essexfamily final report (june 2013)

7/28/2019 Essexfamily Final Report (June 2013)

http://slidepdf.com/reader/full/essexfamily-final-report-june-2013 1/48

ESSEXFAMILY



2

CHAPTER 1 LOCALITIES

“Itseemswehavemoretimeand

spacenowthatwedon’thavesomany

meetingstogotoandpeopleinvolved.

Aworkman’sonlyasgoodashistools

andnowyou’vegivenusthetoolswe

canmanagemuchbetter.”

Father discussing their Exit Plan

from the programme in Tendring



FOREWORD 4

INTRODUCTION 6

CHAPTER1:LOCALITIES 10

1.Tendring 12

2.Harlow 14

3.Colchester 16

3.CastlePoint&Rochord 18

CHAPTER2:NEWAPPROACHES 20

1.Newwaysondingandrecruitingamilies 22

• Identifying the right families 23

• Embedding a new approach within an existing system 25

• “Who is the family?” 26

2.Newwaysogivingamiliescontrolandresponsibility 27

• Family Outcomes Star 28

• Family-led assessment 30• Goal setting 32

3.Newskillsandwaysoworkingbypractitioners 33

• Key worker 34

• Permission to work differently 37

• New relationships 38

• Volunteers 39

CONCLUSION 42

CONTENTS



4


FOREWORD

Recentmonthshavebroughtrenewedpoliticalandpracticalemphasison‘amilieswithcomplexneeds’.

Weneedtodobetterorthoseamilieswhoseemtozoomroundandroundtherevolvingdoorsopublicservices,

strugglingtogetreerommultipleproblems.Thecoststothepublicsectorareartoohighandtheimpactointerventionstoolow;mostimportantlyamiliesarecontinuingtoliveotenunhappylivesodependencyandconstantlyrecurringdiculty.

THECHALLENGE



5

FOREWORD

We recognise that the conventional

delivery models to which we have

been wed for years are simply not fit

for purpose. They are siloed, (slowly)

reactive, and do not address the

underlying causes of problems. There

is a tendency to disempower people

who are supposed to benefit from

services, to create waste by failing to

recognise families' own strengths and

assets, and to engender a culture of

dependency that just stimulates more

demand. We are beginning to see that,

particularly in situations of complex

and generational need, the idea of

co-producing better outcomes with

service users must be embraced.

We set up the EssexFamily programme

to do just this. Supported by a small

amount of money but a lot of explicit

permission to try things out and take

calculated risks, 4 localities in Essex

committed to work with families to

explore new ways of doing things

that would be more successful in

transforming lives sustainably.

On a surface level the approaches

they have developed probably sound

quite familiar; “team around the

family”, “multi-agency this and that”

have become all-too-common buzz

words churned out in pretty much

every strategy and programme.

Underneath, however, it is clear

that the EssexFamily localities have

been experimenting with radically

different models of practice. Making

sometimes small but carefully

considered changes to the way things

are done, they have been developing

relational models of care that change

out of all recognition the balance of

power and control between families

and practitioners. As a result families

have been given ownership of and

responsibility for their own situations;

have deployed their own assets and

energies to make changes, supported

by professionals; and have started

journeys towards independence from

the public services they were once so

bound to.

The EssexFamily prototypes have

prioritised professional behaviours

that build relationships, shifting the

locus of control into families whilst

retaining high levels of appropriate

challenge. This has to be the way

forward. But it has huge implications

for what we in public services think

and believe, what we resource, how we

behave, what we measure, and what

we should count as “success”. Our

work is very much a work in progress;

we hope that this lively document

stimulates and encourages those who

are choosing to make a similar journey.

Joanna Killian

Chie Executive

Essex County Council

Dave Hill

Executive Director – People

(Children’s and Adults)

Essex County Council



6


INTRODUCTION

From2011toSpring2013,

multiagencylocalityteams,ledby

DistrictCouncils,workedtogetherwith

EssexCountyCouncilandInnovation

Unit1todevelopnewapproachesto

workingwithcomplexamilies.

WecalledthisprojectEssexFamily.

1. Innovation Unit is a not-for-profit social enterprise committed to

using the power of innovation to solve social challenges.www.

innovationunit.org



7

INTRODUCTION

THECHALLENGE

The precise details o the urgent

problems locality teams wanted to

solve varied rom place to place but

they shared concerns that:

→ statutory services help people

in times of crisis but do little to

prevent them getting there in the

first place;

→ a focus on helping individuals -

children or adults - largely ignores

the circumstances of the family

around them; and

→ the cost of multiple agencies

working episodically with

individuals in families is growing,

with little or no impact on

improving outcomes.

A deep dive analysis unpacking case

studies o amilies rom across Essex

highlighted that:

→ the system is highly complex tonavigate (numerous assessments,

recording systems, structures);

→ there is long-term impact on family

members, with intergenerational

transmission and poor outcomes;

→ high immediate costs are met by

local agencies;

→ very conservative estimates

give an average cost of £139k

per family mainly for reactive

interventions; and

→ up to 90% of this spend is

reactive / failure costs: only 6%

could be considered investment

in strengthening families.

Localities extrapolated these figures

to understand what was being spent

in their Districts on just the small

numbers of families whose needs

could be considered “complex”. For

example, a District with around 280

complex families could expect to be

spending around £40m every year

on failure costs, falling mainly on the

County Council's Children and Adults

Services, the District Council (for

housing), Health services, and Police.

And unless change happened,these costs looked likely to continue

year-on-year.

As part o the early stages o

EssexFamily, locality teams also met

with amilies to hear their views.

The teams learned that:

→ families were frustrated by how

little control they could exercise

over services designed to help

them;

→ families were fed up with constant

changes in personnel and not

having a decent relationship with

anyone they could trust; and that

→ even families they thought of as

troubled or “problem” really wanted

the same things: a job, a nice place

to live, friends, and their children

doing well in school. They just didn't

always know how to get there.



8

INTRODUCTION

FINDINGSOLUTIONS

EssexFamily teams realised that small

adjustments to existing arrangements

were never going to help address these

issues. Instead they needed radical,

system-wide innovation: a complete

overhaul of their approach to working

with complex families. They needed to:

→ shift the focus from individual to

family, and the locus of control

from provider to service user;

→ reduce demand for expensive and

too-late interventions; and

→ recognise families' assets and

support them to improve outcomes

for themselves, instead of constantly

trying - and failing - to fix them.

Leadership

This is an ambitious agenda and teams

quickly realised that their leadership

was going to be critical to the success

of the enterprise. In fact we learned

quite a lot about leadership together

over the length of the project.

Teams experienced the difference

between espoused leadership and

active leadership; just because someone

sits on a project steering group does not

necessarily mean they will drive activity

in the right direction - especially if that

means that they or their organisation

need to do things differently. Gaps

between declared commitments and

actual actions sometimes needed to

be highlighted and addressed, during

sometimes difficult conversations.

At an operational level, practitioners

are clear that they must be able to

“do whatever is necessary to sort

the family out”. System leadership

must give permission for this type of

flexible and creative practice, which

goes beyond the confines of traditional

organisational or personnel boundaries.

It's clear that license to work differently

needs to reiterated at many levels,

and must be imbued with trust. Short

feedback loops help everyone to feel

safe, and allow activity to flex and adjust

quickly in light of learning.

Risk

Empowered by the bold leadership

of the Director of Children's Services,

teams in EssexFamily took an

experimental approach, creating

prototypes and trying things out

in controlled environments that

managed risk carefully. Some

things worked and others didn't. In

EssexFamily we learned that creating

the space and freedom to innovate,

and providing specialist expertise

about innovation processes, enables

locality-based teams to design

approaches that work in their context.

The risk with this approach is that

multiple approaches proliferate

without much opportunity to gather

evidence about their relative

effectiveness. In EssexFamily we

managed this risk by developing

together a set of principles, to

which teams then held themselves

accountable.

The EssexFamily principles were:

→ Families will be involved as active

partners in determining what willwork for them

→ The active involvement of the

community will also be key to success

→ We will take an intentional

learning approach

→ The interventions and approaches

we prototype will need to be

scaleable

→ We will take a bold, non-traditional

approach to resources

→ We will support all this with a

commitment to honesty, being

brave enough to have the

“conversations that matter” even

when it's difficult

NB: everyone was surprised by how hard

this work was, how much time it took, and

at times what a rollercoaster ride it was.

Tenacity was a priority ingredient.



9

INTRODUCTION

ABOUTTHISPUBLICATION

EssexFamily has generated a range

of bespoke approaches to working

with families in new and exciting

ways. Because the EssexFamily

principles have guided and shaped

the work, and because the teams have

collaborated throughout the project,

the approaches developed have

many features – we have called them

components - in common.

