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ryantunnardbrown
service development : children and families

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MN&S Seminar London 15 November 2001
hosted by Research in Practice and RTB

Lessons from:

• BARKING & DAGENHAM
• HAMPSHIRE AND FROM GLOUCESTERSHIRE
• THE NORTH-EAST
• SUTTON

David Ward
Service Manager, Commissioning & Quality Assurance
 

Audits done
 

• All referrals to SSD - we did this audit following a poor joint review and as a service planning exercise to give management control over some key issues.
• Looked-after children and children on the child protection register - this was prompted by the need to understand why there had been a growth in the number of looked-after children and a simultaneous drop in the number of children registered. We wanted to scrutinise the thresholds in operation.
• Disabled children - we did this take stock and develop a more co-ordinated approach to responding to needs.

• What we discovered

• Very high levels of need.

• The ‘service’ provided to children and families more often than not was a social worker – there was no inter-agency activity and a lack of preventive services.  We need to think about how we can increase preventive services and as a result of doing the audit we have shifted resources from day-care to family centres which can better target children in need.

• Adolescents were over-represented in the looked-after sample which reflects the lack of appropriate preventive services for them, an issue which we are now addressing.

• The evidence about the high levels of domestic violence in families in contact with social services has enabled us to get money from the Home Office for a Domestic Violence co-ordinator.

• We have three Sure Start projects in our area and are due to receive £1 million from the Children’s Fund.  We want to develop services with the voluntary sector rather than focusing on social services providing all services.  The MNS work will inform the criteria for bids for services funded by these initiatives.

• The audit showed us that looked-after children were spending long periods of time in the system and their needs were not necessarily being met while they were there. Partly this was about children not being placed in a suitable placement and partly it was related to children being placed long distances out of the Borough. The evidence enabled us to persuade Members to pay higher foster care rates and this has improved our recruitment of local foster carers.

• The audits, although not inspections, have raised practice issues. The importance of our staff was emphasised and the evidence from the audit has informed our thinking about how we can best support our staff - for example, b providing mentoring and coaching for staff implementing the Assessment Framework.

• The audit showed that although we are using the LAC/AF materials better, information is still largely recorded as narrative and we are a long way from staff being clear about identifying needs and outcomes, which still makes it difficult to tell whether needs are being met.

• MNS provided valuable information about the thresholds that were operating in our services and this has provided important evidence for negotiations with members over increased resources.

• The disabled children’s audit was genuinely inter-disciplinary reflecting good joint working and joint planning.

• Although the process takes a week for staff who get involved they all say what an enormous amount they get out of it and are very energised by the process.  They want to take things forward and get actively involved, together with parents, in the service planning process.

MNS is important in informing thinking and discussions. Each audit cost about £5,000. The audits did not produce any surprises but they have been important in enabling us to gather local evidence. This activity is worth doing only if you can use the evidence provided to improve outcomes for children.
 

For more info - [email protected]

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LESSONS FROM HAMPSHIRE AND GLOUCESTERSHIRE

Moira Swann
Assistant Director, Children and Families, Gloucestershire
 

Audits done
 

• Children newly accommodated
• New referrals to social services
• Children with disabilities

• MNS has helped me tackle difficult issues about the planning of services in both Hampshire and Gloucestershire.

• The audit of children with disabilities was particularly helpful in highlighting the importance of involving other agencies and also children and families. It produced better evidence about need than we had before and has added value because this is evidence produced by local practitioners. It has proved useful, too, in making the case for resources, including the appointment of a development worker for new domiciliary services, building on the needs identified in the audit.

• The other two audits confirmed what we knew anecdotally - that huge amounts of money were being spent on patchy residential services for adolescents. We have used Quality Protects money to begin to address the inequalities we found. In Gloucestershire we are trying to divert money spent on out-of-county placements into local services for our children. The Invest to Save Strategy would help with this. the application of MN&S is an evolving process.

Over time I have become more relaxed about mixing and matching - about taking from the audit work what I can use to move us along and make the changes that are needed.
 

• All is not necessarily lost if an audit has been collecting dust on the shelf. Audit information from 3 years ago is now being used to reshape services and is giving us the opportunity to take a long-term view by conducting some audits into specific aspects of our work. In particular, we are drawing on past audit information to plan for Sure Start and Children's Fund money, and to inform our Best Value reviews.

• MNS audit and development work require tenacity and flexibility, a commitment to keep going, an appreciation of the importance of continuous improvement in service development, a balance of qualitative and quantitative evidence of children and families' needs, and an ability to step "outside the box" when thinking about the future.

