Matthew's family and their multiagency keyworker
When he was eight months old, our son Matthew was seriously ill in hospital, suffering from pneumococcal meningitis. This left Matthew with brain damage, autism and epilepsy. In the months after Matthew came home from hospital we were finding it extremely difficult to deal with his complex medical problems. We were also noticing significant delays in his development.
As the time passed and our concerns were being dismissed, we began to feel increasingly isolated, not knowing which way to turn next for help. Then we made contact with the charity, One Hundred Hours. Our immediate impression was that at last we had someone who would listen to our concerns for Matthew however long it took and whenever it was, and genuinely sympathised with them.
One Hundred Hours began helping us to find the right people to contact. They then supported us at the subsequent meetings to ensure that we were getting a proper response to our concerns. Very soon we were able to obtain a diagnosis on Matthew’s development, which, although heart-breaking for us, enabled us, with One Hundred Hours’ considerable help, to identify what would be the best and most appropriate help that we could get for Matthew. This culminated in us very quickly obtaining a place for Matthew at the local Mencap nursery.
The next initiative suggested to us by One Hundred Hours was to arrange a meeting with both Matthew’s doctors and the nursery staff who were looking after him. This ensured that there was a co-ordinated approach and that everyone involved with Matthew was aiming for the same objectives. It was only after this that we began to start seeing some improvements in Matthew’s development.
One Hundred Hours continued to work with us providing ‘a shoulder to cry on’ during our many low points. Finally they assisted us in completing Matthew’s Statement of Special Needs, helping us to ensure that we obtained a place for Matthew at the school most suitable for his needs.
We know that if we hadn’t discovered One Hundred Hours when we did, Matthew would probably not have made the progress that he has so far achieved and for that we cannot thank them enough.
By Mr and Mrs Firth, parents with whom the One Hundred Hours voluntary organisation worked in Yorkshire, UK.
Anya, her family and her keyworker
This account is taken from Anya’s keyworker’s notes and so describes a real situation, but with names changed. The experience of each child and family and the situation they find themselves in is unique. The experience of Anya, her family and keyworker reinforces the following elements of effective joined-up early support thinking and practice:
Early support for the child and family should come as early as possible. Anya and her family would have benefited from earlier help with play activity and in getting answers to their many questions.
Ideally, the regularity of sessions and the duration of each session is determined by the needs of the child and family at the time. Anya’s family had at the beginning six or seven visits per month with each visit lasting about two hours. Other families had more frequent visits perhaps of more than two hours during difficult times. Some families wanted only weekly visits of between sixty and ninety minutes.
Within a ninety-minute or two-hour session there is usually enough time to focus on the infant and to talk to parents or other family members. This avoids the tension that can arise in a practitioner trying to work with an infant while the parent is upset and crying, or attending to the parent’s need while being conscious that an opportunity is being missed to extend the infant’s learning.
Parents of babies and infants who have challenges to their development and learning need a trusted and knowledgeable person to talk to in an ongoing helping relationship. There are so many questions to ask and so many thoughts and emotions to sort out.
There can be benefit for the whole family when parents or other family members are supported in giving the child the best possible experience of being alive. This can mean seeing the child and not the impairment. It can mean helping parents see they have a valued new family member and not a little invalid to nurse.
Anya was approaching her first birthday when a keyworker from a voluntart agency made the first working visit to her home. Anya’s parents had asked for this free service and this first session followed a period of phone calls and informal meetings while her mother, father and grandparent learned more about what was being offered. There followed two years of regular home visits by their keyworker until Anya started school on a part-time basis. After that time, the keyworker stayed in touch with occasional visits during a few more years and was able to help with some issues that arose about Anya’s schooling.
Families had a variety of reasons for having a One Hundred Hours keyworker. Some would articulate their expectations of the service very clearly. Other families felt they wanted support but did not go beyond general terms and were not asked to. Anya’s family were in the latter category but it was clear their wanting a keyworker came from their deep care and concern for Anya. Anya stayed in hospital for a few weeks after birth and was given a diagnosis of cerebral palsy before going home. She was under the care of a paediatrician at the local child development centre and had been seen intermittently during this first year by a physiotherapist and twice by a speech and language therapist. She did not attend playgroup or nursery and was mostly at home with her mother, Jo.
For most sessions with the keyworker Anya was at home with her mother while occasionally Anya’s father or grandparent was also present. How each session began depended on the immediate situation and any new concerns. In most sessions there was time focussed on Anya and time for conversation with her mother, usually with a cup of coffee. There were occasions when Anya was asleep so the session changed accordingly. The relationship between the family and the keyworker was warm, trusting and respectful and sessions were relaxed.
During the first weeks of this support the keyworker wrote to Anya’s paediatrician, physiotherapist and speech and language therapist with the aim of developing future collaborative teamwork around Anya and her family. The keyworker learned from Anya’s parents about what these practitioners had already said and done and suggested Jo tell them each time she sees them what was happening in the sessions with the keyworker. This would be an opportunity for them to keep up to date with what Anya is doing and to comment on the approach if they wished.
Topics of conversation with Anya’s family ranged widely and could be focused on Anya or be of a more general nature. Confidential conversations were not recorded in the keyworker’s notes and are not listed here. First topics included Anya’s habits, her likes and dislikes, her birth, her time in hospital and how she reacted to coming home. There were many conversations with Jo on her own, some with laughter and some with tears. The keyworker’s role varied between being an active listener and giving or promising to get information. Advice was never offered - a rule of the agency. During these first few weeks topics included vision, hearing, epilepsy, medications, head circumference, cerebral palsy, children who die, guilt, survival and length of life, sleep, appetite, feeding and drinking skills, stiffness, eczema, reflux, use of hands, use of hands and eyes together, play, vocalising, physiotherapy, exercises, speech and language therapy, early communication and understanding, finger sucking, crying, teething, weight, blood in faeces, cranial osteopathy, playgroup, nursery, school, drinking bottle, cup, spoon, potty training and constipation.
