation. [Best Start Latrobe]

Using the learnings from Best Start

We encourage others working in early years services to consider which of these promising practices could be applied to their setting. It’s important to note that although these ideas have shown promising results in their site of origin, each of them will require testing and possible adaptation through Plan-Do-Study-Act cycles in new and different contexts. The following questions may be useful in terms of identifying which of these ten promising practices to consider testing in your own context.

• What service would you like to improve participation in? Look for promising practices specific to your service i.e. kindergarten, Supported Playgroup or Maternal and Child Health
• What is it that you’d like to improve? Enrolments or attendance? Look at the practices under the appropriate heading?
• Do you have a particular cohort in mind e.g. Aboriginal, out of home care, refugee/asylum seeker? Look for the practices focused on the cohort of interest.
• Finally, for each relevant promising practice:
  • What is the appetite of your colleagues and partners to test and/or adopt this idea?
  • What structural or resource barriers exist to testing this idea? How easily might they be overcome?
  • What’s your hunch about the likelihood of this idea being successful in your context?

Promising Practice in Best Start series

This post has been adapted from ‘How to increase participation in early years services’ from the Promising Practice in Best Start series. The Promising Practice in Best Start series captures what is being learnt through Best Start about how to use quality improvement to increase participation in early years services. The series draws on insights from Best Start facilitators and is produced by the Centre for Community Child Health.

Learning and changing with quality improvement blog series

Access all blogs in the series:

1. Four practices of effective quality improvement
2. How a pandemic makes QI more relevant than ever (but also a little tricky)
3. How quality improvement can help services to adapt to COVID-19
4. Practices of an effective quality improvement coach
5. How to increase participation in the early years: promising practices identified through quality improvement