Transcript Families First and Team around the Family Building on Team
Commissioning Services for Children and Families – How to Move Forward Positively?
9th July 2012
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Institute of Public Care
For well led, evidence-informed public care.
Oxford Brookes University.
Social care, health, education, youth offending, housing Analysis, implementation and development.
Performance management, commissioning, managing practice quality and change.
Central, regional and local government, NHS, private and voluntary sector.
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Our Recent Work
Early Intervention and Prevention Projects (including Families First Wales) Materials for commissioners (for CIB):
SEN Market Facilitation
Complex Needs
Looked After Children Deep dive reviews of services for Children in Need / Children on the Edge of Care / Care Leavers National Market Analysis Centre National Learning Framework for Joint Commissioning (Scotland) Evaluations of national VCSE Programmes
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Our Recent Work
National Project to exploring the potential for integration of adults and children’s social care assessments and eligibility (Wales) Development of Health and Wellbeing Boards Regional networks of commissioners IT systems development including for intelligence sharing sharing across regions Team Manager Development Programme Bespoke Development Programmes , short courses and contributions to regional succession planning programmes
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National Context
Cuts affecting most public services Reduction in ring fenced budgets and control from the centre (localism) Delegation of budgets for some EIP services away from LA (e.g. to schools) Unclear arrangements for commissioning community health services (CCGs) AND local government re-organisation (e.g. People Services) Increased demand for care services Some ongoing national programmes e.g. Community Budgets + Children’s Centres + Troubled Families Reduction in national infrastructure support e.g. CWDC
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Open Public Services ‘We are opening public services because we believe that giving people more control over the public services they receive, and opening up the delivery of those services to new providers, will lead to better public services for all’.
‘…wherever possible, public services should be open to a range of providers competing to offer a better service…..’
Open Public Services White Paper, HMG July 2011
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Impact Less
National Direction Money Overall Single Agency Provision
More
Local Choice Money for some areas eg TF / Complex needs Opportunities for Providers to deliver and innovate Service Fragmentation 8
In this context, important to continue to think about
Best use of the total resource to meet local needs Applying this in a concerted way with partners around the key areas of overlap or interest Being evidence based - applying what we know works to commissioning practice Key agencies’ leadership roles relating to EIP (even where not delivering services) Market facilitation and support (even where not delivering services)
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What is Market Facilitation?
‘Based on a good understanding of need and demand, market facilitation is the process by which commissioners work with providers and other stakeholders to ensure there is sufficient appropriate provision available at the right price to meet needs and deliver effective outcomes, both now and in the future' IPC 2009
working with enabling influencing stimulating brokering
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How does the challenge feel in practice?
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Spectrum of activities
Capturing & Sharing Market Intelligence Structuring the Market Intervening in the Market
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Specifically what?
Market Intelligence
Intelligence gathering & sharing Advice Encouragement
Structuring
Whole system support Brokerage Workforce Development Seed funding / Small Grants Business Support
Intervening
Contracts (inc PBR) SLAs / Target Setting Performance Management / Quality Assurance activity 13
Market Facilitation - at what level?
National Regional Local
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What might determine your approach?
Extent of knowledge about the market Aims – what are you trying to achieve + with whom?
Market conditions, for example:
Stable
Underdeveloped Sufficient / insufficient community involvement Risks Service quality (good or bad)
Accepting of or resistant to change Relationship with providers and between providers Costs of the market facilitation activity or whether you can tailor the activity to make it cost effective?
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Worked Example 1: Fostering
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Market factors to bear in mind include
Huge increased demand National shortage of family placements Huge range of need from ‘mainstream’ to specialist and for different ages, sib groups etc Usually gaps in all areas Mixed market is established but still a large proportion of looked after children fostered via the local authority family placement service Recent reports emphasise local authorities are still under-performing in the recruitment of foster carers
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Market facilitation to address this issue might include:
Intelligence gathering
(e.g. Process mapping recruitment and analysing performance at each stage) Comparing this with research and best practice (e.g. Fostering Network publications)
Intelligence sharing
(e.g. With family placement team and other stakeholders)
Re-design of the pathway
to make it more robust and fit for purpose
SLA with family placement service
in relation to some if not all types of placements
Tight performance monitoring
of in-house as well as IFA services (including performance around recruitment + retention) 18
Other activities likely to be helpful?