The topics about children who die and about guilt are put together in the above list and were linked in the conversations. When an infant has a multifaceted condition and an uncertain future, a parent’s mixed emotions can include fear the infant will die and, at the same time, apprehensions about how difficult life might be for child and family in ten, twenty or thirty years if the child survives. These apprehensions can feel to a parent almost like hoping the child will die – and then guilt arises. The time spent with Anya as the main focus was always with parent and keyworker sitting on the living-room floor with her. The adults responded to her mood and energy level and tried to develop any activity Anya initiated. Jo was always keen to do the exercises given her by the physiotherapist and was much less enthusiastic about the speech and language therapist’s suggestions. This pattern continued with the strong parental hope and anticipation of Anya learning to walk.
The following extracts from the session notes have been selected to focus only on play activity. Early conversations with her parents indicated that Anya did not play. When awake, her time between caring activities was spent propped against cushions on the sofa or doing the physiotherapy exercises. This seemed to be a pattern set when she first came home from hospital many months ago. Play was not a parental expectation and Anya had no collection of her own toys.
Session 1
Anya was happy and smiling propped against cushions in an armchair. Her hands were mostly in her mouth, first one then the other, and she held a rattle when it was put in her fingers but could not release it. She repeatedly took the rattle to her mouth. She was moved to a supportive floor seat, which she had occasionally used before, with a plastic tray, which she had not used before, and a shiny bell was held within her reach. She looked at this and once or twice accidentally knocked it. This excited her. While the adults talked she did reach and touch the bell while it lay on the tray. The keyworker suggested parents suspend noisy toys in front of her when in this sitting position. Jo was delighted that Anya had sat to the tray and knocked the bell.
Session 2
Jo was pleased that Anya has been using her hands more since the last visit and has been vocalising more. Someone has rigged up a frame for Anya which consists of toys suspended from a bar which clamps to her tray. During the visit Anya sat in the floor seat propped forward with padding up to the plastic tray with the suspended toys. She once or twice knocked the toys while, some of the time, looking at her hands. She also made occasional contact with toys placed on the tray.
Session 3
Anya was sitting in the floor seat with her tray and suspended toys. She was not touching them or looking at them, instead she was sucking her fingers (either hand). Later, held in a supported sitting position on the keyworker’s knee with Anya’s knees flexed and her feet held flat on the floor, she reached for and touched a suspended bell. She then grasped the bell in first one hand and then reached again and grasped it in the other – while looking at it. Jo said she had never reached for something she was looking at before. Later, Anya was seated on the floor with supporting props. She did not reach for a toy in front of her on the floor but did then touch a bell that was draped with a ribbon over her foot.
Session 4
Anya has now developed the ability to reach to the floor to pick up a toy while she is seated on the floor.
Session 5
With a pop-up toy and with a telephone with small buttons, she showed improving manipulation while looking at what her hands were doing.
Session 6
When she was fingering some small toys she picked her spoon up without help and put it in her mouth.
I want to re-emphasise that these extracts focus only on use of hands in play and cover only the first four-week period. This wa part the ‘getting to know each other’ phase. These notes have not fully reported the family’s delight from the first session onwards at seeing Anya play with toys. They had not expected this ability.
Anya’s story supports the idea that children with these challenges will benefit from the earliest possible support for their development and learning. It seems very unlikely that eleven-month-old Anya’s readiness for this play activity matured at exactly the same time the keyworker started visiting. It is much more likely that Anya was responding to a new situation and was awakened to new possibilities in her life. Focussing on Anya’s play activity helps make the point that early support has a direct bearing on quality of life. While ‘hand/eye co-ordination’ or ‘visually directed reaching’ are valid terms describing a developmental stage, reaching for toys for Anya was just play in the here and now. Life now could be less passive and much more exciting. With keyworker intervention, Anya achieved the normality of an infant at play. And play is fun!
Conversations with the family suggested they had always thought of Anya as a sick baby and as an invalid. While parenting Anya required extreme watchfulness for signs of ill health, careful feeding, managing crying episodes and getting her through the practicalities of each day, it had not included baby play activity with fingers, toes, rhymes or playthings. Parents and grandparent were loving and caring but were taken over by the idea of Anya as a medical case – not so much as a child. The time spent on physiotherapy exercises were part of that mindset. It is not unusual that parents who have accompanied their baby through a medical crisis with survival at risk and then weeks or months of hospitalisation before the baby comes home, can maintain a medical view of their baby and even see their role as more nurse than parent. It could be that the professionals who first support the baby and family are similarly medically focussed and do not mention the importance of baby games and play – but it could also be that parents only hear what they are ready to hear and what seems most relevant to them at the time.
There is no intended accolade for Anya’s keyworker in the above account. The keyworker did what all experienced nursery workers and teachers do on meeting a new child – quickly appraise the child and the situation and engage them in some sort of play or social activity. This does not wait for a formal assessment. Within the first seconds or minutes, the child’s response is observed and the activity is adjusted as necessary. It seems highly likely that Anya could have started playing earlier if she had joined a playgroup or nursery, but there are very many reasons why parents of infants with significant challenges can delay or decline these opportunities. It is my experience that this sort of early childhood intervention, wherever it happens, can help bring the infant and the family out from the medical world into a more normal place with less restrictive assumptions, attitudes and activities. Anya’s new play activity lifted the whole family and raised their opinion and expectations of her – and I think perhaps of themselves as a family.
Note:This account is based on the appendix in the book 'Early Childhood Intervention without Tears' by Peter Limbrick
Keyworking Pilot Project in Wolverhampton, UK
This keyworking pilot project was established by Wolverhampton Local Education Authority and Wolverhampton Primary Care Trust for families who had a pre-school child with complex needs. The aim was to explore the benefits of supporting a sample of these families with the Team-Around-the-Child model with a Keyworker as TAC Team Leader.
When the evaluation of the pilot was designed, it was agreed that the perceptions of parents and other family members, and only those perceptions, would determine the value of the TAC approach. It was also agreed that parent approval would not be enough to carry the pilot forward into accepted practice for Wolverhampton.
