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Right Decision Service newsletter: October 2024

Welcome to the Right Decision Service (RDS) newsletter for October 2024.

1.Contingency arrangements for RDS outages

Development of the contingency solutions to maximise RDS resilience and minimise risk of future outages is in progress, aiming for completion by Christmas. As a reminder, these contingency arrangements  are:

  • Optimising mobile app build process
  • Mobile app always to be downloadable.
  • Serialising builds to mobile app; separate mobile app build from other editorial and end-user processes
  • Load balancing – provides failover (also enables separation of editorial processes from other processes to improve performance.)

 

In the meantime, a gentle reminder to encourage users to download essential clinical toolkits to their mobile devices so that there is an offline version always available.

 

2. New deployment with improvements.

A new scheduled deployment with minor improvements drawn from support tickets, externally funded projects, information related to outages, and feature requests will take place in early December. Key improvements planned are:

  • Deep-linking to individual toolkits within the RDS mobile app. Each toolkit will now have its own direct URL and QR code, both accessible from the app. These can be used to download the toolkit directly where users already have the RDS app installed. If the user does not yet have the RDS app installed, they will be taken to the app store to install the app and immediately afterwards the toolkit will automatically open and download. Note that this will go live a few days later than the improvements below due to the need to link up the mobile front end to the changes in the content management system.
  • Introducing an Announcement Header field to replace the hardcoded "Announcements and latest updates" text. This will enable users to see at a glance the focus of new announcements.
  • Automated daily emptying of the recycling bin (with a 30 day rolling grace period)  in the content management system. A bug preventing complete emptying of the recycling bin contributed to one of the outages earlier this year.
  • Supporting multiple passcodes (ticket 6079)
  • Expanding accordion section to show location of a search result rather than requiring user coming from a search result to manually open all sections and search again for the term.
  • Displaying first accordion section Content text as a snippet on the search results page as a fallback if default/main content is not provided
  • Displaying the context of each search result in the form of a link to the relevant parent tool/section. This will help users to choose which search result is most likely to be appropriate for their needs.
  • As part of release of the new national benzodiazepine quality prescribing guidance toolkit sponsored by Scottish Government Effective Prescribing and Therapeutics, a digital tool to support creation of benzodiazepine tapering/withdrawal schedules.

We are also seeking approval to use the NHS Scotland logo and title for the RDS app on the app stores to help with audience engagement and clarity around the provenance of RDS.

3. RDS Search, Browse and Archive/Version control enhancements

We are still hopeful that user acceptance testing for at least the Search and browse enhancements can take place before Christmas. Thank you for your patience and understanding in waiting for these improvements. Timescales have been pushed back by old app migration challenges, work to address outages, and most recently implementing the contingency arrangements.

4. Support tickets

We are aware that there continue to be some issues around a number of RDS support tickets, in part due to constraints around visibility for the RDS team of the tickets in the existing  support portal. We are investigating the potential to move to a new support ticket requesting system from early in the new year. We will organise the proposed webinar around support ticket processes once we have confirmed the way forward with the system.

Table formatting

There is a known issue with alterations in formatting of some RDS tables which seems to have arisen as a result of the 17 October deployment. Tactuum is working on a fix and on implementing additional regression testing to prevent this issue recurring.

5. New RDS toolkits

Recently launched toolkits include:

NHS Lothian Infectious Diseases

Scottish Health Technologies Group – Technology Assessment recommendations

NHS Tayside Anaesthetics and Critical Care projects – an innovative toolkit which uses PowerAutomate to manage review and response to proposals for improvement projects.

If you would like to promote one of your new toolkits through this newsletter, please contact ann.wales3@nhs.scot

A number of toolkits are expected to go live before Christmas, including:

  • Focus on dementia
  • Highland Council Getting it Right for Every Child
  • Dumfries and Galloway Adult Support and Protection procedures
  • National Waiting Well toolkit
  • Fertility Scotland National Network
  • NHS Lothian postural care for care homes

6.Sign up to RDS Editors Teams channel

We have had a good response to the recent invitation to sign up to the new Teams channel for RDS editors. This provides a forum for editors to share learning, ideas and questions and we hope to hold regular webinars on topics of interest.  The RDS team is in the process of joining participants to the channel and we’d encourage all editors to take part, using the registration form – available in Providers section of the RDS Learning and Support area.

 

7. Evaluation projects

The RDS team has worked with colleagues in NHS Grampian and the Digital Health & Care Innovation Centre to evaluate the impact of the Prevent the progress of diabetes web and mobile app in a small-scale pilot project. This app provides access to local and national resources and services targeted at people with prediabetes, a history of gestational diabetes, or candidates for remission. After just 8 weeks of using the app, 94% of patients reported increased their knowledge and understanding of diabetes, and 88% said it had increased their confidence and motivation to make lifestyle changes, highlighting specific behaviour changes. The learning from this project is informing development of a service model based on tailored support for patient groups with, high, medium and low digital self-efficacy.

Please contact ann.wales3@nhs.scot if you would like to know more about this project.