Usually, at the end of a project, it is

traditional to write a linear report

that neatly wraps up what was done,

how successful it's been, and what

recommendations might safely be

made for others hoping to travel a

similar journey. But there's nothing

traditional about EssexFamily and this

publication is no exception.

Instead, our aim has been to “get

under the bonnet” of the new practice

and tools designed by locality teams

in EssexFamily. In the opening section

you will find a summary of each

locality's overall approach to working

with families. But the devil – and the

opportunity – really is in the detail.

So we've subjected some of the

components to a kind of “exploded

view” that offers more insight into

the how of practice. We'll show you

the subtle differences between the

ways in which localities are deploying

components, and how they have made

them work, so that you can choose the

approaches that feel most pertinent to

your context and requirements.

What has become clear is that

relationships are key to getting

things to work or complex amilies:

behaviour change can only result from

a trusted and meaningful relationship

between families and those supporting

them. A common theme across the

localities is therefore the development

of practice which supports a relational

model o care. This is often achieved

through very subtle and “below the

radar” mechnisms: watch out for these

in the text.

AWORDONCOSTS

There is still work to do to cost and

budget accurately for new approaches

beyond these R&D years. Evaluations

of the individual prototypes are on-

going, and Essex County Council has

developed a detailed cost-benefit

model for the roll-out of a Family

Solutions Service due to go live in

October 2013. Savings may well accrue

if we can take account of what from

the existing arrangements might

be decommissioned as the new

approaches begin to reduce demand

on statutory services (though they

must be cashable not just notional).

But equally, we are conscious that as

families grow in confidence they will

start to tell their friends about the

success of new approaches, and new,

thus far unmet need may well emerge...

We firmly believe that the biggest

savings will come not from simple

demand reduction, however critical

that is in the short and medium

term. We are looking further ahead

to improved outcomes for families

that means that as well as staying in

their homes and schools, and out of

A&E and the criminal justice system,

they can gain an education, work,

pay their taxes, raise their families

successfully and safely, and become

net-contributors to the communities in

which they live.

We hope you find something of interest

in here that will help families in your

locality too. For more information

about EssexFamily contact:

Julie Temperley

[email protected]



10


CHAPTER 1

LOCALITIES

“Imustcommendthe

incredible,valuableandhighly

supportiveservicecoordinated

anddeliveredtotheamilyby

theEssexFamiliesteam.”

Response from a partner agency, Tendring



11


&ROCHFORD18

TENDRING 12

COLCHESTER16

HARLOW14

CASTLEPOINT



12


UNDERSTANDING

Building on what had been learnt by theirFamily Intervention Project, the team ran

community workshops involving local

families, and drew on information from

the local Connected Care project.

THECHALLENGES

• Some families were failing due to poor

coordinationof care and a lack of anyagency having responsibility for the

whole family.

• Agenciesworkingonsingleissues

withindividualmembersof the family

were missing out on being able to deal

with issues that were inter-related and

impacted on other family members'

outcomes.

• The current system involved an

inecientuseoresourcesas some

families had numerous agenciesinvolved with no single support plan.

• Barriersinsharinginormationmeant

that agencies did not generally talk to

each other about individuals they were

all working with, or other members of

the family.

THEBIGQUESTIONS

Localitylead

Senior individual in the district

council with some of their time

specifically allocated to this project

Localcommissioningleads from health and county council

children's services

Awiderangeopartners, including a strategic steering

group (senior representatives)

and an operational group

(frontline representatives)

Aexible3rdsectorprovider

THETEAM

TENDRING

Howcanwesolve

theinormation

sharingconundrum,

sothereisnoexcuse

oranyagencynot

toplayball?

Howcanwesupport

andempoweramilies

totakeresponsibilityortheirownutures?



13

CHAPTER 1 LOCALITIES:TENDRING

An intensive programme of

problem-solving and buildingresilience and skills for

independence, with the aim of

leaving families able to manage

things independently within 6

months. Families are given control

of their own circumstances, and

supported to change behaviours

and outcomes: a huge cultural shift.

Each family has a single key

worker, who has a maximum

case-load of 5 and works to afocused 6-month timeline for

most families, brokering support

from other agencies as needed.

Core is the convening of a Team

Around the Family (TAF) meeting

within a couple of weeks of the

intervention starting, designed

to bring a family together with all

the relevant agencies, to agree

a coordinated support plan for

the whole family. Crucially, thischanges relationships between the

family and agencies, enabling them

to work together effectively.

The negotiation of the support

plan ensures greater co-ordinationbetween agencies who would

normally all engage with the family

separately. This makes more

efficient use of resources available.

The approach also includes:

•Intensivevisitstoamilies

2 to 3 per week, including

unannounced visits, with

flexibility to “ebb and flow” with

families' needs and levels of motivation

•Flexibleprogramme (i.e.

not delivering a manualised

programme) using elements

of the Signs of Safety model.

Families experience both whole

family sessions and individual

sessions

•Familysupportworkers have

a small budget to spot purchase

services that would otherwise beunavailable or have long waiting

lists, or to remove obstacles

or risks that would otherwise

make the safety or progress of the family decline (e.g. buying a

young person a coat so that they

would go back to school).

•Consistentnonengagement can lead to families leaving the

programme, but the door is left

open for them to return if they

are more motivated

•Involvementoextendedamily

has been pivotal for someprogress on actions etc.

For more details, see:

LEARNINGIt has taken much longer than envisaged

to establish and deliver. In particular it

takes a long time to:

• Identify the “right” families

• engage families and build relationships

• get new service known about and

trusted by agencies

• recruit key workers with the right skill

sets and attitudes

• create the conditions for the TAF

to take place effectively, and

• resolve enduring cross-agency issues

such as data sharing: considerable

effort was needed to get all services

signed up to and then actively using the

information sharing protocol.

THENEWAPPROACH

Identifying the

right families p23

“Who is the family”? p26

Fostering new

relationships between

families and services p38

At the time of writing, the first cohort

of 10 families is nearing the end of their

6-month programme and families for the

second cohort are being recruited.

x10x6months



14


Ledbypassionateadvocates

attheDistrictCouncil,

a bi-monthly Harlow EssexFamily

(HEF) Steering Group was formed

consisting of organisations with a

track record of working together

previously: Harlow District Council,the Harlow Education Consortium

(representing all the schools in

the area), and some 3rd sector

organisations.

Organisations contributed

to the prototype by:

• contributing free or paid

secondees, staff and other

resources to the delivery team

• contributing free/fast track

access to specialist servicesfor client families

• offering access to a fast trackspot

purchase facility for specialist

services

KEYPLAYERS

HARLOW

UNDERSTANDING

Harlow built upon their learning

from their Family Intervention Project.

The District Council contacted a number

of organisations, statutory and non-

statutory and ran a series of workshops

to (a) enlist the involvement and support

of these organisations and (b) develop an

initial prototype proposal.

THECHALLENGE

HEF was deliberately designed to test out

an innovative approach to the provision

of effective early intervention support

for families with multiple and complex

needs. HEF wanted to work in a way

which would allow the “methodology” of

operation/delivery to be frequently and

if necessary radically adjusted over the

course of the lifetime of the programme.

THEBIG

QUESTIONS

Canwedeliver

efectiveearly

interventiontowhole

amilieswhichleads

toimprovedoutcomes

andindependence?

Canweshowthat

thisinvestment

iscostefectiveorthetaxpayer

overtime?



15

CHAPTER 1 LOCALITIES:HARLOW

HEF's approach is three-fold:

1.Buildengagementoagencies

withinageographiclocality to

grow commitment to the new

approach; facilitate referrals

of the right families; facilitate

families' access to support

services they need

2.Buildtrustedrelationshipwith

amilies,through empowered

key workers giving them a

central role in whole family

assessment and action planning,

and key workers sorting outimmediate difficulties and

achieving quick wins

3.Deliveractivitiestodevelop

amilies’strengthand

independence,so that the family

can do things for itself.

How is HEF different from

“business as usual”?

•

Agencies typically work inisolation from each other, and

work with an individual family

member on an individual problem,

such as offending or mental

health (the classic “single person,

single issue” approach). HEF works

with all members of families and

looks at all areas of their lives.

• Staff from other agencies are

typically “not allowed to go

beyond their front door” in

terms of only offering fixed

appointments at their office, and

will not think beyond the remit of

their organisation – and therefore

may ignore some problems as

they do not see it as their role

to address them. HEF will work

with families to identify all issues

impacting on them and then

either work on addressing those

or ensure fast track access (“more

than just signposting”) to the right

services to meet the need.