The evaluation of the pilot project therefore had two parts:
The views of parents about the value of the TAC approach.
The views of practitioners and managers about how they felt about this way of working, how it impinged on the rest of their work, what support TAC Team Leaders needed and what additional resources were required.
Parents’ views were sought in structured interviews in their own homes. Practitioners gave their views in a questionnaire.
Both parents and practitioners spoke in positive terms and the project is now being extended to support more families. Practitioners, especially Keyworkers, highlighted time constraints and the need for clerical support. The following is a selection of parents’ comments. More information is available from Wolverhampton Early Years Service.
Parents’ comments about their Keyworker
‘I get on with her, I have got to know her as a friend and I can tell her my problems. She has a lot of experience with children and she knows how to deal with parents.’
‘I trust her.’
‘She has the most information about my child.’
‘She is a point of reference when you don’t know who to go to.’
‘She has been there at the lowest points, we have grown close.’
Parents’ comments about TAC meetings
‘I’ve got a great team to help me. I like the meetings and look forward to them.’
‘We all understand each other.’
‘Everybody gets to say what they want to say. We take turns to speak.’
‘I like them. I sometimes feel nervous about what they might say. They might tell me I am doing something wrong.’
‘Everybody gets together and shares information on my child’s development. This helps me to see the development.’
‘They all understand what I am going through.’
‘The meetings are informal. They are important because we discuss activities and agree the next goals.’
‘I am thrilled by the Keyworker project. It would have been valuable earlier... If there was a problem (in the first year) which affected everything about him we did not know whom to ask about it. It was not holistic. The first meeting was the most useful; we ironed out different approaches and agreed clear, consistent objectives…’
‘We have a meeting every three months at home. All the children are here. My Keyworker is really good at leading the meetings. They last 60 to 90 minutes.’
‘Doctors try to take control. TAC does not.’
‘I always say what I want and they listen to me. They ask me what, as a mum, I want my child to be doing. I get on with them all and we are open as friends. They do listen and help.’
‘My child has problems sleeping. She is up and down and then I usually get up with him at about five. I haven’t talked to my health visitor about this or told the TAC.’
Parents’ comments about the Family Support Plan and the learning goals
‘Yes, I got a report. My reading isn’t very good but I understand it.’
‘I get a written plan, I don’t know what it is called. I’m not sure where it is. It just says what was discussed so I don’t need it much. It has the same words as at the meeting. They are all sticking to the plan as much as they can (when my child is not ill).’
‘I get a report from the Keyworker. It is a summary with clear objectives. The Keyworker had even drawn hands to help get a point across! It is good to have something to refer back to.’
‘I understand the goals.’
‘I think they are the right goals, they make sense.’
‘I like the goals. They are the same goals as last time. I would like more progress.’
‘The goals are OK but I would like faster progress. Goals are physical now but I would like more on speech.’
Parents’ comments about support for the whole family
‘The team are here to help me and my child. My partner works a twelve-hour day. He has been to some appointments but he would like to be more involved.’
‘The team acknowledge that I have another child and they take that into account. He comes to some of the various sessions unless they say he shouldn’t. My Keyworker is mostly here for my child. My partner has met the Keyworker a few times and he gets on with her.’
‘We have had lots of support. TAC is for the whole family and it meets our needs.’
In the time since this evaluation was carried out Wolverhampton has been able to use the initial comments made by parents to reshape their thoughts and approach in their Team-Around-the-Child model.
Note: This account is taken from Part 2 of the book 'Early Support for Children with Complex Needs'
Halton Team Around the Child, UK
The system
Team Around the Child (TAC) in Halton provides enhanced Care Co-ordination, at the level of the family, for children with complex support needs 0 to 19 years, using a ‘key worker’ from within the professionals already involved. This role has been given the title of Team Around the Child (TAC) Facilitator.
Eligibility criteria
The acceptance range is from birth to 19 years.
Children with complex and/or multiple health, social or educational needs that are persistent and ongoing and affect the child’s functioning.
The child must receive, is eligible to receive or is about to receive specialist services from three or more disciplines from any agency, including the voluntary sector.
The child/family must live in Halton, or be registered with a Halton GP.
Families can refer themselves or be referred by any professional involved with the child/family, with their knowledge and consent.
Background
In the time before TAC there was recognition that, for many children, the services could and should be ‘more joined up’. Staff themselves wanted ‘to do better’. Some put time and effort into extra support for families where they felt a need. This was on an ad hoc basis and if that person left, families were back to square one. It often represented a special relationship between a family and professional. At worst this was well-meaning and genuine on behalf of the professional and, at best it gave the family positive help and a champion for their cause. However, nowhere in a professional’s role was this extra commitment recognised for the source of support it was to the family, or the added work-load it meant for the professional. In order to provide a reliable service a structure and mechanism had to be developed with commitment from all agencies at all levels.
The Early Support Pilot Programme (DfES) provided the funds to try out Team Around the Child in the form of a Project that ran from November 2002 to July 2003. The Project enabled development of training and support for the professionals in the use of TAC, alongside developing the scheme and supporting 13 families during that time. It is now open to a wider age band.
Team-Around-the-Child Facilitator role
The TAC Facilitator is identified by mutual agreement between the child and family and the professional. The role encompasses all elements of key working and a job/role description1 was developed to recognise this. The Team Facilitator:
provides a proactive contact point for families
operates within boundaries agreed with families (e.g. confidentiality)
gives emotional and practical support
researches information and enables action on behalf of/with families
is an advocate with a small ‘a’
liases/negotiates with other members of the child’s team to ensure action
is available to families (at least at the end of a telephone) when needed during regular working hours
TAC Assistant
The original Project bid to Early Support Pilot Programme contained a generic support worker (the TAC Assistant). The rationale was to enable practitioners to relinquish some of their own uni-professional work with families in order to gain some time to dedicate to the multi-disciplinary work of a TAC Facilitator. All families have welcomed the TAC Assistant role as it seems to plug a gap in services not provided elsewhere. Tasks include direct individual family support and indirect support such as support groups and assisting at delivery of group interventions led by a practitioner. Direct support to practitioners in terms of providing or assisting their interventions also features highly in the job profile. The remainder of the time is used for record-keeping, administrative support to TAC, training, and supervision sessions for herself. Further breakdown and investigation into the added value that families experience is currently ongoing.
