References

Early intervention: the next steps, report of the independent review of early intervention. 2011. https://www.gov.uk/government/publications/early-intervention-the-next-steps--2 (accessed 6 January 2020)

Black M, Surkan P. Child development and maternal wellbeing: family perspectives for low-income and middle-income countries. The Lancet Global Health. 2015; 3:(3)E426-E427 https://doi.org/10.1016/S2214-109X(15)00084-4

Department for Children, School and Families. The impact of parental involvement on children's education. 2008. https://dera.ioe.ac.uk/10600/7/DCSF-Parental_Involvement_Redacted.pdf (accessed 4 January 2020)

Department of Education, Department of Health. Families in the foundation years evidence pack. 2011. https://www.gov.uk/government/publications/supporting-families-in-the-foundation-years (accessed 5 January 2020)

Fathers Network Scotland. 2019 Health and wellbeing Survey Results. 2019. https://d3n8a8pro7vhmx.cloudfront.net/fathersnetwork/pages/4239/attachments/original/1561655107/FNS_Survey_2019_Findings_formatted.pdf?1561655107 (accessed 6 January 2020)

Improving school readiness Creating a better start for London. 2015. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/781623/improving_school_readiness.pdf (Accessed 5 January 2020)

Marmot M. Fair society, healthy lives: the Marmot Review: strategic review of health inequalities in England post-2010.London: The Marmot Review; 2010

McDonald SW, Kehler HL, Tough SC. Protective factors for child development at age 2 in the presence of poor maternal mental health: results from the All Our Babies (AOB) pregnancy cohort. BMJ. 2016; 6:(11) https://doi.org/10.1136/bmjopen-2016-012096

NatCen Social Research. Predictors of Wellbeing. Commissioned by the Department of Health. 2013. http://www.natcen.ac.uk/study/predictors-of-wellbeing

PACEY. Being School Ready. https://www.pacey.org.uk/working-in-childcare/spotlight-on/being-school-ready (accessed 5 January 2020)

The impact of early education as a strategy in countering socioeconomic disadvantage. 2013. http://www.crec.co.uk/docs/Access.pdf (accessed 6 January 2020)

Public Health England. Early years high impact area 2: Maternal mental health. Health visitors leading the Healthy Child Programme. 2018. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/754790/early_years_high_impact_area_2.pdf (accessed 6 January 2020)

Public Health England. Initiatives to improve school readiness across the South East. 2019. https://www.gov.uk/government/publications/improving-school-readiness-initiatives-across-the-south-east (accessed 6 January 2020)

Public Health England. Child and Maternal Health Statistics. 2020. https://www.gov.uk/government/collections/child-and-maternal-health-statistics (accessed 6 January 2020)

Public Health England. Public Health Profiles. 2021. https://fingertips.phe.org.uk (accessed 6 January 2020)

Ready for school: prepared to learn and develop. 2015. https://vivbennett.blog.gov.uk/2015/09/30/ready-for-school-prepared-to-learn-and-develop-justine-rooke-and-wendy-nicholson/ (accessed 4 January 2020)

Sheridan M. From Birth to Five Years.London: Routledge; 1973

Warwickshire County Council. Warwickshire Smart Start Strategy 2016–2020. 2016. https://api.warwickshire.gov.uk/documents/WCCC-990-741 (accessed 6 January 2020)

Warwickshire County Council. Smart Start Strategy, executive summary. 2016. https://api.warwickshire.gov.uk/documents/WCCC-630-922 (accessed 5 January 2020)

Williams M. Fathers Reaching Out – Why Dads Matter: 10 years of findings on the importance of fathers' mental health in the perinatal period. 2020;

World Health Organization. Early child development – Maternal and child mental health. https://www.who.int/topics/early-child-development/mentalhealth/en/ (accessed 6 January 2020)

School readiness: The importance of a multi-agency approach

02 December 2020
Volume 1 | British Journal of Child health · Issue 6

Abstract

The transiton to school from the home or early years setting is a crucial time in a child's life. Public health nurses and early years professionals have a crucial role to play in ensuring that children are ready for school entry. In this first part of a two-part series, Neil Henty looks at the definitions of school readiness and the factors affecting it.

