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Think Family: Strengthening collaborative working between families

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1 Think Family: Strengthening collaborative working between families
Caroline Prichard and Lia Borgese Department for Children, Schools and Families

2 Developing the potential of parenting and family support to improve child outcomes
We know that evidence based parenting programmes work and have lasting effects in improving behaviour even in cases where parents are initially reluctant to receive help. A review of evidence based parenting programmes by the National Institute of Clinical Excellence shows significant long term effects in improving children’s behaviour (of between 1-10 years). Despite this: Problems with supply and availability Agencies don’t refer Or don’t refer early enough Targeting & reach Issues about quality of practice Parenting programmes can make a big impact on a child’s outcomes. However, there are problems around parents accessing evidence based programmes and linking in with the right service to make sure that parents are referred at the right time and supported to attend.

3 So what are we doing to expand parenting and family support?
Three main strands of activity: Supporting local authorities to develop parenting support Developing the workforce Increasing targeted provision Government set out its vision in the Children’s Plan one year ago. The Children’s Plan was published after extensive consultation and discussion: - held events across the country at which parents and professionals debated the issues affecting children and young people. We invited children and young people to participate in discussion and held an online consultation to gather views. The Children’s Plan set ambitious Goals and clearly stated principles around improving the support for parents and families. - and an update on how the Department is doing so far in implementing its goals is due to publish in the next few weeks. We also want to improve the way services engage fathers. Children can benefit enormously from having strong relationships with their fathers. Yet public services often don’t reach out to fathers, particularly when the father does not live with the child.” (The Children’s Plan for Parents and Families)

4 Supporting local authorities
In 2006 LAs asked to appoint single commissioners of parenting support and to develop a parenting strategy by March 08 Majority of LAs have strategies in place and are now moving to an implementation phase Parenting Implementation Project to test effective practice in developing parenting strategies to develop a national framework for all LAs Local authorities are expected to provide parents with a continuum of support from information and advice through services offered in the Family Information Services through to more intensive/enhanced support for the most disadvantaged families. When this document was published, local authorities were also given an average of around £50,000 (depending on the size of the LA) to help them get the right people together to develop their parenting strategy. The Parenting Strategy identified the gaps in support in their local areas, and how the LA would make sure that the needs would be met. Ie identifying specific groups to target, or improving access to services. The guidance also asked LAs to identify a parenting commissioning who would take the lead to ensure that these services are being offered to families.

5 Supporting the workforce
The National Academy for Parenting Practitioners Mission - To transform the quality and size of the parenting workforce across England so that parents can get the help they need to raise their children well Training in evidence based programmes & skills needed to work with parents – training starts this month Provide ongoing support to practitioners; through individual and group consultancy and online services. Developing the evidence base Plus feeding into wider workforce development e.g. Children’s Workforce Strategy for 2020 We have been working very closely with the NAPP which was set up a year a ago to agree their strategic plan for delivery over the period of the grant. They have selected the programmes which have the evidence based so that we can be confident that they work. They are also currently collecting information from other parenting programmes that are being used extensively in the UK, to see if there is sufficient evidence available to be confident that they work. They have held a series of regional events for LAs to discuss the free training offer. They are providing training for Parenting Experts and staff that work in children’s centres and extended services. LAs would need to speak directly to NAPP about this offer. They are also providing advice to LAs and DCSF about parenting training for specific families at risk linked with programmes funded by DCFS eg PEIP, FIPs. Has been a bid challenge, but we are seeing good progress in all these areas.

6 Increasing parenting and family support services across a spectrum of need
Increasing needs Early signs of risk High Needs Parenting programmes Whole Family Support Parenting Early Intervention Programme Parenting Experts Family Intervention projects Family Pathfinders Of course some families need more than help with parenting and this needs to be one element of ‘whole family’ support This slide identifies the programmes that DCSF is funding to reach families at risk. It demonstrate the continuum of support being offered from early intervention to high need families. These are described in more detail in the next slides. They are being offered across a number of LAs, but there is not full coverage at the moment. The programmes offer support in terms of parenting classes for children that are identifying the earliest signs of risk, right through to an intensive multi agency package of support for the most high need families. At the high needs end, we are looking at whole family support. The PEIP increased the pool of trained facilitators, approximately 1100 additional trained staff. PEIP provided parenting training for 3575 parents on 425 courses. The training was very successful as measured by improvements in the parents’ mental well-being, their parenting skills, their sense of being a parent, and also in the behaviour of the child about whom they were concerned. The PEIP almost halved the number of parents who classified their children as having significant behavioural difficulties. Changes parents reported included being calmer with their children, more confident in parenting, and giving more time to talking and listening to their children. They thought their relationship with their children had improved, as well as their behaviour, well-being, self-esteem and interest in school, although this was not universally the case.