Management
The Project was ‘mainstreamed’ with minimal recurrent available resources with some additional short-term funds (Sure Start and New Opportunities Fund) to maintain the scope of support to families.
A multi-agency Management Group, including parents, meets bi-monthly to oversee Halton TAC. There is a management lead from a senior clinician, a co-ordinator (now within the CDC Co-ordinator’s role, upgraded and with some time released), clerical support and the TAC Assistant. The personnel profile is as follows:
TAC Lead 0.1 WTE (Whole Time Equivalent)
Co-ordinator 0.3 WTE
Clerical Officer 0.3 WTE
TAC Assistant 1.0 WTE
Training
The rolling training package developed for the TAC Facilitators during the Project has been further developed and refined by use and by the feedback of participants of courses run so far. The training explores the background of care co-ordination and identifies the need, develops skills to pick up the issues from the parents’ perspectives, identifies the skills and attributes of a Team Facilitator, addresses the practicalities of working within Halton TAC (introduction to the system, the process and the personnel and ongoing support) and participants are encouraged to identify further training needs to help them to be effective TAC Facilitators. The TAC personnel, using a mixture of approaches including presentations, practical exercises, group work and discussions, deliver the package as a group effort. Following comments received from previous participants, it is now run over two half-days, each culminating in lunch to allow networking and further development of peer discussions generated during the training. A case scenario introduced during the first half-day links the two sessions. This scenario provides the basis of identifying the parents’ perspectives and is worked in, through the practical exercises, to joint goal planning at the end.
A bi-monthly peer support group meeting allows further sharing of experience and gives support to those using the TAC model and an opportunity for the TAC personnel to gather feedback from practice. Multi-disciplinary training monies have provided further in-depth training using external consultants to develop skills gaps identified by TAC Facilitators.
Evaluation and monitoring
The Process Flow Chart and associated audit tool provides easy evaluation of standards. The Sure Start contract monitoring forms for individual children/families gives us quantitative data with regards to time spent on TAC. There is some feedback gathered by the National Children’s Bureau as part of their independent evaluation of projects funded by DfES through ESPP. During the initial Project interviews were undertaken with families and professionals using TAC, and this gives a ‘taster’ of the impact TAC was having on them.
Future plans are for evaluation of the TAC Assistant role to include a parent questionnaire possibly through telephone interview, as well as an activity survey of the Assistant’s role to identify key support needs of families and how the Assistant fulfils them. The survey will also gather parents’ perspectives of the whole scheme and will be covered at the same time. Training is routinely evaluated using a standard feedback form and these have helped to ‘fine tune’ the package.
Barriers to Care Co-ordination
Despite care co-ordination featuring large in many recent government guidance documents, as well as many that reach far back into the past, it is still not fully funded. We have used the TAC model as a ‘low-budget’ option and have effected changes in working practice to re-invest time from individual interventions into TAC to provide a more co-ordinated service to families. The structure to support busy clinicians to use TAC will need ongoing resources throughout the disciplines and agencies.
The TAC Project identified the unexpected amount of time needed. Commissioners, managers or clinicians must not ignore this time element. It would be all too easy to drop TAC as ‘icing on the cake’ when many services are already hard pressed to even provide their ‘core’ bread-and-butter services. The commitment, to ‘go the extra mile’ for families, is inherent in many clinicians’ practice but the reality of constantly striving to ‘do more for less’ can be destructive. Substantial changes at senior and middle management levels could also be inhibitive to schemes like this, where a shared history of development and knowledge of TAC is suddenly lost, and where organisations are under severe financial restraints. The take-up of TAC training in education establishments has been slow, possibly due to tight timetables, however commitment to the principles of care co-ordination has been good.
The future for Halton
Locally TAC has been embraced at all levels of the agencies and features in the Children with Disabilities Strategy for Halton and the Child Development Centre Action Plan. It has been heartening to see the level of commitment from front-line workers to making things better for the families they work with. TAC now features in job roles and job descriptions in several disciplines. New recruits in any discipline are being introduced to TAC as an integral system in the procedures in Halton. The training package is running three times a year to mop up existing staff volunteers and to pick up new recruits in all disciplines and all agencies.
C. K. Superintendent Physiotherapist in Paediatrics and TAC Lead.
Pre-school Integration in Ethiopia - 2025
By Sahilu Baye Alemu, Founder & Director, Enrichment Center Ethiopia (ECE)
Over the past two decades, Ethiopia has witnessed a remarkable transformation in pre-school education evolving from a fragmented, largely private system into a more formalized and government-supported structure. Early Childhood Care and Education (ECCE), once overlooked in public policy and often treated as a private enterprise, has now gained recognition as a cornerstone for national development and social inclusion.
The introduction of the government-led O-Class program in 2010 marked a watershed moment in this journey. Designed as a one-year school readiness initiative for six-year-old children before entering Grade 1, O-Class was the first major step toward integrating early learning within Ethiopia’s formal education system. Implemented under the Education Sector Development Program (ESDP IV) and aligned with the country’s Growth and Transformation Plan (GTP I), the program aimed to improve school readiness, reduce repetition rates, and bridge early learning gaps. By 2012/13, approximately 26.1% of eligible children had access to pre-primary education—an impressive increase from 6.9% in 2009/10.
Despite these achievements, true integration of pre-school education remains a complex challenge in Ethiopia’s diverse and multicultural context. Integration means more than including children with disabilities; it involves addressing disparities between urban and rural areas, linguistic and cultural diversity, and socioeconomic inequalities. With over 80 ethnic groups and languages, Ethiopia’s diversity presents both opportunities and challenges in creating an inclusive early childhood system that reflects and respects its cultural richness.