Market Intelligence
Intelligence gathering & sharing Advice Encouragement
Structuring
Whole system support
Brokerage
Workforce Development Seed funding / Small Grants Business Support
Intervening
Contracts (inc PBR) SLAs / Target Setting Performance Management / Quality Assurance activity 19
Worked Example 2 - EIP
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EIP with Families
‘Intervening early and as soon as possible to tackle problems emerging for children, young people and their families or with a population most at risk of developing problems’
C4EO: Early intervention and prevention in the context of integrated services: evidence from C4EO and Narrowing the Gap reviews (2010)
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Market – related factors to bear in mind include
Demand still high but less money to play with overall?
Less money for EIP services in later childhood, more for EIP in early childhood More emphasis on improving higher tier interventions e.g. with troubled families Increased fragmentation of the market But some ‘steady players’ e.g. Health Visitors, YOS Some ‘unusual suspects’ or ‘outside players’ could make a big difference Different perspectives of different players including ‘expect some resistance’
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1 2
Increasingly national discourse has settled around the ‘middle bit’
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What works?
Services Systems
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Similarities between effective intervention at Tiers 2 and 3
2 3
Multi disciplinary Team around the Child / Family Effective engagement of families Key Worker Whole family approaches Strengths-based Focus on improvements in parenting Evidence-based interventions
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Additional key factors at Tier 3
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More intensive interventions (but still with broader base of multi-disciplinary support) Longer period of intervention usually required (12 18 months) Assertive, persistent Key Workers with lower case loads
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Whole System Support
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Typical elements are:
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The Key Finding from Research?
Initiatives seeking to integrate all elements of the whole system (CAF):
Common / whole family assessment Lead professional TAC/TAF model and meetings (and evidence based services wrapped round as a result)
Action planning and reviews for individual families are more likely to embed successfully and secure better outcomes than projects that concentrate on only one or two of these elements.
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Recent research on cost effectiveness
Recent research by the Local Authority Research Consortium (March 2012) has confirmed that:
CAF/TAF arrangements are leading to better outcomes (particularly where combined with specific evidence-based programmes shown to be effective with vulnerable children and families)
In response to a whole range of needs, from early prevention to higher level (falling just short of the threshold for specialist services) Savings of between £5,000 and £450,000 have been reported (80 case sample) Most CAF processes cost under £3K (more complex cases up to £8K)
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More on the impact of TAF - style systems
Use of holistic assessment has been helpful in supporting accurate identification of needs.
These arrangements help to embed information sharing.
Children and families value greatly the LP – and there is evidence of better relationships for families with services, higher morale, and less isolation where they are involved.
Where YP / parents are involved, the whole process is more effective.
TAC doesn’t go far enough – TAF approaches are required to deal with the wider problems faced by family members (Kendall et al 2010)
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8 Ways to improve whole system support cost-effectively 1.
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Draw in the ‘unusual suspects’ including adults services to support families Identify the ‘right’ families effectively Embed and make cost effective use of Key Workers / Lead Professionals Use multi-agency panel(s) effectively Use systems minders effectively Support workforce development in key areas of skill need / gaps for multi-agency as well as single agency work e.g. engagement with families Good communications and leadership Evidence their impact over time
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More information on the ‘how to’ Early Intervention and Prevention with Families: Getting the Most from Team around the Family Systems http://ipc.brookes.ac.uk/publications/index.php
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Contact Katy Burch – Principal Researcher Consultant Institute of Public Care Oxford Brookes University 01225 484088 [email protected]
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