There is no question that children need support on their learning journey and there is no doubt that each child's journey is of vital importance. Not only to themselves, but to society at large. We know that change in anyone's life offers both opportunities and challenges. Children, especially young children, face many transitions in their lives, one of the biggest being the move from the home or early years setting to primary school, normally in the Reception year.

To many adults, this transition may seem a natural progression, one that children manage and cope with almost imperceptibly. Often, this is not the case, with issues presenting either before starting school or more commonly in the months and years afterwards. How well prepared children are for school is referred to as ‘school readiness’.

‘Preparing for school entry can be an extremely anxious time for parents and their child. Health visitors and school nurses have a fundamental role to play in supporting parents and ensuring the child is ready and prepared for school life.’

(Rooke et al, 2015)

‘We know there is a strong link between a child's health and wellbeing and their educational attainment. Children with poor socio-emotional skills, low self-esteem and low self-confidence may be particularly vulnerable during the transition to school.’

(Rooke et al, 2015)

‘Preparing for school entry can be an extremely anxious time… Health visitors and school nurses have a fundamental role to play in supporting parents and ensuring the child is ready and prepared for school life…’

Defining ‘school readiness’

As a measure that affects all children you would expect a single unifying definition, but although there is general agreement, actual definitions are more localised.

In 2014, Ofsted published, Are You Ready? Good Practice in School Readiness (Ofsted, 2014), which defined the problem:

‘The term “school readiness” features in many reviews of education and statutory guidance. However, the precise characteristics of school readiness and the age of the child to which it applies are interpreted variously by the providers we visited. There is no nationally agreed definition.’

The current measure is based on the Early Years Foundation Stage Profile (EYFSP), administered at the end of the Reception Year.

The EYFSP is an observation-based assessment of whether children are achieving ‘good levels of development’ in various areas of the Early Years Foundation Stage (EYFS), these are the early learning goals – personal, social and emotional development, physical development and communication and language (prime areas of learning) and in mathematics and literacy (two of the specific areas of learning). These assessments are made by foundation stage professionals who will have worked with the children during the Reception Year, building on the assessments of childminders, nursery and pre-school staff.

‘The Early Years Foundation Stage (EYFS) sets the standards that all early years providers must meet to ensure that children learn and develop well and are kept healthy and safe. It promotes teaching and learning to ensure children's “school readiness” and gives children the broad range of knowledge and skills that provide the right foundation for good future progress through school and life.’

[Statutory framework for the early years foundation stage, 2017]

‘… a common concern among early years professionals, [is] that the focus should not be on children being “ready for school”, but rather more on schools being ready for the children they are welcoming.’

As the EYFS areas of learning make clear, school readiness, by whatever definition is used, is not simply an academic judgement. The profile and the foundation stage recognises that a child's wellbeing and physical development are central components of a child's readiness to attend school.

The following definition of school readiness comes from Dr Marina Korkodilos, deputy director, specialist public health services, in ‘Improving school readiness Creating a better start for London’ (Korkodilos, 2015):

‘School readiness is a measure of how prepared a child is to succeed in school cognitively, socially and emotionally. The good level of development (GLD) is used to assess school readiness. Children are defined as having reached a GLD at the end of the Early Years Foundation Stage if they achieved at least the expected level in the early learning goals in the prime areas of learning (personal, social and emotional development, physical development and communication and language) and in the specific areas of mathematics and literacy.’

‘School readiness starts at birth with the support of parents and caregivers, when young children acquire the social and emotional skills, knowledge and attitudes necessary for success in school and life. School readiness at age five has a strong impact on future educational attainment and life chances.’

Of course, a child's health (mental and physical health) and that of their families, often measured in terms of a mother's health and mental wellbeing (for example, NatCen Social Research, 2013; World Health Organization, no date; Public Health England [PHE], 2020) underpins learning and development, and staff in early years settings are trained to support children and to sport concerns that a child may be struggling in certain areas. They are not trained health and social care professionals. As the above statement makes clear, school readiness starts at birth with support from parents and caregivers. The first 2 years of a child's life are particularly important.

Commonly, there are three main elements to school readiness, regardless of which definition you choose to accept. For example, Oxfordshire County Council adopted UNICEF's description of school readiness in its 3-year strategy document, Oxfordshire School Readiness and Lifelong Learning Strategic Plan (Portman, 2020):

  • Children's readiness for school
  • Families and communities' readiness for school
  • Settings' and schools' readiness for children.