A key issue is the uneven quality and accessibility of ECCE services across regions. Many rural O-Class centers face severe shortages of trained teachers, age-appropriate learning materials, and child-friendly environments. Government preschool teachers often receive only about ten months of pre-service training, while many private institutions provide even shorter courses. This limited preparation tends to promote academically driven teaching methods at the expense of holistic development, emotional well-being, and inclusive participation.
Ethiopia’s Education and Training Policy (1994) underscores the importance of all-round child development and mandates the use of local languages as mediums of instruction in pre-primary education. Yet, implementation remains inconsistent. Although the policy emphasizes continuous professional development and inclusive education, many teachers still feel ill-equipped to support children with special educational needs. Stigma, inadequate infrastructure, and lack of specialized support continue to exclude children with disabilities. Moreover, community perceptions often frame disability through traditional or spiritual lenses rather than educational ones, highlighting the need for culturally sensitive awareness programs and professional training that harmonizes local values with inclusive teaching strategies.
Integration should also be viewed through a social and cultural lens. In many Ethiopian communities, particularly rural ones, early learning begins at home through storytelling, songs, and shared routines rich indigenous practices that nurture social cohesion and cultural identity. However, these traditions are seldom integrated into formal curricula. Strengthening the home-school connection is therefore essential to ensure meaningful inclusion and to build curricula that honour children’s cultural backgrounds.
Several promising initiatives illustrate the potential of a holistic and integrated approach. Community-based childcare centers and NGO-supported programs that combine early stimulation, parental education, health, nutrition, and psychosocial support have shown success especially in disadvantaged areas affected by poverty or conflict. These models view parents and caregivers as primary educators and promote collaboration among teachers, health workers, and social service providers, advancing holistic child development.
Key Priorities for Advancing Pre-school Integration in Ethiopia
Strengthening Teacher Education and Support
Expand and enhance both pre-service and in-service training programs to emphasize child development, inclusive education, and culturally responsive, play-based pedagogy. Teachers must be empowered to nurture children’s emotional, social, and cognitive growth, rather than focusing solely on academic readiness.
Enhancing Community and Parental Engagement
Build strong partnerships with families, religious leaders, and local organizations to bridge traditional knowledge with modern educational practices. Drawing on Ethiopia’s rich heritage of storytelling, song, and communal child-rearing fosters relevance, identity, and sustainability.
Promoting Policy Coordination and Adequate Investment
Strengthen collaboration across the Ministries of Education, Health, and Women and Social Affairs. Coordinated policy implementation, sufficient funding, and consistent monitoring mechanisms are essential to improve service delivery and expand equitable access.
Curriculum Adaptation and Cultural Inclusion
Develop a flexible, inclusive curriculum that values indigenous languages, cultural stories, and play-based learning. Such approaches nurture identity, empathy, and belonging, ensuring early learning environments are meaningful for children from diverse backgrounds.
Ensuring Equitable Access and Resource Allocation
Prioritize underserved rural and marginalized communities. Every child regardless of geography, ability, or socioeconomic status deserves quality early learning opportunities. Sustained investment in infrastructure, materials, and child-friendly facilities must remain a national priority.
Ethiopia’s journey toward a fully integrated ECCE system is ongoing. The O-Class initiative and the subsequent ECCE Framework have established a solid policy foundation that recognizes early childhood development as a holistic, multisectoral endeavour encompassing education, health, and nutrition. Yet, persistent challenges (limited financial resources, uneven implementation, and shortages of qualified personnel) continue to impede progress.
Ultimately, pre-school integration in Ethiopia transcends the educational domain. It is a moral and societal commitment to nurture the whole child rooted in family, culture, and community. By weaving together traditional wisdom and modern pedagogy, Ethiopia can build an early childhood system that embodies inclusion, resilience, and hope for future generations. Strengthening ECCE today lays the foundation for human development, social cohesion, and sustainable national progress tomorrow.
Note: In this study, integration refers to the systemic alignment of Ethiopia’s early childhood education components including policy frameworks, curricula, teacher preparation, and community practices into a cohesive, equitable, and culturally responsive system. Inclusion, in contrast, denotes the provision of equitable opportunities for all children, regardless of ability, background, or circumstance, to participate fully and meaningfully in early learning environments.
Walsall Child Development Service
The Team-Around-the-Child Model
Walsall Child Development Services comprise a multi-disciplinary team of professional workers from Walslall (UK) Teaching Primary Care Trust, Education Walsall, Social Services (represented by NCH) and Walsall Resource Centre. We are currently developing an integrated multi-agency approach enabling ongoing focused child and family support using the Team-Around-the-Child model (TAC). The service is provided to children living within the Borough of Walsall who meet recognised criteria. Currently the service is provided for childrren from birth to five years, although our ultimate aim is for the service to develop the TAC model in order to provide a standard that can be pursued throughout Walsall for children and young adults 0 - 19 years of age.
We aim to assess and monitor the progress of children concerned, giving consideration to the important areas of care, education, advice and support, which significantly affect the child's developmental progress, while continually acknowledging and facilitating the parent's role in all provision. Early identification of the children and families who would benefit from the service is encouraged by the maintenace of a referral system that is easily accessible to all professional disciplines and to parents themselves. Quite often children may be referred as a result of concerns that have arisen when the child attends for routine surveillance in local health centres or problems may be identified when the child attends a local nursery or group.
The earlier standard model
Prior to moving towards a Team-Around-the-Child model of working Walsall Child Development Centre (WCDC) had followed a well-established medical standardised model of service. When children were initially referred to the Centre, they were usually required to attend for a medical appointment before they could be referred to other members of the team. This often resulted in unnecessary delays in receiving provision. In many instances it was considered appropriate for the child, accompanied by an adult carer, to attend for a two-week block assessment followed by a formal Case Conference.