7 But of course some families need more than just parenting support …
Too often parent’s pass their own problems onto their children, creating a never-ending cycle, generation after generation which becomes difficult to break. We are still not doing enough to interrupt inter-generational patterns of social exclusion. 63% of boys with convicted fathers go on to be convicted themselves Parental alcohol misuse is a factor in more than 50% of child protection cases (and there are 350,000 children with drug addicted parents/ 1m with alcohol addicted parents) 1:4 children witnessing domestic violence have serious social and behavioural problems Children from the 5% most disadvantaged households are more than 50 times more likely to have multiple problems at age 30 than those from the top 50% of households Evidence identified in the Cabinet Office Families at Risk review, highlights the difficult in breaking the cycle of disadvantage experienced by the most at risk families. Research has identified that you can predict a child’s outcomes by looking their parents situation. There are clear links between children’s outcomes and whether their parent are involved in crime, drug abuse or worklessness, for example. These predictions could be made even before the child is showing any at risk signs, as demonstrated by the statistics in the slide. Therefore, there is a strong argument to start to intervene early with these families to prevent disadvantage being passed on from parent to child. Rather than waiting for the first signs of risk to emerge in children, we could do more to predict future risk by picking up signals from the family as well as a child

8 Such as the 2% or 140,000 families with children experiencing 5 or more disadvantages
Percentage of families with children experiencing 5 or more disadvantages 2.2 2.1 2 1.9 2 % 2001 2002 2003 2004 2005 The consistency of this figure over 2001 to 2004 suggests that improvements such as the reduction in child poverty may not be reaching such families Basket of indicators of disadvantages includes: No parent in the family is in work Family lives in poor quality or overcrowded housing No parent has any qualifications Mother has mental health problems At least one parent has a long-standing limiting illness, disability or infirmity Family has low income (below 60% median) Family cannot afford a number of food and clothing items This impact on the children is event greater when there is when there are multiple risk factors at play. As highlighted in the Families at Risk review, we have predicted that around 140,000 families are experiencing 5 or more disadvantages. And although we have been introducing policies to support the most disadvantaged children through ECM, Child Poverty and the Children’s Plan, they do not seem to be making impact on these families.

9 Multiple disadvantage can cast a long shadow
This slide shows the impact on a child if they are experiences different number of disadvantaged. Those with 5 or more identified disadvantages are at high risk of getting trouble with the police, leading an unhealthy lifestyle or running away from home. Therefore, there is a strong need for services to respond in a different way.

10 “Every Child Matters is already transforming the way services are delivered for 0-19 year olds. ‘Think Family’ extends this model to include adults’ services and puts families firmly at the centre” Time to ‘Think Family’ ? Developed by the Social Exclusion Taskforce in their Families at Risk Review Reaching out: Think Family (June 2007) Think Family – Improving the life chances of Families at Risk (Jan 2008) Currently being tested by 15 Family Pathfinders Funding to help every Local authority develop the model from

11 What is ‘Think Family’ This extended the logic of collaboration from ECM to beyond children’s services Better co-ordination of all services to support families at risk Systems change Changes to delivery systems and workforce culture to ensure consideration of the family context to need Critical to earlier and more effective intervention with families at risk 15 Family Pathfinders testing how this might be implemented Whole family support Need for more provision to deal with risk in families and how it inter-relates Whole family support available at different levels Including very intensive support (building on the FIP model) for the most risky families Services need to Think Family. The service should be family focussed. Ensuring they identify the inter-relatedness of needs of different members of the family and tackled them together, linking up different agencies across children’s and adult services. This involves a change in delivery system and workforce culture through every level of local services. This is a major challenge. We know what we need to achieve, but have a long way to go to understand what this means in practice to get to a service that truly “thinks family”. We have identifies 15 Family Pathfinders areas who will be developing and testing this approach over three years. We will be learning alongside these areas and disseminating what we find to all local authorities, so that they can also learn from their experience. Six of these areas are also delivering extended services to support Young Carers.

12 Improving the response of services and systems to vulnerable families
Better systems for identifying and engaging families at risk (those with multiple and complex problems putting their children at risk of poor outcomes) Identification Whole family assessment Building on the CAF, which looks at the needs, strengths and interrelation of problems of the whole family Multi agency support plan Managed by lead workers who case work families, working directly with them and co-ordinating other service involvement Improved information sharing To enable early identification and interventions To ensure the full range of evidence based programmes and interventions to meet family needs Joined up planning & commissioning Builds on what has been achieved so far through ECM to join up all services that affect children, now need to make the next step to include those services which affect the whole family. In developing the Think Family approach, we have identified specific themes that need to be developed further. We are currently looking in detail at Whole Family Assessments and doing a specific piece of wok around identifying how we build on the work of the children’s CAF, and find a way of identifying the needs of each member of the family, and how they impact on other members. This is something that the Family Pathfinders areas have said they want to work on. Information sharing across different agencies, has been a particular concern raised by pathfinders. And this will be a increasing challenge as we aim to integrate adult services with children’s services. The Pathfinders are being independently evaluated by York Consulting. Integration between adult and children’s services At all levels of local services – such as clear accountability for families through joined-up governance to and a common vision and agreed outcomes for families across services as part of the LAA process.