There is a clear three-part focus here: children, family, education. This definition highlights a common concern among early years professionals, that the focus should not be on children being ‘ready for school’, but rather more on schools being ready for the children they are welcoming. There is still a sense in more ‘traditional’ teaching circles, fuelled by the pressure of the National Curriculum, that primary schooling is too rigid in its approach to the ‘whole child’.

Oxfordshire County Council goes on to state: ‘Children have the potential to become school ready when families, early years providers and schools work together to support the development of children's confidence, resilience and curiosity.’

Professional Association for Childcare and Early Years (PACEY) describes school readiness as ‘having strong social skills, being able to cope emotionally with being separated from parents, being relatively independent in their own personal care and to have a curiosity about the world and a desire to learn’.

In 2011, the Department for Education (DfE) in cooperation with the Department for Health (DH) published, Supporting Families in the Foundation Years, in which it stated ‘key factors promoting children's health and development during the foundation years’, these were (DfE and DH, 2011):

‘The things that parents or carers do with children at home, like talking to, reading to, and playing with them, are key predictors of future development and readiness for school. The impact of the early home-learning environment on outcomes at age five has an effect over and above factors such as socioeconomic status, maternal education and family income’.

It is clear, therefore, that the home-learning environment in these first few years is vital to a child's future progress, including their readiness for school.

Supporting Families goes on to say (DfE and DH, 2011):

‘Recent research has shown that language development at age two is very strongly associated with later school readiness, with the early communication environment in the home providing the strongest influence on language at age 2 – stronger than social background.’

But these first few years are where there are often ‘disconnects’ in terms of support. Parents receive a great deal of support prior to birth and in the first few months, delivered mainly from health services. Children may also attend early years settings from very young ages with many nurseries having baby rooms and specially trained staff members who will support children according to the Development Matters document of the EYFS (DfE, 2020).

Why the measure of school readiness is so important

As the definitions above make clear, it is important that children have all they need to thrive in their learning and development. The measure of school readiness based on the EYFSP is a good place to start because it is based on observation of not only academic development but also personal, social, emotional and physical development. If a child's needs are met, the theory goes, they will be able to achieve their full potential in life. Being ‘school ready’ means being able to engage with the school curriculum and thrive. It is this last point that focuses policy and research.

The Marmot Review, Fair Society, Healthy Lives (Marmot, 2010), states: ‘Giving every child the best start in life is crucial for securing health and reducing health inequalities across the life course. The foundations for virtually every aspect of human development – physical, intellectual and emotional – are laid in early childhood. What happens during these early years, starting in the womb, has life-long effects on many aspects of health and wellbeing – from obesity, heart disease and mental health, to educational attainment and economic status.’

The inference being that being school ready at the end of the Reception year translates to being a ‘useful’, ‘healthy’ and ‘economically productive’ adult. To a large extent, the evidence bears this out (Department for Children, Schools and Families, 2008; Pascal and Bertram, 2013; Public Health England [PHE], 2014):

  • Every £1 invested in quality early care and education saves taxpayers up to £13 in future costs.
  • For every £1 spent on early years education, £7 has to be spent to have the same impact in adolescence.
  • Targeted parenting programmes to prevent conduct disorders pay back £8 over 6 years for every £1 invested with savings to the NHS, education and criminal justice system.

So investing in early education, care and interventions makes sense not only for children and the future economy, but also for the current economy.

Achieving a good level of development at the end of the EYFS is desirable therefore and the skilled, trained professionals in the early years sector work hard to ensure this. However, children develop at different rates and in different ways, physically, emotionally and academically, and this needs to be borne in mind when creating policy or interventions.

‘By assessing a child's development as they approach school entry health visitors and school nurses can identify need and deliver timely, seamless support. This will enable children to learn and participate in school life, thus reducing the risk of school absences or poor attainment.’

A child's health and wellbeing has a direct effect on their ability to achieve these ‘good levels of development’, and so when a child is assessed as being short of achieving these levels, some kind of intervention is needed, whether that be within the EYFS, or through engagement with health services.