• HEF staff are not judgemental

or pejorative in their approach

whereas many agencies (even if it

is inadvertent) give families this

impression. • Agencies are mostly time limited

or threshold limited in the

support that they can offer. This

approach is not time limited and

criteria are flexible.

• Agencies do not talk to each

other. With families' permission,HEF brings other agencies

together and shares information

more openly in the best interests

of the family.

• Some agencies will shut cases “at

the first missed appointment”,

whereas HEF sticks with the family

and is persistent and tenacious in

keeping them engaged.


LEARNING

Communityengagement:the

programme has not yet been successful in

getting local community organisations to

offer longer-term sustainable support to

families who are leaving the programme,

possibly due to negative stereotypes

regarding complex families.

THENEWAPPROACH

Identifying the

right families p23

At the time of writing the Harlow

Essex Family (HEF) team has been

running for 16 months and has

worked with 50 families

x41x1year

Embedding a new approach

within existing system p25

Family Outcomes

Star p28

Recruiting and

empowering key

workers p34



16


LocalityLead

A senior person in the council,

reporting directly to the Chief

Executive, took the lead on this

project and has driven progress

forward – especially in gaining

local buy-in to the idea of adapting

the Life Programme piloted in

Swindon; and in gaining resourcecommitments and secondments

from statutory partner agencies.

ALocalPartnershipGroup,

was built on the existing

“Colchester Delivers” group and

had a partnership framework and

targets in place before the start

of the EssexFamily programme.This sped up the process of

getting partners together. This

also helped to identify outcomes

early, to target the programme on

its priority groups and to ensure

relevance with other agencies.

Secondingresourcesrom

statutorypartneragencies

was key to this programme. They

form the core team which delivers

the Colchester Life Programme.

PartneringwithParticiple

Colchester partnered with Participle

to bring their Life Programme to

Colchester and to adapt it to local

needs. This partnership sped up

the development process, and

meant that they were able to spend

some of the EssexFamily funding

on bringing on board additional

resources to begin to deliver the

programme. This also gave them

some shortcuts to policies, key

worker tools and evaluation metrics.

KEYPLAYERS

COLCHESTERUNDERSTANDING

Colchester decided to adopt andadapt a model that they had seen in

another Local Authority, run by social

enterprise Participle. They built upon

existing partnership arrangements

that had many of the key agencies in

place. Many of the issues were linked to

complex families, so this infrastructure

was turned into an EssexFamily

steering group for Colchester.

THECHALLENGE

There is a wide range of interventions

and support available to families with

complex needs. But there is also a

growing body of evidence that the

system is failing to deliver positive

and sustainable outcomes for families,

and that the cost is disproportionate.

THEBIGQUESTION

Howcanweworkin

adiferentwaywith

amilies,lookingattheiraspirationsand

spendingsignicantly

moretimesupporting

themdirectly?



17

CHAPTER 1 LOCALITIES:COLCHESTER

The aim is to enable the family

to make changes for the longer

term, not just to deliver short-term

interventions. Key elements of the

model are:

• TheLieProgramme(developed

by Participle) aims to create

different conditions for the family,

involving a co-located multi-

disciplinary team to support

whole families intensively, both as

individuals and as a group.

• Theteamisunderpinnedbysharedprinciples, which include:

> letting go of service-led control

> trusting people

> strong relationships with

partner agencies

> moving families into

independence

• Making these principles a reality

is critical and takes real effort.

• Familiesareencouragedto

developinsightsintotheir

ownproblemsandbehaviours,and then to try to uncover their

aspirations. These are then turned

into a family-owned action plan, in

which families set their own goals

with personalised measures of

success.

• Theprogrammeisexibleand

nonprescriptive, but organised

into 4 stages with 12 steps that

families will move through, with

interventions including bothpractical help (such as painting a

bedroom) and therapeutic help

(e.g. self esteem building). The

team will deploy generic tools

that they have experience of,

for example counselling tools or

mapping exercises. Many of these

are visual and family led, which

changes the way practitioners

work. Negative behaviour

and attitudes by families' ischallenged robustly.

• TheLieTeameedback

to referring agencies on a

regular basis.

• Anyobstaclesimpacting

amilies’progressaretakento

thestrategicsteeringgroup

toberesolvedandinuence

systemchange.This allows

the team to “bend the rules in

real time” to prevent escalation

of problems for families - for

example where a family required

emergency housing, this was

resolved by the team and thestrategic group at significantly

lower cost and much more

quickly than would otherwise

have happened.


LEARNING • Establishing multi-agency teams takes

significant time and effort

• There are complexities in getting

secondments organised for a multi-

disciplinary team – even when all

partners are in agreement (e.g. whose

policies do they work to?)

• Getting to the “right” families at the

“right” time is difficult - as agencies

anecdotally say they have many suitable

families and then do not refer; there is

a time lag on data which means issues

have changed by the time a service gets

to them; agencies making the referrals

don't always hold accurate data on the

whole family or may not be prepared to

share the information they do have

• Engaging families into a new

programme takes time and

cannot be rushed

THENEWAPPROACH

Identifying the

right families p23

The Colchester Life Programme are

working with 6 families, with a further

4 families to be identified shortly.

x10

Allowing practitioners to

work differently p37



18


UNDERSTANDING

CP&R conducted ethnographic

work with complex families in order to

find out what did not work about the

current system. The resulting powerful

insights were used as the basis for

the development of a whole family

assessment tool and a family led process.

THECHALLENGE

• The current assessment processes

withmultipleagencies,each focused

on individual problems with individual

members of families, is an obstacle to

engagement, and not cost effective

• Families'holisticneedsarenot

recognised by “the system”

• Hugeineciencies in the current

approach – with too many agencies

being involved at too great a cost, with

too little success

CASTLEPOINT&ROCHFORD

Amultiagencygroup

(with frontline practitioners and

managers) was convened by the

two District Councils working inpartnership. It met regularly over

some months to understand the

experience of “frequent fliers”: repeat

users of public services in the locality.

The way families get assessed

over and over was clearly a major

problem. The team unpacked the

assessments used by different

agencies, and synthesised these

to create a core list of aims,

questions and data fields that

were common to all.

They used this list and the insights

from the ethnographic research with

families to create new assessment

forms/processes, which were

prototyped with local families.

THETEAM

Canweworktogethertodevelop

anewassessment

toolthatallagencies

aresatisedwithand

whichbetterengages

andbuildsrelationship

withwholeamilies?



19

CHAPTER 1 LOCALITIES:CASTLEPOINT&ROCHFORD

The new approach contains

the following elements:

• Familiesinthedrivingseat,

with the involvement of morethan one generation plus the

extended family and friends now

a mandatory part of assessment

and action planning

• Frontlinepractitioners

retrainedto think differently, to

listen better, and to see building

relationships and trust with

families as the most important

thing they must do

• Newapproachtocapturing

theamily’s‘story’ through

new assessment tool which all

agencies have agreed to accept

Teams in Castle Point and in Rochford

are now beginning to use these

new approaches to engage small

numbers of families in intervention

activities such as manualisedparenting programmes, budgeting,

debt reduction, and healthy eating

courses, using a key worker model.

They are also exploring the use

of personalised family budgets to

halt downward trends and create

independence and strength.

Castle Point are beginning to

deploy volunteers to offer “step-

down” support to families for upto 8 months after they finish a

programme.


A detailed new approach to the

assessment process has been

designed with families, and

prototyped. Local agencies are signed

up to accepting the new recording

form in lieu of their own initial

assessment or a CAF. Supporting

training for practitioners has been

designed and delivered to ensurethat the behaviour and skills of

practitioners match the new approach.

The family led assessment tool is

already being harnessed elsewhere

by Essex County Council. The Rochford

team is now at the early to middle

stages of using this approach with 10

families. The Castle Point team is at the

starting point of engaging 6 families

onto the programme.

ROCHFORD

CASTLEPOINT

x10

x6“Who is the family”? p26

Family-led assessments p30

Recruiting and empowering

key workers p34

THENEWAPPROACH



20


CHAPTER 2

NEWAPPROACHES“Iamreallyhappywiththesupport

Ihavereceived.MykeyworkerreallylistensandIknowIcancallherwhen

Ineedto.Withmykeyworker’s

supportIamabletounderstandmy

child’semotionsbetterandamableto

managehisbehaviourwhenheisangry.

Mykeyworkerishelpingmesortout

myproblemsmyselsoIeelmorein

controlomylie.Icanseemylieis

gettingbetter.”