• It's important not to forget that internal services are also costly. Audits can help you look at the whole system and get a clear understanding of the range of needs we have to provide for.

Moving from one authority to another has made me realise the importance of having a champion for MN&S work - follow up work tends to dip if important people move on without being replaced. Another key message is that the real challenge begins when the audit is done. It's about creating a framework for making use of the audit information, and managing the change as we move from one sort of service response to another.
 

For more info

[email protected]

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LESSONS FROM THE NORTH-EAST

John Brown
Quality Protects Officer, Gateshead
 

Audits done

A variety of audits have been done in Newcastle and across Tyne and Wear:
 

• A combined audit of children in need referrals and children newly looked after
• Children with disabilities
• Children in external placements
• Children in external placements from across Tyne and Wear

• Audits have the potential to inform out-of-authority commissioning, the development of diversionary services for children likely to become looked after, and the planning and development of inter-agency family support services for a locality.

• The audit process needs time to get it going. Persuading other agencies to get on board can be harder than anticipated but is time and energy well spent.

• The information produced by an audit is more than an authority has had available in the past, although there are still gaps. There is a danger that agencies - especially if they have not been involved in the audit itself - get diverted into wanting more and more extra information before moving on to planning and implementing services. Good analysis of the audit data can help avoid this.

• The process needs a motivated "key driver" within the lead agency to champion the work.

• Audit work is an important learning process for the staff involved and we need to think about better ways of passing on that knowledge and understanding to other colleagues and new staff.

• It is particularly hard to decommission a service and create a new one without clear evidence that the new service will be more effective, even in the absence of evidence that current services are effective. Evaluation is needed for both existing and new services, so that practitioners can help build up the evidence base for their work.

[email protected]

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LESSONS FROM SUTTON

Kevin Dillon
Strategic Development Manager

Toby Price
Service Manager, Family Support (Young Children & Children with Disabilities)

David Worlock
Executive Head of Services, Children and Families
 

Audits done

Two multi agency audits:

• an audit of looked after children, and
• an audit of children in need in the community

• The structure provided by the MNS work had enabled to increase coherence and reduce complexity. It has given us a more systematic approach to planning by:
• finding out about the nature and extent of need in the community
• agreeing the outcomes that existing and new services should achieve
• researching what services are most effective
• (re) designing services on the basis of research evidence
• evaluating the effectiveness of service developments

• At present we are concentrating on service design for four need groups arising from MNS audit work:
• Family conflict – where the conflict is between parents and their adolescent children
• Parental substance misuse
• Loss and trauma
• The need for significantly improved parenting

• Two new services are in place as a result of this approach - for family conflict and substance misuse.

• Two other services will soon be in place to help improve parenting. For families with good attachments where there has been a difficult life event, Webster Stratton parenting programmes are to be run by primary care professionals from health and education who have had joint training. For families where there are chronic difficulties, including serious attachment problems, a joint service will be provided by CAMHS and the SSD, from a community Family Centre base.

• There are clear links between MNS work and Best Value reviews. Challenge, Compare, Consult and Compete should underpin improved services. MNS provides an excellent vehicle for demonstrating the concept of Challenge.

• Using BV and MNS together produces the best of both worlds. MNS helped us secure cross-agency commitment and planning structure, and BV links into the political process.

Planning is a complex activity because it involves several service providers and a range of specific policy initiatives. We used not to have good information about need to inform our planning. The information is better now, as a result of the MNS work.

The difficult challenge is how to turn that information into real service developments and improved outcomes for children? This is what we've learnt from trying to meet the challenge:
 

• It's important to have partnership working from the outset – to include politicians, decision makers and parents.

• Have a senior management team that only includes people who can make decisions.

• Adopt a shared vision and a systemic conceptual framework (evidence based/outcome led) which informs and drives all aspects of business – this is crucial when you have no money.

• Commitment to change and to continuous improvement overcomes all obstacles (you need this when difficult decisions have to be made, such as   decommissioning posts to create new ones).

• It's too easy to say "we don’t have the resources to do this". In reality, the lack of resources makes the above approach even more crucial.

• Even with low-level resourcing, it's possible to start to bring about real change and provide a solid basis for further service development when opportunities for increased funding occur. (We are clear how Sure Start and Children’s Fund monies will be spent when our turn comes for being included.)

• It's exhausting work – you still have to make sure CP reviews are done on time etc. Nevertheless, it's crucial to get it right. Outcomes, not number crunching, is what we all need to focus on, including the DH and SSI.

• We need more sharing of the experience of those who are taking and evidence based/MNS approach to service development.

[email protected]
[email protected]
[email protected]

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