So how can we determine whether children are ready for school? Justine Rooke and Wendy Nicholson (Rooke et al, 2015), suggest:

‘A state of readiness is determined by the knowledge gained from a holistic assessment of a child's health, wellbeing and educational need – this includes assessing physical, emotional and social development, language skills, concentration and memory. By assessing a child's development as they approach school entry health visitors and school nurses can identify need and deliver timely, seamless support. This will enable children to learn and participate in school life, thus reducing the risk of school absences or poor attainment. Health visitors and school nurses can facilitate effective support to improve equity to learn, they can provide support for emotional wellbeing, speech and language, toileting, immunisations, nutrition and healthy weight.

‘This is also an ideal opportunity to offer timely and appropriate support to children with additional needs and their family: we know intervening early can improve health, wellbeing and educational outcomes for children. Health visitors and school nursing services can offer a continuum of support which can be delivered in partnership with early years, schools and wider stakeholders.

‘Early identification of need and targeted interventions can be offered and may include: children with special educational or additional health needs, children who have not previously attended an educational establishment, children who are looked after or in need of protection. Working with parents to identify need is essential to support school readiness, improve parenting skills and to contribute to wider public health outcomes. Building strong trusting relationships with families allows health visitors and school nurses to provide continuity of services and better understanding of local population health needs. This provides an opportunity to provide integrated services which are responsive to children and families and wider public health needs. The transition of support from health visitor to school nursing services ensures families can establish new relationships with school nursing services as the child enters an exciting phase of their life.’

What factors negatively affect school readiness?

All children need certain basic abilities to be able to get the most from school. Whether there is general consensus on what all these are and to what level children need to be operating at. But some children will need more help than others; children from disadvantaged households or from deprived areas, for example. Again, exact definitions vary and not every child who falls into either of these two categories will need support to be ‘school ready’. Conversely, there will be children who fall outside of these categories who will need support.

However, interventions intended to address school readiness issues will necessarily need to focus on certain areas, whether that be speech and language, children with special educational needs, from disadvantaged backgrounds etc. This is largely due to cost and resource limitations. The link between poor speech and language development and later problems is well established.

Policy

In 2011, Graham Allen MP, delivered his first report on the need for, and benefits, of early intervention practices: Early intervention: the next steps, report of the independent review of early intervention (Cabinet Office, 2011). In it, he stated:

‘I recommend that all children should have regular assessment of their development from birth up to and including 5, focusing on social and emotional development, so that they can be put on the path to “school readiness” which many – not least from low-income households – would benefit from. Accountability is confused and divided, policy is incomplete and there is an unnecessary separation between the Healthy Child Programme reviews and the Early Years Foundation Stage assessments.’

‘Given what we know about the need for young children to form close and strong attachments to parents, this is an area of research and intervention that deserves much greater attention.’

As the Allen report makes clear, education and health assessments have historically been separate entities, and while collaborative working does take place, there is still room for programmes that see the child ‘holistically’ from ‘both’ a health and education viewpoint to improve the life chances of children, whether you see that in terms of school readiness or from some other viewpoint. The Oxfordshire County Council programme mentioned above puts children at the centre of multi-agency working.

Family

As already mentioned, the first few months of a child's life at home have a big impact. Therefore, a child's family situation will affect school readiness. Family income, structure, support networks, engagement in learning, reading with children, and many other factors play a part. To some extent, early years settings and health professionals will be able to offer the support that families and children need to achieve good levels of development.

However, this is not always the case: the PHE document, ‘Initiatives to improve school readiness across the South East’ (PHE, 2019), reveals the gap in levels of development between children eligible for free school meals and their peers:

‘Although 74.7% of children in the South East achieved a good level of development in 2017/18, this was only the case for 57% of children with free school meal status. This situation has improved since 2012/13, when only 36.8% of children in the South East achieved a good level of development. However, the gap still remains in achievement between all children and those on free school meals. Across the South East in 2017/18, this gap ranged from 6.6 percentage points in Slough, to 31.1 percentage points in West Berkshire.’

While statistics tend to focus on particular demographics, such as county, region or local authority, there are real variants even within geographically neighbouring areas. ‘Initiatives to improve school readiness across the South East’ is a useful document, which identifies many of the causes and concerns regarding school readiness.