Ruth, Harlow



21

CHAPTER 2 NEWAPPROACHES

Identifying theright families p23

Embedding anew approachwithin an existingsystem p26

“Who is thefamily”? p25

FAMILY-CENTREDAPPROACHES

2 NEWWAYSOFASSESSINGNEEDS

3 NEWSKILLSANDWAYSOFWORKING

Recruiting andempowering keyworkers p34

Fostering newrelationships betweenfamilies and services p38

Family-ledassessments p30

Goal setting p32

Family OutcomesStar p28

Allowing practitionersto work differently p37

Using volunteersto support families p39

1 NEWWAYSOFFINDINGANDRECRUITINGFAMILIES



22

CHAPTER 2 NEW APPROACHES


AsyoulearnaboutthenewEssexFamilyapproachestondingand

recruitingamilies,youmightliketothinkabouttheollowing:

→ Howwelldoyoureallyknowthecommunities

andamiliesinyourarea?

→ Whatdiferencedoesitmaketoamiliesitakingpart

isagenuinechoice,madewithoutpenaltyorcensure?

→ Howdoesyourservicedene“amily”?Whatroleisthere

orwiderkinship,neighboursandriendsinyourofer?

→ Outsideoormalpartnershipandundingarrangements,

whatrelationshipsdoyouhavewithcolleaguesromother

teamsandagencies?

→ Whatwouldbetheimpactiyourprogrammesteering

boardspentmoretimediscussingtheactualworkwith

amiliesthantraditionalgovernanceissues?



23



COLCHESTER

“CHATHAMHOUSERULE”

• Inormalnominationprocess

during which steering group

members put forward families

for consideration. This produces

a rich, informal discussion

between partner agencies abouttheir experiences of families,

backed by an information

sharing protocol.

• Criteriaornominationare

quitenuanced, including “being

stuck in the system”; having

“a history of involvement with

multiple services”; and “families

being ready and willing to

change”.

• As the programme has matured,

localnetworkinghas also led

to identification and referral of

families.

LEARNING

• It takes a lot more time and energy to

get families engaged in the Programme

than can be anticipated. Families who

have been in the system for a long time

can be skeptical, and sometimes several

conversations or visits are needed

to build trust and understanding.

However, the benefit is that once they

do get involved they are making a real

commitment, rather than being forced

into a process.

• It's important to realise that skepticismexists within services, not just families.

Promoting a new approach/service

across other agencies is vital if they

are to refer into your new programme.

Promotion needs to be both at

practitioner level and at strategic level,

for example by an active steering group

just because an agency is represented on

your steering group this does NOT mean

that agency will actively work with your

new programme in practice!

1.1. Identifyingthe right families



24


TENDRING

HARLOW

NOMINATIONPROCESS

IDENTIFICATION&REFERRALPROCESS

• Partner agencies nominate

families in an anonymous

processwhere they do notgive names, but instead use a

complete matrix of need.

• Thisapproachovercomes

condentiality and information-

sharing issues, as family names

are withheld. This also ensures

there is no bias against specific

families, as practitioners are

aware that it can be very easy to

harbour negative beliefs about

families they have previously

known and their ability to change.

E.g. “We've tried everything with

that family and nothing works”

and “I've worked with the Dad

when he was a kid and there's not

much that can help him.”

• Thisisdoneevery6months to identify the next cohort of

families to enter the programme.Members of the strategic group

review all nominations and

choose the families they think

will most benefit.

• Theseamiliesarethen

approachedbythereerring

agency to gain their consent

to make a full referral – the

family has to be willing to

undertake the programme asit is non-compulsory and there

are no sanctions used for

deciding not to take part.

• Familiesareidentiedby local

agencies, by other families whohave been on the project, or

self-refer to the programme

themselves.

• Reerralscomestoa

ortnightlyoperationalteam

meeting and an initial view is

taken on whether families seem

appropriate for the programme.

• Thecaseisthenallocatedtoa

KeyWorker for detailed scoping.

• Itisimportantthatthe

scopingandassessment

processesexplicitlybuild

relationshipsotrust.Key

Workers engage whole families

in scoping conversations to

determine suitability for the

programme, enjoying freedomto use their own judgement on

which questions to ask, and when

to ask them. The operational

team makes final decisions on

taking on cases or not.

• Thereisno“contract”tosign; families are invited to sign a

consent and confidentiality

document allowing the Key

Worker to seek and share

information with other

relevant agencies

• At the earliest appropriate

opportunity after this, an initial

FamilyStarAssessmentand

ActionPlanwill be completed

with families.


LEARNING

Nominations started with a criteria-

based approach, but have moved into

more of a principles-based approach.This helped for the team to be able to

apply principles such as “willingness

to change”, or “being in an actionable

moment, such as on the verge of losing

housing/job/children” in order to work

with those most likely to be able to do

well in the programme.



25




TENDRING

• Familiesdecidewhoisin“their

amily”,and can include as many

people as they wish in their support

network from extended family to

friends. They use “mind maps” to

help create a visual picture of who

can support them with what area

of their lives.

• Theinvolvementotheextended

amilyas proposed by families

themselves has sometimes been a

key factor in success. For example,

grandparents have provedthemselves critical parts of family

infrastructures, and can galvanise

the whole family to engage - or can

undermine the programme if not

fully part of it.

1.2. Who isthe family?




HARLOW

• Takingageographicapproach canbe a useful way of embedding a

new programme within an existing

system. Harlow started with one

ward, Staple Tye, concentrating

efforts effectively. Knowing that

partner agencies were very

skeptical of another new service,

they did not have a big launch, but

invested time and energy building

up trust in the new initiative.

• Keyworkerscontactedlocal

servicesthey already have

relationships with, focusing on

schools, school nurses, support

workers, Sure Start, GP surgeries.

• Skepticismisaddressed

headonby talking face-to-face

with staff at other agencies

to get them to think through

their caseloads and discuss the

flexible criteria used to enter theprogramme. Visits and discussions

are followed up with leaflets about

the service.

• Importanceoclarity:Harloweducated local agencies about:

• what their service would do;

• how it would be different to

other interventions;

• how it could even replace some

of the current support a family

received;

• the key worker role;

• criteria for involvement; and• what was expected of families

who take part.

• Localpartnerswereinvolved in agreeing together a simple

eligibility checklist (based on

evidence of priority needs), which

determined who the prototype

was suitable for - helping with

recruitment: flexible and not

restrictive and inadvertentlykeeping families in need away

from support. Families had to

demonstrate at least two areas

of vulnerability and show

willingness to engage.

1.3. Getting startedand embedding a new

approach within anexisting system


26



2 NEWWAYSOFASSESSINGFAMILIES’NEEDS


AsyoulearnaboutthenewEssexFamilyapproachestoassessing

amilies’needs,youmightliketothinkabouttheollowing:

→ Howmuchtimedoyouandcolleaguescumulativelyspend

makingassessmentsoamilies?Couldthattimebebetter

spentinhelpingamilies?

→ Howdoyouknowwhoelseisassessingandworkingwith

theamiliesyouaretryingtohelp?

→ Whatwouldbetheimpactiamiliesnotproessionals

genuinelyledassessment?Whatwouldbediferentorthe

amily?Whatwouldbediferentortheproessionalsinvolved?

Whattoolswouldberequiredtomakethishappen?

→ Howcanamiliesknowtheyare‘gettingbetter’?Whatmightchangewhenamiliesareabletoevaluateandarticulatetheir

ownprogressorthemselves?

27



28


• Harlow have developed the use

of the Family Star - a version

of the Outcomes Star (www.outcomesStar.org.uk), a family of

tools for supporting and measuring

change when working directly

with people. The Family Star is

useful for assessment, action

planning, monitoring and measuring

progress. Its power lies in the fact

that it is not just a tool for frontline

practitioners, but one that requires

collaboration between practitioners

and families, enabling families to bevery involved and eventually take

the lead in judging what their needs

are, how they might be met, and

how much progress has been made.

• The Family Star focuses on eight

core areas that have been found to

be critical to enabling children to

thrive (see illustration on p29).

• Each core area is assessed against

a ten-point scale, from “stuck” (1-2)to “effective parenting” (9-10). This

enables families to describe their

difficulties from their point of view

and to plot their “journey of change”

from where they see themselves

now to where they'd like to be.

• KeyworkersndtheFamily

Stareasytouse;its visual appeal

engages families who immediatelyunderstand what's different from

old ways of working

• Familiesandpractitioners

experience‘therapeutic’

conversations;not just a

bureaucratic exercise in

information gathering. The Star

creates opportunities for genuine

2-way discussions and reflection,

opening up conversation on difficulttopics; putting families in control

of rating their own progress and

developing an Action Plan with

goals that directly link to the issues

of most importance to them.

• Regularreviewsof the Family Star

and the Action Plan are important

for families to see how far they have

come or where they still need to do

more work.