13 Think Family needs to be part of the next phase of ECM reform
The ECM Framework ‘Think Family’ Integrated front-line delivery Multi disciplinary teams: ‘team around the child’ Lead professionals ‘Team around the family’ Lead worker for the family to coordinate multi-agency plan Integrated processes Information sharing across local children's services Common Assessment Framework Information sharing across children’s and adults services about family needs Whole family assessment Integrated strategy Single Children & Young People’s Plan Pooled budgets to support joint commissioning of services for children Single outcome framework C&YP C&YP and Parenting Strategy includes the contribution of adults’ services to family wellbeing Common vision and agreed outcomes for families Pooled budgets to support joint commissioning of services for families Inter-agency governance Director and lead member for Children’s services Duty to create LSCB Nominated senior lead to ensure clear accountability for outcomes for families Strategic leadership of TF (on CT board?)

14 Family Intervention Projects (FIPs)
A dedicated key worker with low caseloads who works intensively with the whole family. Taking a whole family perspective to assessment and the development of support packages. Use of a contract setting out the changes that are expected, the support that will be provided (building on strengths) and possible consequences if changes are not made. The use of persistent and assertive working methods. Effective multi agency arrangements (referrals panel, information sharing, agreeing the objectives of intervention etc). Accredited parenting programmes are delivered and services (such as health) are brought in and coordinated around the family. Nominated health professional (NHP), to signpost and make appropriate referral to health services. FIP have been successful in delivering whole families services and the family pathfinders will be learning from their experiences. The Family Pathfinders will be trying to develop this way of working but making sure that it extends across all services that work with families. This should have an impact, not just on the most as risk families, but on every family that comes into contact with services ie preventative services.

15 Recent evaluation shows the effectiveness of the model in tackling risk factors in families
Base: Families who completed the intervention (337) National Centre for Social Research monitoring system – based on FIP key workers views

16 Expansion of Family Intervention Projects (FIPs) to reach 20,000 families by 2011
65 Projects aimed at families involved in persistent ASB 2008 budget announced new projects aimed at tackling child poverty and inter generational worklessness. Youth Crime Action Plan announced projects to target families with C&YP at risk of offending in every local authority : 30 new projects National roll out over Number of Family Intervention Projects

17 Expansion of Family Intervention Projects to reach 20,000 families by 2011
New Models “Child Poverty FIPS” Announced in 2008 budget : 10 projects started in October 2008 Further expansion over (around 32 in total) Testing the model with families with multiple problems other than anti- social behaviour e.g. intergenerational poverty & worklessness, substance misuse etc Focus on specific types of risk in families e.g. prolific parental offending, domestic violence etc “Crime prevention FIPS” Announced in Youth Crime Action Plan A project in every local authority : 20 projects to start in January 2009. National roll out over Focus on specific age bands of children e.g. 0-5, 5-10, or 10+ Child poverty FIPs – working closely with National Treatment Agency to ensure FIPs know how to ensure parents receive treatment quickly. Ensuring treatment plans by commissioners reflect the need to prioritise FIP families. They are also ensuring treatment pathways and local screening protocols are clarified between FIP projects and treatment agencies and that, where waiting lists exist, FIP parents are prioritised And an expansion of Crime Prevention FIPs across all LAs. Funding allocations have been announced for As part of this roll out all LAs will also receive funding to develop the Think Family Approach over the same period. In time the various ‘FIP variants’ may merge into joined up intensive whole family support for families at risk

18 FIPs-health impact in families
80% of parents had poor health/mental health problems 47% of families affected by domestic violence, high number of children at risk High proportion of children with ADHD, emotional & other problems Over 50% of the children are obese and overweight, with very poor nutrition Role of the Nominated Health Professional - where health works well Participation on steering group and multi-agency panel; Effective communication between agencies & whole family assessment, including age appropriate children’s services; Links into teenage pregnancy, DAT, school nurses, GPs, psychologists, paediatricians, CAHMS and health visitors which help to create networks, nutrition and obesity prevention. Knowledge of commissioning and levers To come back to how these projects are delivering in terms of improving health inequalities. Important to get support with accessing health care, as we know that families that are referred to FIPs can experience significant health problems such as poor mental health, alcohol and substance misuse, a high proportion of ADHD and behavioural & emotional problems in children and young people, domestic violence and poor nutrition & high obesity rates. We recognise that ensuring access to health services for these families has not always happened quickly, however, we have committed to ensuring that all FIPs now have a dedicated health professional. There is currently partnership working taking place across a range of adult and children services including health visitors, school nurses, GP's, CAMHS, community paediatricians, teenage pregnancy units and drug action teams.

19 Where do we need to get to?
A integrated and appropriate service response to all families at risk How will this be achieved ? Joined up Family Intervention Project type provision sufficient to meet the needs of the most extreme families (whatever their combinations of problems) Changes in attitudes, culture and behaviour at local level and on the front line (achieved by ‘Think Family’, workforce reform and Children's Trusts) to identify and intervene early with all families at risk High Medium Low This slides sets out the challenge ahead – The Think Family across the all services. We need to have a fully integrated system to enable us to intervene early, and prevent further disadvantage through to working with the most at risk families with high needs, through intensive intervention projects. However – need to be realistic. This is a massive change process that will take significant investment and time to deliver. But the potential gains are huge


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