‘At a regional level, the South East is less deprived than the rest of England. Levels of under-18 conceptions, percentage of children in low income families, family homelessness and numbers of children in care are all significantly lower than the national averages. However, within the region there is considerable variation.’

(PHE, 2019)

These factors have an effect on whether a child is ready for school, but do not necessarily lead to it. What the above passage really conveys is how many factors can affect school readiness. What we call ‘school readiness’ is really just another name for child development, and we know that all children develop at different rates.

Parental knowledge

All parents are different, they all come from different backgrounds and environments. Parents need support, just like children. School readiness begins before birth, during pregnancy, and therefore the levels and quality of support a parent or family receives during this time will have an effect. How maternal health affects a child's life chances is an area of growing research (for example, Black and Surkan, 2015; McDonald et al, 2016; Public Health England, 2018). Less is mentioned about paternal health, but it will also have an effect and there is a growing movement to address the mental health of young fathers.

For example, Adrienne Burgess, Joint Chief Executive and Head of Research at The Fatherhood Institute, states (in Williams, 2020) that: ‘Poor mental health in fathers has a huge and often long-lasting impact on both their partner and their children.’ Da Costa et al (2017) found that ‘paternal postnatal depression can negatively impact on infant and child development’. Fathers Network Scotland (2019 survey results) found that: ‘62% of the dads surveyed by Fathers Network Scotland in 2019 felt that their mental health difficulties did get in the way of forging good connections with their children.’

Given what we know about the need for young children to form close and strong attachments to parents, this is an area of research and intervention that deserves much greater attention.

Health visitors are an excellent source of early help for young families, especially in terms of early development and addressing any health or care concerns. Outside of these home visits, how ‘connected’ are young parents to services and sources of information and support? We know this is a crucial period, but in reality, many parents have no thought on school readiness, as the ‘Initiatives to improve school readiness across the South East’ document details:

‘Many parents were uncertain about the idea of what children should be able to do by the time they got to school, stating that they were “not too sure” (parent of a 2-year-old in Brighton & Hove) or that they had “not really thought about it … nursery have prepared her well though” (parent of a 4-year-old in Oxfordshire). This was particularly a common response among parents of younger children for whom the idea of school was far away, with one replying “not thought about it, just trying to get them ready for nursery at the moment” (parent of a 2-year-old and an 8-month-old in Oxfordshire).’

Recent research conducted by the East London Research School, posted to a LinkedIn group by Julien Grenier, headteacher at Sheringham Nursery School and Children's Centre Co-lead, East London Research School, and author of the recently revised non-statutory curriculum guidance document, Development Matters, which supports the delivery of the revised EYFS statutory framework, revealed that:

  • Although 98% of people surveyed believed that nurture was essential to a child's life chances…
  • Only 24% believed the first five years of a child's life from the start of pregnancy to be the most important

Regular check-ups culminate in the health and development review at 2–3-years-old. This is either conducted by an early years professional or health visitor, by this stage developmental milestones such as language and learning, as well as diet, sleep, behaviour etc. will have been assessed. As regular as these health checks are, there are periods when parents can feel ‘alone’ and some will not have any access to support between these visits.

So, how do parents currently access information about their child's development? As can easily be imagined, from a wide variety of sources, not all official, which means there can be no guarantee that parents are accessing helpful or useful materials. According to ‘Initiatives to improve school readiness across the South East’ parents often use the internet and search engine results for information; other sources include friends and family, social media, childcare providers and less often GPs or health services. Perhaps as children grow older and attend early years settings more frequently it will be more common for parents to discuss any developmental or learning concerns with childcare professionals, leaving more physical health issues to a visit to the GP?

Providing support to those families who do not want help or do not know how to access it, of course, is a huge challenge. The aim of health visitors and early years settings (and the EYFS) is to provide all children with the best start in life, closing the ‘disadvantage gap’, but how can this be achieved when not all parents are supported or interested in support?