2.1. FamilyOutcomes Star

HARLOW2 NEWWAYSOFASSESSINGFAMILIES’NEEDS



29


Family Outcomes Star, used by Harlow

LEARNING

• Trust has to be built with families

before the Star can be useful tothem. Stars completed too early in

the relationship between families

and practitioners tend to result in

families “being brave” and resisting

disclosure. They underestimate

risks and gloss over important

issues in the baseline and then

when it comes to review it can

appear that families' situations have

deteriorated and problems are

worse. In fact, what is happening

is that families are becoming

more open and honest about their

problems as the relationship with

the practitioner develops. Family

Stars are therefore best completed

1 to 2 months after commencement.

• Small things matter. Copies of the

Star and the related action plan are

given to all family members, to help

them feel in control of the process

– especially as it lets them clearlysee who should be doing what by

when, including support agencies.


Family assessment toolkit, developedby Castle Point & Rochford




30




2.2. Family-ledassessments

Castle Point & Rochford's ethnographic research

helped them see that many families get “assessed

to death”. Families often have assessments done to

or for them, and have to tell their stories over and

over again to different agencies and practitioners.

A multi-agency team working with families set out

to design a new approach and new forms, which

were tested and amended with families (see p29).

• Aamilyledassessmentaimstooster

aspiritocollaborativeworkingbetween

practitioner and families. It is strengths-based

and relationship focused. It is visual, in-depth,

and conversational: it puts families at ease,

makes them feel included, and allows them togive a more open account of “their stories”.

• ItusesaFacilitatedFamilyMeeting(FFM)

approach to enable whole families to tell their

story. FFM has a “past, present, future” format,

enabling families to recount and describe things

that feel important to them. The approach is

flexible so individual practitioners can tailor it to

fit different families' needs. (The team is exploring

whether there is development of a checklist to

ensure safeguarding issues are fully explored.)

• FFMsinvolveatleasttwogenerations,and

ideally close friends and extended family too.

Each person in the meeting holds a different

and valuable perspective on key issues and

each person is a potential asset and source of

support for the family.

• The output from the FFM is an agreedaccount

otheamilies'strengthsandneedscaptured

in a Family-led Assessment.

• Parents’vulnerabilitiesare often the driver

of children's additional needs; the FFM ensures

that these issues are considered in the round

when previously they were often missed by the

Common Assessment Form (CAF) process.

• Inabigchangeromnormalpractice,

notesarewrittenupby practitioners after

the session, and are then reflected back to

families at the following session, to get their

thoughts and agreement. This approach isfelt to encourage more reflection by both the

practitioner and the family.

• PractitionershaveoundtheFFMallows

themto“digdeeper”and “empathise more”

with families and their situations. Some new

approaches in this are particularly valued,

such as the “describe a typical day in your life”

section.

• Localserviceshaveallagreedtoacceptthe

FamilyledAssessmentinstead of the Common

Assessment Form (CAF) for the families on the

programme. There are obvious efficiencies: for

a family with 5 children identifying unmet needs

only 1 Family-led Assessment form is needed

instead of 5 CAFs.




31


• Whatisit?The Lambeth

Recovery & Support Plan is a

tool being used to support better

integration of health and social care

support. It was co-produced by a

workgroup with service users at

South London and Maudsley NHS

Foundation Trust, and explicitly

seeks to reshape practitioners'

thinking on health and wellbeing by

ocusing on service user ownership

o their support plan. In Lambeth,

the plan is currently being used

in primary and secondary care

settings, peer support services, and

supported housing services.

• What’stheinnovation?The

Recovery & Support Plan is owned

and developed by the patient/

service user, the idea being that

they use it to help them plan the

care and support they want with

their care team. The plan helps

the individual think about whatthey can do to meet their personal

goals and stay well, and enables

them to tell others how they can

best support them. Service users

can write, use audio/video or draw

their plans in their own style. The

plans, and the conversations they

create, concentrate on what an

individual is capable of doing, and

considers patients' wider informal

support networks and community

links as part of the resources on

offer. This challenges the stigma and

assumptions about the capabilities

of people who experience mental

health issues on a day-to-day basis.

• Whatcanbelearnedrom

this?Lambeth Recovery and

Support Plan gives control and

ownership to the service user. It

educates the system about enabling

well-being and support through

self-management, and allows the

service user to determine their

own support needs. Personalising

support for people with lived

experiences and developing tools

like the Recovery and Support Planare essential steps to take if current

support systems are to move away

from prescription and instead

promote choice and control.

• Whatisit?My Health Locker is

an online personal health record

for mental health service users

being piloted by South Londonand Maudesley NHS Foundation

Trust. It allows service users to

access their medical records and

care plan, keep track of how they

are feeling, and access resources

and tips on managing health and

wellbeing.

• What’stheinnovation?

Traditionally, the NHS has not

made it easy for patients and

service-users to access theirown records. By sharing this

information with patients, the

project empowers patients,

increases patient engagement and

encourages them to manage their

own condition.


this?Sharing inormation openly

with service users can instil a

sense o ownership, change the

dynamics o the relationship with

public services, and encourage

them to manage their own health

and well being.

• www.myhealthlockerlondon.nhs.uk

LAMBETHRECOVERYANDSUPPORTPLAN

MYHEALTHLOCKER2 NEWWAYSOFASSESSINGFAMILIES’NEEDS LEARNINGFROM

ELSEWHERE

LEARNING

“It's the Family Star that makes the real

difference. But it's not really the toolitself but how you USE it, or rather what

it allows you to explore with the family.

It really gets them to reflect about

where they are and where they want to

get to. It's visual too, which makes it a

shared experience rather than a form

that you fill in for the family.”

Team member,

Castle Point & Rochford




32


2.3. Goal setting

HARLOW

The creation of an Action Plan over which families

feel ownership and responsibility is critical if

behaviour change goals are to be achieved. This is

also key if families' own strengths and capabilities

are to be harnessed to change things sustainably.

• InHarlow,theactionplanningconversation

involvestheprimarycaregiverandpartner,

andtheKeyWorker,plus children if old enough

to have an adequate understanding of the

situation. Whenever possible appropriate actions

for children are included in the family action plan.

If helpful, other professionals that are engaged

with the family are included at this stage.

• The“results”romthewholeamilyassessment

arerecordedontheFamilyStardiagram, linking

up to form a “star shape” - giving an image of which

areas need the most attention. This is very simple

and visually very effective.

• Goalsaresetdependingontherangeo

issuesintheamily.Prioritisation is important

as some issues need to be addressed early

before others can be worked on. Actions are

discussed, agreed and assigned to individuals

to undertake within a certain time frame,

encouraging ownership and responsibility.

• ApapercopyoStarandActionPlanis

keptbythekeyworkerandamily.Copies

are shared with other agencies working with

the family to ensure goals are linked and

interventions/support is not duplicated.

• TheKeyWorkertakesintoconsiderationthe

amily’scurrentcapacity/abilityorchange;

family strengths; opportunities for support from

extended family/friends; and barriers that might

hinder change. The Key worker will be thinkingabout making sure the targets are SMART

(specific, measurable, attainable, realistic, timed).

• Familiesandtheirsupportersmonitor

progressby reviewing actions, attendance at

appointments, school attendance, levels of debt,

and by listening to feedback from family members

and relevant agencies. Key Workers will carry out

informal reviews throughout their time working

with families, and formal reviews of the Family

Star are done approximately every 3 months.All reviews and plans are signed by both the key

worker and the parent(s). Key workers can use

small incentives to encourage progress towards

the agreed goals.

• TheKeyWorkers’tenacitytochallengeas

wellasincentiviseisimportant.They will

question families if progress is not being made,

and talk about barriers and what has stopped

them achieving. The relationship is characterised

by discussion, negotiation, compromise and

agreement. SMART targets are revisited andrevised if appropriate. A powerful focus on

families' capabilities and strengths avoids

overwhelming the family by a sense of failure;

achievements are celebrated however small, in

order to encourage even greater progress.




33


3 NEWSKILLS&WAYSOFWORKING

Asyoulearnaboutthenewskillsandwaysoworkingbeingdeveloped

byEssexFamily,youmightliketothinkabouttheollowing:

→ Howdoyouknowyouhavetherightpeoplewiththerightskills?

Whataboutyou?Doyouhavetheskillstoenablemoreefective

waysoworking?

→ Howdoyoucreatetherightconditionsorproessionalstodotheir

bestworkwithamilies?Whatarethethingsthatgetintheway?

→ Whatextrasupportmightrontlinestafneedwhentheyare

workinginverychallengingcontexts?

→ Whataretheevidencebasedmethodsthatworkbestwith

amilies?Dostafknowaboutthemanddotheyusethem?

→ Whatcanvolunteersdothatproessionalscannot?

→ Whattrainingandsupportdovolunteersneedtodogreat

workwithamilies?




