Supporting Service-Led Innovation: The First Steps Collaboration

Supporting Service-Led Innovation: The First Steps Collaboration

System-wide change in Children and Young People’s Neurodiversity services

Across neurodevelopmental teams, a growing movement is looking at the use of collaborative, and network-based, models of working to facilitate transformation across neurodiversity services. This transformation includes strengthening support within community settings, in order to deliver care which is not dependent on diagnosis and, instead, improves understanding of children’s needs by designing services with child-centred outcomes in mind.

Nationally and regionally, there are emerging examples of innovation that support a new way of working. These can be used to inform the development of neurodiversity services in the South West. The First Steps Collaboration is an example of the ways in which service-led innovations can help to make a change to the ways that services are structured and delivered through strengthening joint-working and supporting development of a network-based approach to care.

Identifying and spreading innovation practice for service-led innovation

The First Steps Collaboration is a pilot based in Torbay and South Devon NHS Trust which aims to create a common neurodiversity pathway for Children and Young People. The approach helps move towards a child-centred and needs-led approach, which facilitates joint-working and links agencies together to ask the question: ‘what does this child need in order to thrive?’.

The South West AHSN has been supporting the First Steps approach as part of its focus on identifying and spreading innovation practice across the region. Part of this work centres on building capability, a body of work designed to enable local health and care systems to build the culture and capabilities vital to the adoption, spread and development of crucial innovations across our region. Another core part of this work focuses on evaluation and learning, which involves using our experience evaluating improvements and testing innovation to support partners to evaluate the impact of changes and capture learning.

The South West AHSN supports the development of clinically-led innovation, based on an evidenced need, or a defined service gap, to nurture change within the system in order to achieve relevant and sustainable transformation.

Nurturing service transformation

The First Steps team had evidenced a need for change through a service-led pilot, which the South West AHSN were invited to listen and learn from. In October 2021, the First Steps team were invited to attend Spread Academy, a cross-regional innovation training programme, which helped the First Steps Collaboration to form as a team and to continue to innovate to address their defined service gap. Working with the South West AHSN, the team identified methods for spreading and implementing a shared vision for joint-working in order to enable the development of an effective referral and care pathway for under-fives referred for a neurodiversity assessment.

Following this, the First Steps team were invited to present at an innovation showcase event. The South West AHSN also co-hosted a First Steps Collaboration launch event to mark a key milestone in the development of service-led quality improvement, and to support decision-making to embed joined-up and child-centred assessment for children.

Thank you to all of you, from the bottom of my heart. It is a real pleasure to be part of this team – I feel like we can achieve things together that will really make a difference to children and families.” – Dr Lisa Teoh, Community Paediatrician at Torbay and South Devon NHS Foundation Trust


Service challenges identified

The neurodiversity pathway, provided by the community paediatric service in Torbay and South Devon NHS Trust (TSD), currently receives a large number of weekly referrals which come in across several different routes, including primary care, early years teams and school nurses.

The waiting lists cause a delay in getting the support children and families need, and limit the ability of healthcare professionals, within the community setting, to give identified support as early as possible. The need to support children and families’ needs as early as possible must be addressed as part of system-wide change. This will help to evolve a collaborative, network-based model of care which focuses on rapid recognition and response, with long-term and needs-based support.

The First Steps Collaboration initiative

To address the need for rapid recognition and response, the First Steps team devised a patient handbook, which was used to form part of the pilot study in 2020. The tools outlined within the handbook offered both the family, and professionals working with them, a framework – and clear signposting – designed to equip them with the knowledge and skills to support their child from day one. The First Steps team established joint-working clinics and monthly drop-in sessions, designed to bring professionals together at a child’s first appointment to streamline the assessment process.

  • The First Steps pilot has had an immediate impact on patients and families, and has supported a momentum for change across health and social care partners in Torbay and Devon. 50% of patients found the information in the handbook helped them to understand their child more, and 93% of professionals intended to share it in appointments.
  • Children and their families waited an average of 1-2 months for a diagnosis, after receiving the handbook.

The ultimate aim of the Collaboration is to empower families to understand, describe and support their child’s needs from the start. Additionally, the Collaboration has a focus on empowering health care professionals throughout the process and journey of care to support the child and family in the appropriate setting.

Both the handbook and the joint-working clinics formed a pilot which helped to evidence the need and momentum for change. All professionals involved found the joint approach:

  • Helpful to assess children more effectively.
  • Increased diagnosis within the first appointment.
  • Avoided unnecessary onward referrals.
  • Reduced time from being sent the handbook to receiving a diagnosis.

South West AHSN engagement and evaluation support

Engagement of health and care systems has been an integral part of the First Steps pilot. Led by the First Steps Collaboration, the South West AHSN has supported the team to engage stakeholders across primary, secondary and community care; social care partners within school and local authority settings; as well as management teams.

In addition to part-funding the handbook, in April 2022, the First Steps team and the South West AHSN co-hosted a launch event to bring together stakeholders from across the South West, in order to discuss pilot findings and agree consensus for joint working.

The team:

  • Engaged over 200 regional stakeholders in the run-up to the launch event.
  • Hosted over 100 community stakeholders at the launch event, either in-person or online.
  • Gained ICS, CCG and CFHD commitments to support the First Steps pilot as a test for change across systems.

Following on from the event, 74% of stakeholders felt confident and committed to integrating First Steps as a way of working with families and children.

The South West AHSN is continuing to support the First Steps initiative with foundations for evaluation and learning. This will be delivered through the design and development of a ‘Theory of Change’ approach which will:

  • ensure that the initiative has strong evaluation foundations that enable system thinking at the design phase, and opportunities for a test and learn approach.
  • capture current contextual insights about the system, mechanisms, enablers, and barriers at this design phase; and
  • offer support and advice on the most appropriate and robust methods for evaluating the impact.

Crucially, any work that is done at a service-level must support wider system change strategy, which is a lens that will be adopted for support going forward to support children and families to access timely needs-based support across the region.

Find out more

The South West AHSN, in collaboration with the West of England AHSN, are creating a space for innovation to develop, in a secretariat role of a Community of Practice, bringing together clinicians to develop approaches and form consensus on how change can happen across the system.

If you are a healthcare professional and would like to receive more information regarding a case study, and tools that support engagement around service change please contact

  • Building capability: If you’re interested in learning more about how the South West AHSN can support you to build the capability to make positive and impactful change across health and care systems, please visit our building capability webpages.
  • Evaluation and learning: If you would like more information on the ways that we support partners to evaluate impact and apply evidence and learning to improve the delivery of a wide range of services, please visit our evaluation and learning webpages.
  • Innovation exchange: Please visit our Innovation Exchange webpages to find out more about the support that we offer to innovators looking to spread and scale their innovations across the South West.

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