This process may have met certain requirements and deadlines for professionals but it was often unnecessarily daunting for the families concerned.
How and why the project started
In many ways the groundwork for developing our particular model of Team Around the Child (TAC) was already established with the Child Development Centre at its hub. Team members had already set up effective systems of communication and liaison with other professionals working in various departments and networks with other community provision such as local Family Centres and Sure Start groups. This provided a continuity of services for the children and families concerned.
In June 2002 some of our team members attended a Handsel Trust conference regarding ‘Integrated Working Practices in Children’s Services’ held in Birmingham. This planted the seed. We became enthusiastic about the idea of moving towards establishing a Team-Around-the-Child model of working in Walsall. Later that year, in October 2002 we set aside three separate days in which to consider the possibility of change:
Day one - for parents
Day two - for all team members
Day three - for managers at a strategic level
Day one
The focus group of parents involved with these discussions highlighted their desire for more direct participation and control over the planning and decision-making stages, recognition of their expertise and the need for a Key Worker to guide them through the confusing terminology and processes.
Day two
The team members learned more about the Team-Around-the-Child model and considered the options available, including the viability of taking on a Key Worker role with their individual families in addition to their existing role. It was agreed that many of them already functioned as a Key Worker with the families concerned and the discussion was a means of recognising this and defining their practice more clearly.
Day three
In this facilitated group discussion the strategic managers of all the services involved welcomed with enthusiasm the principle idea of adopting the TAC model, as most participants were already convinced of the need to move towards more integrated working practices.
As a conclusion to these sessions we agreed to completely adapt our service provision towards the Team-Around-the-Child model of working, to place children and families at the centre of care and to include more recognition of the Key Worker status. A ‘Statement of Intent’ for children with complex needs was defined to rationalise the various groups that have a responsibility for children 0 – 19 years.
Starting out
In January 2003, having taken three months to write protocols and establish paperwork, we began, with a degree of trepidation, our initial Team-Around-the-Child Panel Meetings.
The Panel consists of practitioners from each discipline involved at an operational level, thereby including representation from health, education and social services. Gradually, as the word spread, we have been pleased to welcome other key representatives of complementary services onto the Panel. Because the Walsall project is relatively early in its evolution, the team have found it necessary to have regular planning meetings in order to continually formulate the process, to tailor it to the local area, to begin the process of audit and to meet ongoing training needs.
Planning meetings by necessity create additional deadlines, which may have to be squeezed into an already busy working schedule. We have been fortunate in having an Operational Group who have driven the project and been totally committed to this change.
The child’s journey
Our Panel meets on a weekly basis to consider all new children being referred to the service and to review the ongoing provision for children to meet their individual needs. Education Services and Speech and Language Therapy may already have had some involvement with the child. Referrals to the panel will have previously been discussed with their operational manager who is a member of the referral Panel. When a referral is received, the Specialist Health Visitor will screen the information for any presenting acute medical concerns that may need more urgent attention, whilst administrative staff collate the records. The child is then discussed at the Panel meeting to establish that the referral meets the recognised criteria for our involvement and to consider how best to proceed. The referral details usually direct the Panel in allocating the two services most relevant to the child for the Initial Assessment. The two Panel members carry out a home visit during which one team member discusses and documents the child/family story using a detailed Initial Assessment Form whilst the second team member engages in play with the child. Afterwards their initial findings are noted in the ‘Home Visiting Observation Record’.
In the past parents/carers have often complained of having to repeat their story to professionals. In our model, when the family are asked to provide their detailed story it is explained that they will not be required to repeat it all again when they subsequently meet other members of the team. The two members then report back to the Panel as formerly agreed and at this point allocation of appropriate services, medical follow-up and any other provision tailored to the individual child and family’s needs can be arranged.
Where the child is deemed to have more complex needs requiring two or more services to be involved in their care, the Panel appoints an immediate Team Around the Child consisting of other appropriate members from the wider team. One of the initial visiting professionals known to the family is appointed as Initial Co-ordinator.
The role of the Initial Co-ordinator
The Initial Co-ordinator’s role is to set up the first meeting of the Team Around the Child. Ideally this happens within 4 to 6 weeks to ensure the establishment of the team and to give the team members, one of whom will become the Key Worker, some initial support in establishing their relationship with the parent/carer and in gaining an understanding of the needs of the child. The Co-ordinator begins to prepare the Family Service Plan (FSP) with the family by exploring the needs of the child and the initial concerns of the family about the level and type of support they want from the team.
The Family Service Plan is based on the Early Support Pilot Programme (ESPP) Tool Kit. The Family Service Plan is owned by the family and contains their personal thoughts and feelings and includes information they require in a way that is considerate of their needs. It puts them at the centre of planning and delivery of the services.
At the initial review the plan is used to outline how the multi-agency team aim to work with the child and the family, and to establish the targets and aspirations they have for the child by providing information and practical support at a pace that is acceptable to the family. The venue for this meeting may be in the family home or any other venue chosen by the family so long as privacy can be ensured.
The team members strive to provide a relaxed, non-threatening atmosphere to reduce the risk of stress to the child and the family.
The Key Worker to be appointed must be approved by the family. At this stage, the Co-ordinator will pass over responsibilities to the appointed Key Worker.
The role of the Key Worker
The following points inform the role of the Key Worker:
Key Workers may be drawn from any of the disciplines involved with the family.
They aim to ensure the family continues to receive the type and level of support that is needed. Consideration is given to other family commitments, the needs of siblings, time limitations and whether the family would prefer their support to be provided at home or at other centres.
Parents should be treated as equal partners and have significant influence.
Some parents may choose to act as Key Worker for their own child and this progression would be encouraged.
The Key Worker is required to be aware of the network of social and family support that is available locally and nationally. They often access information from within the services or from existing information resources.
They need to be aware of cultural and religious aspects which may impact on the choices made by the family.
Walsall has a large ethnic minority group and it is often necessary to ensure that interpreters are available for assessments, medical appointments and Team-Around-the-Child reviews.