34



LEARNING

Harlow's Key workers are relishing the

new ways of working: “The flexibility

and trust you are given is refreshing.”3.1. Recruitingand empoweringkey workers

Lots of family and community-based

approaches involve key workers.

So what makes a great key worker?

In Harlow, after several years of

recruiting and developing key

workers for their locality based

projects, they have some firm ideas

about the kind of people they're

looking for. Formal qualifications are

felt to be less important than the

following set of skills:

Goodcommunicator;ability to

engage others (both families and

agencies)

Abilitytomotivateandchallenge,

and to be open with families.

Abilitytoworkexibly,and to “think

outside of the box”: not giving families

the same response they are used to

from agencies.

Asoundlocalknowledgeof services

and support available: this helps topersonalise the service for the family

and can normalise elements of what

is delivered, and is key to getting

referrals of families and to brokering

services and support for them.

Candoattitude: preparedness to

do what's needed when it is needed

(within reason): e.g. rolling up sleeves

and joining in with the housework.

Tohaveaproessionalattitude

at all times, while remaining honest

and practical rather than removed.

Nottobearaidtochallenge other

(sometimes senior) professionals

Toeelcondentandsecure in their

role / identity of the team. Being wellknown by local people and services is

advantageous.

Experienceoworkingwith

wholeamilies.




35


HARLOW3 NEWSKILLS&WAYS

OFWORKING

Harlow's key workers are given a

high degree of autonomy within

a clear plan to increase families'independence and skills. There is a

clear progression:

The key worker provides very

practical support and generates

quick wins, meeting their basic

needs first.

The family carries out tasks

with the Key Worker

The family carries out tasks by

themselves getting feedback and

support from the key worker.

• Keyworkersmaynot

requirespecicproessional

qualications,but do needto be able to successfully

deploy evidence based tools.

For example, during the early

phase tools they use include

Strengths & Difficulties

Questionnaire (SDQ), the

Parenting Scale, and the Family

Outcomes Star. During the

strengthening phase they may

use parenting courses (such as

Triple P, Strengthening Families

& Parentplay) in a group or

individual setting and the

Budgeting Tool from the Harlow

Advice Centre.

• Creativeuseismadeorewards

andincentivessuch as access

to gym facilities, education or

work opportunities to encourage

progress. Families' success is

explicitly celebrated, even if it

is only a small step forward. Keyworkers can access a budget for

troubleshooting, e.g. paying for

transport, or spot-purchasing

services.

• Basicskills are taught during the

early phase, including about how

to deal with other people, familymembers and agencies effectively.

Key workers aim to identify

sources of support and build

social networks to support the

family to make progress (helped

by geographic focus on single

ward Staple Tye).

• KeyWorkersareabletoaccess

“asttrack”support from other

agencies for families in key areas

of need, due to arrangementsput in place by the project's

operational group and steering

group: often for issues for which

families have struggled to get

support for years.

• Evidencebasedprogrammes

ointerventionare used in

the strengthening phase when

appropriate (e.g. the Triple P

Parenting Programme, and theFreedom Programme for domestic

abuse).

• KeyWorkershaveclinicaland

groupsupervision, and have

caseload of 8 families maximum.

• Supervisionandsupport

Once you've found the right

people to work with families, theirsuccess and safety depends on

the support they get. Supervision

and support for key workers for

is critical given the challenging

nature of the work. This includes:

• Regular supervision by the

programme manager, including case

management, personal development

and personal feelings. The

programme manager has an “open

door” policy

• Line management by their own host

organisation

• Regular operational group

meetings where the whole team

can share learning and challenges,

and changes can be made to the

approach. The multi-disciplinary

team ensures that tools and

skills can be shared amongst the

members to use with their families

• The team are co-located which

allows for important informal

support to take place and ensures

that workers do not feel isolated.




36


In Castle Point & Rochford, teams

realised that regular, high quality

supervision is vital for key workers,

encouraging them to reflect on their

practice and to work differently.

The teams receive formal clinical

supervision and informal team

supervision by being co-located.

• Whatisit?The Brief Encounters

model is an approach to one-to-one

interactions and conversations that

gets relationships right at the start, and

models good relationships between

practitioners and families. It is based on

the development of a relational model

of care (time, attention, respect), active

listening and effective communication

skills in practitioners. This enables them

to be attuned and responsive to parents,

in turn developing relational capacity infamilies (parent-to-parent and parent-

to-child), and also communities. When

relationships are developed in this way

then they are more likely to be positive

from the start.

• What’stheinnovation?The approach

enables practitioners to model effective

relationships in the way that they conduct

their relationship with their client/service-

user, building trust from the outset. It

is underpinned by the evidence-based

helping process: an emphasis on helping

parents to engage in a process to bring

about behaviour change.


this?The basic relational skills opractitioners are critical in whether

support that is ofered is taken up and

has long-term impact. The evidence

is clear that changing practitioners'

attitudes and skills hugely improves the

efectiveness o their work.

ONEPLUSONE’SBRIEFENCOUNTERS:ARELATIONALMODELOFCARE

LEARNINGFROMELSEWHERE

LEARNING

Key learning about what makes a difference

for practitioners includes:

• the “importance of the remit” or

“license” to work differently;

• being able to use their common sense

to make decisions; and

• being supported to work flexibly

and creatively.

Practitioners believe these things have createdthe conditions for them to be able to help

complex families overcome their issues and

make progress. In short, it has allowed staff the

freedom to work to the best of their abilities.

They feel “trusted” to work in the way that is best

for each family, which is something they feel is

very important.






37


3 NEWSKILLS&WAYSOFWORKING COLCHESTER

The multi-disciplinary team is made up

of 5 staff, with specialisms in substance

misuse, health, housing and social work.

Some are seconded onto the team from

other agencies. The team has been given

permission to work differently. The

things that make the biggest difference

to families are:

• Theocusoncoachingand

independence-building with the

whole family;

• Theteamapproach,rather

thanworkinginisolation.Therelationships they build with each

other, with families and other

agencies are more helpful than

tools and data systems. This helps

to blur unhelpful professional

boundaries. Practitioners who

have been involved with a family

in Colchester for years have found

themselves able to operate in new

ways, coming together as team to

significantly improve outcomes;

• Supervision: Life Programme

Practitioners receive supervision

on a 1 to 1 basis from CAMHS

(monthly) and group supervision

from the Tavistock (weekly).

3.2. Permissionto work differently

LEARNING

Where does this permission come from?

It is reiterated by senior people from

practitioners' home agencies, whoseinvolvement in the programme steering

group has ensured their understanding

of and commitment to the new ways

of working. The team can feed directly

back to these senior leaders, who give

them confidence to keep on “bending

the rules” and “doing whatever is

necessary”.

The way the service and job

descriptions are spoken about

reinforces these permissions. And careis taken only to recruit people who are

really up for working in this way.




38

C O C S

In Tendring, practitioners no longer

tell the family what they should do

(e.g. “you should access counselling”).

Instead they are ready to listenand willing to support families in

decisions they make for themselves.

Families are given control of their

own circumstances, and supported

to change behaviours and outcomes.

The intervention is described by those

involved as “erecting a scaffold around

the family and making sure that when

the scaffold is removed in 6 months

time, the family is ready to support

itself”. This is aimed at giving the family

the tools for building resilience and the

skills for independence. Thisisahuge

culturalshit,andonewhichwill

needtobeactivelymaintained.

If changing families' behaviours is key

to reducing their dependence on the

State, then families have to be actively

given control. This requires a shift

in often long-standing relationships,

facilitated by a key worker for each

family. The key worker aims to harnesslocal agencies' support to scaffold the

family through difficulties and move

them into independence. The idea is

that relationships with local agencies

improve to such a degree that when the

scaffolding is taken away (they aim for

6 months from start of engagement)

the family is able to stand on its own

two feet and continue its journey intoindependence and improved outcomes.

Although practitioners adopt a

collaborative, listening and nurturing

approach with families, they do so

using clearly defined approaches or

protocols, including:

• Anexpectationthatmostamilies

shouldonlyneedthescafoldingo

theprogrammeor6months

• Arequirementthatthepivotal

“teamaroundtheamily”meeting

musthappenwithin2weeks

of families' engagement on the

programme. The TAF meeting is

designed to bring families together

with all the relevant agencies, to

agree a coordinated support plan.

Marshalling these agencies to

engage fully is a crucial milestone

• TheTAFuseselementsothe

“SignsoSaety”modeland

FamilyGroupConerencing

approach;family members speak

first, and have support to prepare


3.3. Fosteringnew relationshipsbetween families

and other services

TENDRING




39


3.4. Using volunteersto support families All sites have indicated that they

would like to harness community

volunteer capacity to further support

families, especially as they step down

from intensive support measures.