  1. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 29th November 3-4 pm
  • Thursday 5 December 3.30 -4.30 pm

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

The Right Decision Service:  the national decision support platform for Scotland’s health and care

Website: https://rightdecisions.scot.nhs.uk    Mobile app download:  Apple  Android

 

 

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Typical development 0 - 5 years old

Each child will be different and may not present as their chronological age because of past experiences or additional needs. (8) Therefore, you may need to use language and resources from other age/stage sections of this toolkit.

  • Children’s sexual development starts at birth.​ Babies are discovering their own bodies. They often touch themselves, sometimes their genitals, too. This happens by chance rather than intentionally.
  • Toddlers are becoming aware of themselves and their bodies. They also learn that they look different from other children and adults (they develop their identity). 
  • Children aged 2-4yrs learn that they are boys or girls (they develop their gender identity). 
  • Children start to pick up messages from the world around them about gender stereotypes; that some toys, clothes, behaviours and jobs are for boys and some are for girls. 
  • They become very interested in their own body and those of people around them. Often, they study their own body and genitalia in detail and sometimes show them to other children and adults.They start deliberately touching their genitals because it makes them feel good. 

See also: WHO guidance (1)

Support and learning required from carers and staff

All children need help from adults to distinguish between appropriate and inappropriate behaviour. Past trauma may mean that a child or young person displays inappropriate and sometimes sexualised behaviour. Be clear with everyone in the house or care setting about what is acceptable and about the need for personal privacy. (8)

At this stage, there is a lot of personal care involved in looking after children and this provides daily opportunities to teach social rules that are protective. You will already be experienced at teaching other social rules, for example saying ‘please’ and ‘thank you’ teaching children to take turns in games, how to eat meals together, share toys etc. 

Children aged 2-4yrs exploring their bodies and being interested in other children’s bodies is typical behaviour, but they need to be taught protective social rules about this: 

  • "We don't show each other our pants or what's inside them because that’s private” The NSPCC Pants Campaign made this video to help explain this to young children - The Pantosaurus Song (duration 2 minutes 30):

 

  • "You don't touch/rub that part of your body in front of other people"  
  • “You don’t touch someone else’s penis/vulva or bottom and no-one should touch yours”. There will be situations when this will be required e.g. helping to wipe clean after using the toilet or as part of a medical examination. It’s important that we teach children that these are exceptions. This story book is a helpful way to get this across - Your body belongs to you by Cornelia Spelman (duration 3 minutes 03):

  • Children need to be taught the accurate names for the private parts of their body – penis or vulva and bottom. They may use a range of other words e.g. flower, wee man etc. It’s ok if they use these, as long as they are also taught the correct words. 
  • Staff and carers should demonstrate that they respect children's right to ownership/ autonomy of their body. As with teaching social rules, this can done as part of everyday situations, for example, saying goodbye at nursery, asking ‘would you like a hug?’ instead of automatically hugging them.  
  • Children need adults to help them learn how to assert and articulate their right​ to bodily autonomy. For example, if another child picks them up or hugs them without asking, the adult can intervene: ‘I’m not sure that x wanted to be picked up/a hug. You need to ask them first’ This short video explains it well - Consent for kids (duration 2 minutes 43):

 

 

Gender stereotyping

Gender stereotyping can limit children’s expectations for themselves and they need the adults in their lives to challenge this. It is important that staff and carers help them learn that girls and boys are not limited by their gender. This can be done as part of day to day care by encouraging children to play with a range of toys, dressing up outfits etc and sharing stories about people that challenge gender stereotypes.

This video shows the impact of gender stereotypes on children’s ideas - Redraw the Balance (duration 2 minutes 07):

 

 

 

 

This story book, William's doll by Charlotte Zolotow, is about a boy who wants a doll (duration 5 minutes 58):

 

Brain development

Children will benefit from activities that help brain development, both at this stage and as a part of laying the foundations for adolescent brain development. This video from the NSPCC - Building a strong brain architecture - is a helpful overview (duration 3 minutes 12):

 

What children should be learning at school and how to back it up at home

Children attending Early Years services/nursery should be benefitting from the Early Protective Messages approach used by staff. This approach promotes gender equality, bodily autonomy and child protection through situational learning/teachable moments. Workshops for kinship carers and foster carers are also available to help build this approach into day to day care.

All children in Scotland should be getting Relationships Sexual Health and Parenthood (RSHP) lessons at school as part of the Health and Wellbeing curriculum. Individual schools can choose what resources to use but most will now use Go to website: rshp.scot, as it is the most up to date resource. All the content on this website is available for anyone to view and use.

These links take you to an overview of what children are learning at school and what you can do in the home setting to back this up.

Go to website: Early Level information from rshp.scot

Go to website: Information from rshp.scot 

Behaviours that are not developmentally typical and how to respond

This tool has been developed by Stop it Now for parents, but is suitable for carers and staff to use. It describes behaviours that are developmentally expected and behaviours that are not healthy or safe.

Carers who are concerned about a child’s behaviour should share their concerns with the team around the child as a first action.

Staff should refer to their locality guidance and protocols.

Stop It Now traffic light tool for under 5s