It may be necessary for the Key Worker to rationalise appointments for the family. Often at critical stages the parent/carer becomes overwhelmed by too many demands.
Key Workers assist the family by co-ordinating the work of all team members, ensuring that the family has a good understanding of both medical and education issues.
The Key Worker is expected to have a proactive rather than reactive style of working and, at the same time, to be aware of the limitations of their role. Key Workers are advised not to give difficult information alone and to refer to their mentor/line manager when situations become difficult to handle.
The Key Worker will co-ordinate review meetings with the wider team at which the Family Service Plan is updated. The Key Worker can call upon their mentor/line manager or another member of the team to take on a specific role at the review meeting, e.g. chairing or minute-taking.
They may need to ensure continuity of support for the family throughout periods of transition for the child. Eventually the Key Worker may reach a point where they no longer represent the lead agency or are no longer involved with the child. A new Key Worker will then be approved at a review meeting with the family.
A new Key Worker can also be appointed if the current one requests a replacement for reasons of incompatibility.
Training of practitioners
All practitioners involved in the changing process have accessed ongoing training and learning opportunities which advance their practice. The Operational Group (who make up the Panel) have arranged training days on a termly basis to involve the wider team in all of the new developments and to further the knowledge and awareness of Key Workers. These have taken the form of presentations by local/national support services, including:
Sure Start
Home Start
NCH Project, Walsall
The Benefits Agency
The Citizens Advice Bureau
The Family Fund
In addition, team members have participated in multi-disciplinary awareness training on the following topics:
Policies and procedures
Group work—roles and responsibilities
Chairing and minute-taking—guidelines
All participants were armed with their ‘A to Z of Key Working’—a handbook of useful information explaining the role of the Key Worker and containing valuable local and national information pertinent to the role and a ‘Protocol for Team Around the Child’ which aims to share information and formulate principles involved.
Management and funding
The Operational Group launched the change to Team Around the Child with the encouragement of strategic management but without the benefit of any additional resources. It has become evident that in order to move forward it is essential to have a Strategic Management Team for the Team Around the Child to which the Operational Group reports on a three-monthly basis. This helps steer the change to multi-agency strategic planning for Team Around the Child. One particular aim is to develop service provision beyond that currently available for children under five years of age.
The Strategic Management Group has recently been established with agreed terms of reference. The Groups consists of one key representative from each agency involved. It will steer the team providing clarity on local and national policy and current developments and will represent Walsall CDC Team-Around-the-Child service at a local planning level.
Monitoring and evaluating the change
In truth we are at a very early stage in the process of auditing and evaluating the change. Practitioners have collaborated to offer training and support to others working in locality. We are currently exploring the ESPP multi-agency evaluation tool for qualitative evaluation whilst providing an information technology audit to track the process and numbers of children moving through the service.
Waiting lists for initial discussions, initial assessment, physiotherapy and detailed assessment are all significantly reduced.
Aims and values which reflect a shared vision of a family centred service are now agreed. Services have joined together to agree clear policies for an integrated referral process including a single point of entry and a multi-agency referral panel.
A Parent Focus Group is being established to monitor parental views and gather user involvement news regarding information and services.
All new referrals are presented at the Panel within seven days. This means children and families have earlier access to support services and dates are agreed for reporting back to the Panel and the establishment of Team Around the Child.
Article by Members of Walsall CDC Team-Around-the-Child Service
Note: There are two diagrams accompanying the original article. Let me know if you would like to see them - peter.limbrick@mailfence.com
Essex (UK) Holistic Planning Model
In Essex, a group of professionals from Education, Health and Social Care met to discuss the future provision for children with complex needs. Their prime concern was how services should plan together a way forward which would offer children and young people with disabilities and their families a seamless and co-ordinated service. A pilot project was initiated and through tripartite funding from Education, Health and Social Care a project co-ordinator’s post was established in 2001.
There were two special school sites dedicated to pilot the project. The children were aged between three and nineteen years old, and their needs ranged from having severe to moderate learning disabilities (with and without profound physical impairment), severe autism spectrum disorders and complex medical conditions.
The purpose of the project was to work towards setting up multi-agency resource centres that would bring together education, health and social services and the voluntary agencies, to provide integrated and holistic support for children and their families.
A county multi-agency steering group provided the strategic direction with representation from all the statutory and key voluntary agencies, and included parent representation. Local steering groups, whose multi-agency membership mirrored thatof the county steering group, developed the operational practices and designed the holistic planning model.
The framework offers the opportunity to deliver more co-ordinated services and address the needs of the family collaboratively.
During the project most aspects of the holistic planning model were piloted, evaluated and refined. The evaluation also sought to clarify current and preferred working practices and this information had an influence on the development of the model.
The Holistic Planning Model
The holistic planning model supports the person-centred approach to child and family focused planning, the Team Around the Child concept, the role of the key worker and the preparation of one plan for the child and family. It provides the structure for joined-up planning and working practices.
It has key elements that include:
Placing the child and family in the centre of all planning
Developing the Team Around the Child concept
Providing a process for joined-up planning
Establishing the shared goals
Addressing the shared goals or next steps
Establishing one holistic plan
Designing a role for a ‘key worker’ and a ‘lead practitioner’
1. Placing the child and family in the centre of all planning
The child and family are placed at the centre of the planning and, with the identified Team Around the Child, develop shared goals or next steps. These give the strategic direction to all planning.
2. Developing the Team-Around-the-Child concept
The different disciplines and agencies work together as the Team Around the Child. Families and practitioners identify this team and clarify who is part of the ‘close’ or ‘extended’ team. The ‘close’ team is defined as those most involved with the child and their family. This distinction between the two is important. Identifying who is directly involved and then the links with the extended team make good use of resources when planning or reviewing. For children with complex healthcare needs, the school nurse or children’s community nurses could be ‘close’ members whilst the paediatrician or specialist at a tertiary centre may be identified as members of the ‘extended’ team. Alternatively, the specialist teacher for children with visual impairment could be a member of the ‘extended’ team whilst the child’s teacher is a member of the ‘close’ team. Each family will have a different Team Around their Child to match their individual needs. Some teams may be very small, just two or three people including the family, whilst others may be larger and represent the greater number of people who are directly involved. The Team Around the Child will change as the child’s situationalters and some members may move between the close team and the extended team depending on their role and the need for their more direct or indirect involvement.