Ideas are still at the developmentstage, but there is a lot to learn from

practice elsewhere.

Using volunteers is often assumed to

be straightforward and cost saving,

but this is not necessarily the case.

Doing it well is a real challenge to

“business as usual”! However,there

areantasticexamplesoplaces

wherewelldesignedprogrammes

haveharnessedthecapacityo

volunteersinexciting,powerulandsometimessurprisingways

toimproveoutcomes.Thereisno

needtoreinventwheels;let’s

learnromthem.

COLCHESTER


HARLOW

TENDRING

what they want to say during their

sessions with a family support

worker. Families are respected as

experts in their own history andneeds. There are no surprises for

families and the atmosphere is

neither judgmental nor punitive.

As a result relationships between

families and some local agencies

have been transformed.

• Duringmeetingsanynotesand

actionsarewrittenuponthewall

so they are visible to all, including

the family.

• Theoutputisawholeamily

supportplan,that is written up for

the family by the key worker, but

written in the family's language,

using their personal goals. A copy

of this is given to the family to keep

as a “family held record” or “family

owned support plan”.

• Theamilygetstoseeanynotes

put on the record and to agree thecontent before it is shared with any

other agencies.

• TAFmeetingsarereconvened

every few weeks as necessary.




40


• Whatisit?The Transforming

Early Years steering group members

in south Reading have learnt to

prototype their ideas with families

first before these are adopted widely.

When Reading Council began to

recruit volunteers for their “Parents

Supporting Parents” programme,

they originally designed a complex

and expensive process. After sharing

this prototype with members of

the local community, the residents

saw quickly that there were better

options. They designed a simple

poster with a picture outlining why

others should get involved and used

their own words. The poster was veryeffective and managed to recruit 62

volunteers in one week.

• What’stheinnovation?

Engaging the local community in

designing a recruitment process to

generate local volunteers makes it

much more effective.


this?Processes like this are much

better designed by citizens thanpublic services, as citizens know

how to speak to other citizens in the

simplest, most effective ways, and

therefore can help the process to

have greater impact at lower cost.

READING,USINGVOLUNTEERSTOTRANSFORMEARLYYEARS

LEARNINGFROMELSEWHERE

• Whatisit?The PBB programme is a

cost-effective model of peer support

for expectant and new parents in

disadvantaged communities through

pregnancy, childbirth and early family

life. The well structured and proven

model enables a healthier pregnancy,emotional wellbeing, improved birth

experience, and a better start in life

for infants.

• The programme revolves around

the design and implementation of a

sustainable, community owned •Peer

Support Hub• to support a defined

community. Parents are supported

by people they choose from their

community, in places they feel

comfortable. The approach seeks to

build a nurturing neighbourhood by the

community for the community.

• The volunteer peer supporters

are rigorously recruited from the

local community and professionally

supervised. The City & Guilds

accredited training meets national

occupational standards, nurtures

new life skills and enables pathways

to employment. The peer supporters

provide strengths based dependable

and easily accessible preventativesupport for the most vulnerable

parents.

• What’stheinnovation?In this

programme, the early intervention

approach operates alongside

professionals releasing time

and resources to be used more

appropriately. The peer supporters

are active intermediaries who help

families to engage at the right time with

the right service. One-to-one focused

home visiting (including emotional and

physical support during labour and birth

if needed) builds trusting and positive

relationships with families promoting

resilience. Parents describe their peer

supporter as “someone in my corner.”

• “She was very easy to speak to and

always made me feel at ease. She made

me feel confident about my pregnancy

and the day I gave birth. She also made

me feel empowered as a new mum.”

•

“I saw a sister and a best friend in her,who stood by me through it all. I drew

strength from her positivity, words

and most of all the overall support she

provided”

• Whatcanbelearnedromthis?

Relationships on different levels play an

important part in supporting families

during the key life transition of becoming

a parent. The quality of the support

relationship enables parents to be the

best nurturers they can be. Investing in

the relational capacity of local residents

to offer support to other parents

particularly helps get support to those

parents who are wary of public services.

It helps to nurture a neighbourhood and

promote resilient and confident families.

PARENTS1ST:PREGNANCY,BIRTHANDBEYONDPEERSUPPORTERS




41

• Whatisit?Chellow is a local area

in the city of Bradford that provides

local residents with coaching support

from other residents. A “Chellow” is a

community member who volunteers

to support local people. Their aim

is to build relationships between

communities and services, through

friendly support that is easily

accessible. There are three types of

Chellows:

• Smiley Faces - they are visibly

available outdoors in the local

area and help to make the area

feel safe and act as “gateways” to

help, support and information.

• Family Coaches - they are

members of local families who are

“doing well”. They offer support

to other local families who might

be struggling. This might include

organising bedtime routines andtalking about the challenges of

parenting.

• Expert Coaches - over time, these

Chellows will become “expert

coaches” by offering support to

the most vulnerable families in

the area.

• What’stheinnovation?Families

are willing to, want to and already

do turn to local people they trust

for help and support. Supported

appropriately, this volunteer resourcecan be harnessed effectively to make

a positive impact.


this?If public services can build the

capacity of local people to offer high

quality support, then an incredibly

powerful resource can be created

and could be well-placed to help the

families who most need help and

are often least reached by formal

services.

• Whatisit? In a Circle of Support,

a group of six community volunteers

provide intensive support to a

sex offender for twelve months

to help them reintegrate into the

community. Volunteers have daily

contact with the core member,

helping him/her to reintegrate

through various tasks such as help

in finding housing and employment,

attending medical appointments and

shopping. If the ex-offender shows

signs of reoffending, s/he is held

accountable to the volunteers.

• The core member must abide by

conditions imposed by the court,

avoid high risk behaviour and

communicate honestly with the

circle members. This inner circle

of volunteers is supported by the

specialist expertise of an outer

circle of supportive community-

based professionals, for example

psychologists, prison officials or social

workers. Evaluation has shown theprogramme to be highly successful

in reducing sexual re-offending in

comparison to control groups.

• What’stheinnovation?People

in the community, if supported in the

right way, are valuable resources in

helping integrate excluded groups

integrate into their communities

- even sex offenders, perhaps the

most excluded group of all. The

programme has demonstrated that

holding people directly accountable

to their own communities is an

effective preventative method.

Additionally, public fears can be

assuaged by involving the community

in the rehabilitation process..

• Whatcanbelearnedromthis?

With the right support in place,

communities are willing and able to

offer effective voluntary support to

some of the most challenging issues

facing their communities.

COMMUNITYCOACHESINBRADFORD-CHELLOWS

CIRCLESOFSUPPORT,CANADA

Could you imagine

approaches like these

making an impact in

your area?”




42

CONCLUSION

Thereareno‘quickxes’oramilies

strugglingwithmultipleandcomplex

needs.Itisocoursepossibletohelp

solveorbringundercontrolsome

immediateissues(eg.debt,housing)

withinrelativelyshortlengthsotime,

butresolvingendemic,evengenerationalproblemsrequiresintensive,sustainedand

sometimesconstantlyrepeatedwork.

CONCLUSION



43

The EssexFamily prototypes sought

to address these issues robustly,

mixing what they knew from evidence

about “what works” whilst testing

out and constantly reviewing the

implementation of their plans

within their localities. They used the

EssexFamily Principles as a compass,

to hold them true to the course of

genuine innovation whenever it

seemed as though there was the

potential for things to veer off course.

The prototypes had different starting

points and developed at different

rates. It is not therefore possible at this

stage to compare directly the progress

that they made in terms of outcomes

for families: to date one prototype

has worked with nearly 50 families,

some of whom have successfully left

the programme, whereas another is

working with its first cohort of 10. Sites

are still collating evidence of impact;

forthcoming external reviews will

enable analysis of costs, benefits and

value for money over time.

Localities have had to address very

practical issues, such as securingappropriate interventions in a timely

manner once families' needs have been

identified. For example, non-clinical

emotional health & well-being and

mental health issues were extremely

prevalent (affecting 85% of cases

in Harlow, for example), and getting

access to intensive or specialist

(high tier 2 and tier 3) interventions

remains a constant headache for

the EssexFamily prototypes. Getting

local commissioning right will be an

absolutely key factor in successfully

addressing families' needs in any

locality. But it is not the focus of this

document.

Our intention here is to learn from

the prototypes about what it takes to

innovate, the practicalities of getting

programmes like this to really work onthe ground, and what are the things

that can get in the way or slow things

down. Here we have sought to shine a

light on the approaches and practices

that are perhaps less visible, that lie

below the headlines, but which can

substantively alter business-as-usual

on the ground. These are the things

the EssexFamily teams wish they

had known before they'd started, or

that they'd like to pass on to those

following after them:

“Ithasbeengood.