A lack of uniform approach to improving school readiness

To be clear, there are many, many initiatives around improving school readiness. Returning to ‘Initiatives to improve school readiness across the South East’ it is abundantly clear that there is no lack of effort being put in place to help children achieve their potential. However, digging into the detail reveals slightly more worrying statistics: a snapshot of survey answers to four questions regarding school readiness, broken down by public health teams in 16 local authorities across the South East of England, as of the publication date in 2019 reveals (PHE, 2019):

  • In only 11 local authorities was school readiness part of the health and wellbeing strategy
  • Only five had a school readiness steering group
  • Six replied that there was a specific strategy in place with the aim of improving school readiness
  • Three stated that they had identified it as a priority but had taken no specific action to tackle it yet
  • Eight said that they had initiatives targeting school readiness of children eligible to receive free school meals in an early years setting
  • Nine said they provided resources for parents to highlight school readiness
  • An encouraging 14 out of 16 had initiatives to improve speech, language and communication in children from birth to 5-years-old
  • Thirteen had plans to work closely with early years providers to improve school readiness.

These figures provide a snapshot. Figures around the country will differ, as will levels of support and the initiatives being undertaken, but I make the assumption that these figures for the South East are roughly equivalent to the national picture.

The last bullet point is particularly interesting. From everything we have seen, a collaborative approach is needed to ensure all elements of child development are supported to aid school readiness.

What does not seem to affect school readiness

According to the findings in ‘Initiatives to improve school readiness across the South East’, what does not seem to affect school readiness is the percentage of children receiving a 12-month health visitor review, or the ‘proportion of children offered the ASQ-3 as part of the developmental review at 2 to 2½ years', neither does the percentage of children taking up the funded nursery entitlement offers for 2-year-olds or 3- and 4-year-olds (PHE, 2019).

It seems very much, as expected, that quality is far more important than quantity. If the accepted statistical measure of school readiness is achieving a good level of development in the prime areas of the EYFS and the specific areas of literacy and mathematics, then outcomes are improving right across the country.

What improves rates of school readiness?

According to the Public Health Profiles data, the percentage of children achieving a good level of development at the end of reception rose from 51.7% in 2012/13 to 71.8% in 2018/19 with the highest levels in the South East and lowest in the north west regions (PHE, 2021).

In terms of children achieving expected levels in communication and language skills, the trend has also been upward, from 72.2% in 2012/13 to 82.2% in 2018/19.

Obviously, there are many variations within each region and even within towns and communities at a more local level, but the upwards trend is encouraging.

What seems clear is that school readiness is not a single agency issue, and improving the percentage rates of children achieving a good level of development involves education, health, social care, Local Authorities, government policy, parents, families, communities etc.

We might say that school readiness starts before birth and that the first steps are taken in partnership between parents, families, health services, perhaps in some cases, social care professionals, and that at some point the main support structure becomes early years settings, whether that be nurseries, childminders, or children's centres.

A joint publication between the DfE and the DH (2011), ‘Families in the foundation years evidence pack’, identifies school readiness as being supported by: good maternal mental health, learning activities, including speaking to your baby and reading with your child, enhancing physical activity, parenting support programmes, and high-quality early education

In 2014, Gill Jones, Her Majesty's Inspector, Deputy Director Schools and Early Education at Ofsted, published Early Years Education Annual Report 2014 (Ofsted, 2014). It contained the following advice about good practice when engaging parents and carers:

‘The best settings were particularly effective in working with other agencies to engage vulnerable families and target support where it was most needed. Providers worked closely with parents and carers through the transition period, providing information and guidance. Partnerships were vital in ensuring continued support for children with special educational needs and/or disabilities as they moved from one setting to another. Families were provided with a clear and well-organised programme of informal and formal meetings… The best settings worked with other professional agencies to ensure progress in key areas was regularly reviewed, next steps identified and to agree a common approach.’

There are three key themes here:

  • The best early years settings work effectively with other agencies
  • Providers worked closely with parents and carers, with clear communication, especially during the transition period (from nursery to school, from the EYFS to the National Curriculum)
  • Partnerships were vital in ensuring continued support for children with special educational needs and/or disabilities as they moved from one setting to another.

I have only briefly mentioned children with special educational needs and/or disabilities – children and their families require specialised support throughout their learning journey and in terms of this article I am assuming these needs will be taken into account. It is vital that these children and families receive appropriate high-quality specialist support at all times, especially during times of transition.

Conclusions

The transition to school from home or early years settings can be a very stressful time in a child and family's life, and school readiness has a substantial impact on children's future life chances. It is clear that the best outcomes for children and families are delivered when all key stakeholders work together, including health, care, and education.