West Midlands, NESS Workshop - Sharing Findings Start Mainstreaming Pilots by Geoff White, SQW 19th July 2005 NATIONAL EVALUATION OF SURE START

Contents 1) Mainstreaming – general 2) Mainstreaming – multiple providers a)Integrated or unified model b)Co-ordinated model c)Federated network model 3) Transition from pilot to mainstream change 4) The role of monitoring and evaluation 5) Constraints on service providers 6) Overcoming the constraints 7) Focus for evaluation

1) Mainstreaming - general Service improvements targeted by the pilots  Policies  Redirecting resources  Reshaping services  Extending & improving access Pilots Clients mainstreaming  Integration, extension, infrastructure, preparation  Test-bed for more widespread change  Innovative, risky & counter-cultural

Joining up resources, cultures, practices & activities integrated  coordinated  networked 2) Mainstreaming – multiple providers Mainstreaming pilots – service providers HealthEducation Social services Pilots Clients mainstreaming

Multiple service providers Achieving steady state in the joining up of resources & activities Target clients Model 1: Unified, horizontal linkage, co-location and/or integration 2a) Integrated or unified model

Multiple service providers Achieving steady state in joining up Target clients Model 2: Formal co-ordination – synchronised training, standardised referral & information sharing protocols - some co-location 2b) Co-ordinated model

Multiple service providers Achieving steady state in joining up Model 3: Network within a coalition - federated structure – with single provider in the lead 2c) Federated-network model Target clients

3) Transition from pilot to mainstream Risk Reward High Low ABI 1. Continuity funding 2. Applied in targeted way 3. Absorption of good practice 4. Scaling up 5. Steady state mainstreaming

4) The role of monitoring & evaluation  Making an evidence-based case for change to service providers  Acknowledging the broader implications – this is not just a “project”  Considering process as well as impact outputs and outcomes  Engaging the providers and generating learning materials – a legacy  Recognising the constraints on providers and addressing them in an appropriate vocabulary

 Provider capacity constraints – partnership overload  Provider risk aversion – preserving scale economies  Short-termism – competing pressures  Incompatibility of targets/priorities – equity issues  Local authority constraints – political & governance  Information deficiencies – need and supply  Vertical disconnection within single provider  Horizontal communication failure between providers 5) Constraints on service providers – the evidence from the mainstreaming pilots

6) Overcoming the barriers – what worked  Achieving consensus on the mainstreaming aim “we aim to improve existing services not create new ones”  Adopting strategic, focused & continuous approach “establishing fit with national and local agendas and priorities”  Securing a mainstream champion with clout “getting providers to take responsibility to identify problems & solutions”  Setting up structures & processes for innovation “engaging partners & clients transparently through existing networks”

6) Overcoming the barriers (contd)  Providing resource & support to front line staff “clear definition of roles, training & operational guidance, peer support – team working – networking, systems – tools - protocols”  Making the case for change in provider ‘language’ “focus on how change enables targets to be achieved more efficiently”  Learning & disseminating lessons & good practice “leave something behind – a legacy – protocols, guidance manuals” “pro-active and evidence based promotion of mainstreaming lessons”

7) Focus for evaluation  Costs and activities, outputs and outcomes at different volumes and for different client groups  Nature and extent of achieved integration & issues of scaling up  Development of capacity – strategic partnership leadership, multi-professional & multi-agency management of delivery chain and at front-line  Reliable risk management – taking account of multiple & diverse needs, addressing weak links in & between delivery chains, harmonising & sharing of cost and other information  Outward and engaging perspective – providers, users & potential users and their communities