Mumdoesthingswith

menow.Lastweek

Mumhelpedmewith

apuzzlegame.Wedid

ittogetherandthen

Ididitonmyown.”

Alex, aged 11




44

RELATIONSHIPSWITHFAMILIESAREEVERYTHING

The non-punitive, voluntary form

of engagement is very important in

establishing a totally different picture

of power and ownership. “The bond of

“trust” between the Key Worker and

the family is vital to the effectiveness

of this approach” (Harlow Evaluation).

Every single aspect of contact with a

family (letters, face-to-face meetings,

how meetings are recorded) reflects

and reinforces the nature of that

relationship, so the rejection of tick-

box assessment processes done “to”

the family, and replacement by rich

dialogue with the family is critical

in invoking empathy, encouraging

reflection, and giving ownership. It is

hard to over-emphasise how different

this feels to families who have often

been on the receiving end of many

public services.

Do you know how your families feel

about the services they have been

offered to date? What has the impact

been on their trust and confidence

in “the system”? Do your frontline

practitioners know what it feels like

to be in receipt of their services?

Giving families physical ownershipover assessment records, goals,

meeting notes etc is a powerful

symbol of changing the locus of

control, and reminds both family and

practitioners that responsibility lies on

both sides of the relationship.

ASSET-BASEDAPPROACHES

The deficit approach, in which the

public sector identifies incapability

and sets out to fix it, builds

dependency. The localities all took

starting points that sought to identify

strengths, energies, aspirations

and capabilities in families, and to

build on them. They did this whilst

maintaining a sharp focus on issues

like safeguarding: the two are not

mutually exclusive.

Do your services start with what

families can do rather than what

they can't do? What would have to

change about the way your services

are run to make this the reality?

CROSS-AGENCY/SERVICERELATIONSHIPS

If services do not accept and support

your new ways of working, the

programme intentions and execution

can be undermined; embedding your

programme within the local system

is key. This can take significant time,

resource and effort: it is not a case

of telling people once what your

intentions are. Sites found that they

needed to invest explicitly in the

relationships with local agencies and

prioritise communication with them.

The quality of conversations

between professionals, especially

at the stage of identifying families

to work with, is important. Sites

found they had to discard the

old ways of making referrals and

create swifter, less bureaucratic

approaches that facilitated deep,

nuanced conversations in which real




45

intelligence could be shared. Getting

cross-agency sign-up up to formal

information sharing protocols (NB

requiring a huge investment of time)

was felt to be an important facilitator

of this in some places.

Beware of standard approaches to

cross-agency partnerships. It was notthat difficult to get most agencies

to provide a person to sit on a

governance group. But localities found

that this “support” did not necessarily

translate into any active engagement

on the ground: some agencies'

commitment to the programme did

not extend to putting in their own

resources to make things happen.

Teams found this frustrating, and

significant energy was expended

trying to get people truly on board.

The importance of getting senior

cross-agency buy-in to a shared vision

and shared ownership of outcomes for

families cannot be overemphasised.

Reflect on your cross-agency

governance arrangements. Arepeople genuinely committed to

shared objectives, best demonstrated

by pooling resources to achieve

outcomes for shared “customers”?

How honest are the conversations

around your Board table?

SKILLS

Innovation is not everyone's passion

or forte: it can often feel destabilising

and very disruptive. And it can be a

real challenge for those with a sense

of ownership in the existing system

to facilitate new thinking that could

ultimately undermine the very things

they have been working hard on

for so long. It is critical that projectteams contain people with confidence

and capability to think and work in

new ways, and can hold their nerve

when things get difficult (as they

undoubtedly will). If you do not have

these qualities to draw upon, then you

need to acquire them from elsewhere.

“Ittakesconsiderable

skillonthepartothe

KeyWorkertobalance

challengeandsupport,

andprogressivelyleadthe

amilytotakeownership

otheirownlivesandnot

looktotheKeyWorker

orall/everysolution” (Harlow Evaluation).

The approaches taken by the

EssexFamily prototypes have all

involved the deployment of very

different skillsets in working with

families. Existing workforces are

not necessarily equipped with the

capabilities and personalities to work

in these very different ways. New,

challenging training is required (and/

or the recruitment of new skills), and

existing measures of professional

practice and supporting management

processes may need to be significantly

altered.




46

Do you have leaders who are

comfortable with disruption and able

to hold people on course even when

challenging the very system in which

they exist? How will you ensure that

vested interests do not water down

or sidetrack efforts to innovate?

Does your system support andincentivise use of the skills the

EssexFamily prototypes have

deployed? What would it take

(training? support? measuring

different success criteria?) to embed

relational models of frontline

practice in your locality?

LEADERSHIP

The EssexFamily teams have been led

in very different ways, supported by

some radically different permissions

from the most senior leaders in Essex.

License to work differently has been

given, and given over and over again:

the gravitational pull back to the

“usual” way of doing things is very

strong and needs active avoidance.Leaders have been prepared to

operate outside the narrowest

definitions and boundaries of their

jobs, understanding and supporting

the taking of calculated risks.

How will leadership in your area

need to change if it is to support

this type of work? Where are the

tensions likely to occur? What risks

will need to be managed?

TIME

“Prepareorhardwork.

Ittakesalongtimeto

changeasystem.”

Our localities were all surprised

by the time that is needed to re-

think and re-design how services

work on the ground; many team

members were expected to continue

with their “day jobs” alongside

running the innovation programme,

and therefore progress often felt

agonisingly slow. Senior leaders need

to demonstrate commitment to doing

things differently by freeing up time

in people's diaries, and by ensuring

there is sufficient resource committed

to the project. Patience is important

too if we are genuinely interested in

reflective practice and prototyping

things properly to stress-test models

in order to reduce risk of failure later:

the pressure to “just get on and roll

out the new thing” (whether or not

we're really confident that it will work)

is very high.

How could you free up resources to

support more substantial and faster

work on systems change?

Are you committed to stress-testing

models before roll-out?




47

There is still a considerable amount

of work to be done to sort out the

recurring problems in public services

that we know get in the way of

providing transformative supportfor families with complex needs.

Agencies remain too siloed; budgets

are not pooled; information is not

shared; there is resistance to working

closely together born out of having

differing objectives, independent

measures of success, and often a lack

of trust. The EssexFamily prototypes

have demonstrated that it is possible

to overcome some of these issues,

through casting a better, alternative

vision; through demonstrably different

leadership priorities; through dogged

hard work and showing tenacity

like steel; and through courage and

showing patience over time. They

continue to battle institutional

resistance in places: the work is not

done and dusted.

But solving institutional problems like

these will not necessarily transform

the experience of families on the

ground: it is perfectly possible for a

joined-up, budget-sharing, trustedpartnership of public services to

deliver top down services that

maintain dependency and keep control

outside the family. We must look both

at how our services are configured

organisationally, but also how they are

experienced on the ground.

The EssexFamily prototypes have

made clear that it is possible to build

relational models of care, in which

power dynamics are acknowledged

and control is explicitly placed into the

hands of the family: through changing

the beliefs of frontline practitioners,

through the use of very different tools

to engage families, assess needs, and

make plans of action. Some of the

simplest of changes (such as letting

the family tell its story in its own way;

sharing the notes of a meeting with

the family before they are formalised;

asking the family to assess its own

priorities) significantly change theway a family feels: they change from

passive (and sometimes resistant)

recipients of public service efforts to

become active participants in activity

to create a better future. It is their

beliefs and behaviours that need to

change (to prioritise school, to get a

job, to parent more authoritatively, to

manage money more effectively) and

therefore they must feel ownership

over the project, and invest their

own ambitions and energy to achieve

success.

Sir Harry Burns, Chief Medical Officer

for Scotland has noted empirically

that patients who perceive more

“control” over their lives make faster

recoveries from surgery than those

who don't, even when controlling for

diet, underlying health, poverty etc.

To fix health inequalities, he argues,

“We must not concentrate on deficits

but on assets, skills and capacities. Wemust build social capital so individuals

can offer each other friendship and

mutual support.” This assertion makes

total sense, and is relevant to a wide

range of policy areas, not just the

needs of families with multiple and

complex needs. There is huge, as-yet

untapped potential for radical change.

But to grasp the opportunity we

will need to embrace the significant

implications for what public services

think and believe, what we resource,

how we behave, what we measure,

and what we should count as •success•.

There is a long way to go.

.



“Thishashelpedme

inawaythatnoone

elsehas.Iamgiven

waystogetoutothe

house,Iamableto

ocusontryingtosort

myselout.”Sally, Harlow

CAN Mezzanine

49-51 East Road

London N16AH

www.innovationunit.org

essexfamily final report (june 2013)

Documents