3. Providing a process for joined up planning
The opportunity for a joined-up planning meeting is key to holistic planning and crucial for effective communication. This part of the process brings together the ‘close’ Team Around the Child, including the child and family. The purpose of the meeting is to establish shared goals or next steps and identify actions. Actions also include agreeing a date for when the plans are to be reviewed. The meetings are scheduled to take approximately forty minutes and require good chairmanship and clarity of purpose. Families have the opportunity for support from the ‘key worker’ or ‘lead practitioner’ during this process.
4. Establishing the shared goals
Families and children and the Team Around the Child share their own goals or next steps with each other at the joined-up planning meeting and the discussion results in shared goals being established and agreed. The Team Around the Child works together to identify how they will contribute to each shared goal or next steps and what actions need to be taken. The different agencies and services will have varying priorities but all the shared goals are addressed.
The shared goals are key to holistic planning. They should give the directional lead to planning. They belong to the family and the Team Around the Child and are not service or discipline specific.
5. Addressing the shared goals or next steps
Many of the shared goals will require the acquisition of key skills that may be addressed in smaller steps. An example of this could be ‘Lucy to be able to make herself understood to those who do not know her’. This is a shared goal that probably requires the acquisition of smaller targets towards effective communication that can be addressed in part through the child’s learning plan, and as an integral aspect of the curriculum. The strategies to support the achievement of many of the shared goals may involve several disciplines, agencies and settings. There may be a need for joined-up assessments. For some goals the emphasis may be on actions as well as key skill development. The Team Around the Child will have different priorities relating to each shared goal. They will also have the opportunity to share the responsibility for their acquisition. The goals or next steps can be revised at each planned review meeting.
6. Establishing one holistic plan
The one holistic plan is called the ‘Unified Plan’. This should be considered a working document, accessible to everyone supporting the child and available to all settings. It is written following the joined-up planning meeting as the shared goals and agreed actions are crucial to its preparation. The child’s Unified Plan should be central to the planning for all Statutory Reviews. The family, including the child, agrees to the Unified Plan being shared with all involved in its implementation.
Key features of the Unified Plan include:
The introduction of the child through a pen portrait. Families and children, with support from the Team Around the Child, prepare this in language that encapsulates the perspective of the child.
The shared goals or next steps for the family and the Team Around the Child are clearly expressed, and there is evidence that they are central to the direction of the planning. They are written in common, jargon-free language.
The key skills to support the acquisition of the shared goals are identified in the learning plan. This is essential to support the child’s learning opportunity and ensure their curriculum entitlement. There should be shared recording mechanisms to enable the Team Around the Child to record progress and identify successful learning outcomes.
For some children there may also be:
A quick reference guide that highlights behaviour that should be encouraged or discouraged, written from the child’s perspective.
A communication guide that interprets the meaning of the child’s communication, written from the child’s perspective.
Practical support plans to facilitate learning, positive behaviour and leisure activities.
Practical support arrangements with an emphasis on the social care aspects to support the family through practical assistance.
7. Designing a role for a ‘key worker’ and a ‘lead practitioner’
There is a need for a designated support worker or ‘key worker’ whose dedicated role is to support the child and their family at home, school and in the community through the implementation of the plan. There is also another role described as a ‘lead practitioner’ or ‘plan co-ordinator’. The Unified Plan should be co-ordinated by one key professional as identified by the Team Around the Child, the child and their family. This person may be from any of the agencies involved and should be identified from the Team Around the Child. Within the school setting, the plan co-ordinator may be a teacher. However, this should not be assumed and may need reconsidering, especially during the school holidays, or if another professional has a significant role in the child’s life. Parents and children are involved in this decision-making process.
The holistic planning model is based on the principle of placing the child and family at the centre of all planning, the concept of the Team Around the Child, the one holistic plan and a designated person within that team whose role is to support the co-ordination of the plan. The model should be considered to be cyclic with implementation and review being integral aspects.
What makes it possible is the idea of the shared goals or next steps. They give the Team Around the Child a common denominator from which to work and each team member has the opportunity to use their specific skill and knowledge base to support the achievements of the various shared goals or next steps. The model also supports avery effective and efficient means of communication through the joined-up planning meetings.
Recent feedback from the Teams Around the Children is encouraging. The feedback included the following:
Health and social care staff reported they felt:
their contributions were more accepted
the process was beneficial and good use of time
it resulted in joined-up planning around common themes / shared goals
Families reported they felt:
listened to
the plan was more meaningful
pleased with the attendance and contribution of the Team Around the Child
involved with the planning
it made the annual review process more relevant
Teachers reported they felt:
they learned a great deal from the Team Around the Child,
the resulting unified plan was more appropriate to supporting the child’s needs
Essex Children and Young People’s Service and Health Services within Essex continue to sign up to this model. This ensures joined-up working practices continue using existing resources. The holistic planning model is being adopted by other special schools across Essex as they work towards becoming multi-agency resource centres, or New Model Special Schools, for children and young people with disabilities.
Acknowledgements
The MARC project would like to acknowledge and thank the school staff, parents and children involved in the two project sites. Their participation and feedback has been much valued and has influenced the design of the holistic planning model. The project would also like to acknowledge the time and commitment of all those involved in the county and local multi-agency steering groups. Their contribution, wisdom and enthusiasm have resulted in the development of the holistic planning model and all its supporting processes.
By L. F. Paediatric Physiotherapist, Clinical Specialist, Multi Agency Resource Centre Project Co- ordinator
Note: The two diagrams with the original article are vailable if you want to see them - peter.limbrick@mailfence.com