Making a difference to children, young people and families

What now happens differently for children, young people and their families as a result of your actions?
What were the outcomes? This might refer to national indicators for example

As a result of our actions, there have been reductions in the number of parents experiencing mental health problems and the number of children at risk, as shown by the clinical tools and other measures:

1 There was a statistically significant improvement as measured using the Kansas Parental Satisfaction Scale (t=-7.4;p=<.001) with the improvement maintained to a statistically significant level six months after the intervention (t=-4.2 ; p=<.001).
2 Using the Index of Family Relationships, there was a reduction of 22 per cent in the number of parents with clinically significant problems, although the percentage of parents with severe mental health problems remained the same.
3 There was a statistically significant reduction in the number of children on the child protection register (t=4.40; p=<.001) and in the number of adults on the Care Programme Approach (t=7.41;p=<.001).

Evidence from one health visiting area, using the Health Needs II tool to assess vulnerability, suggested that the intervention of Building Bridges had contributed to halving the number of vulnerable families on their caseload.

Feedback from one parent in particular shows the positive effect Building Bridges has had:

Her 8-year-old son had “gone to bed one night and then he woke up and I wasn’t there and I was in hospital for 3 or 4 weeks. That left quite a bad effect on him.” Not surprisingly, her son was angry with her and also reluctant to leave her to go to school. He also found his mother’s behaviour frightening when she heard voices and didn’t understand why sometimes she wouldn’t leave the house.
“The family support worker helped him understand what was going on and that it’s not just this house where this happens, there’s other people who has this.”

Other parents and children felt that the Family Support Worker had become almost a friend:

“He looked forward to her coming, he really enjoyed her company and looks on her as a family friend. She played with him and played games with him and did puzzles with him. He trusts her.”

“At that time she was the only friendly face who came into my house, I felt I could tell her anything and she would understand.”

“It was good just sitting down and talking. I had psychology service things but I didn’t want to always talk about my life on and on and on. Like she was there just like a friend, it wasn’t like an interview, or a psychology session, but just talking. And she could relate with me because she was a Muslim, she wore a scarf, we both could understand. It wasn’t that important, I get along with
anyone, but I just felt more relaxed and closer to her.”

What now happens differently for the services involved?

Feedback from other agencies show the contribution Building Bridges has made to families:

“We particularly appreciate that they work with families where children are on the child protection register as many other voluntary agencies don’t. They’ve also been core group members.
They are good at re-referral when there are more issues than initially thought and then joint working with us. We don’t worry that things are being missed and we’re confident about the quality of their work.”
Social services manager

“Building Bridges works with those who are the hardest to engage with, who aren’t motivated to go to a parents’ group or whatever. When we agreed to fund them we agreed they would start with the harder to reach families and that’s what they’ve delivered.”
Manager

“They fill a real gap in children and mental health services who only deal with very serious cases and there are long, long waits for services. Where I’ve asked parents how they’ve got on they’ve been very positive. It means they’re not making these demands on GPs. It does the trick from my point of view, relieves me of a major burden, it definitely makes a difference to my workload.”
GP

“Since Building Bridges started our caseload of families needing intensive support has reduced. We’ve noticed a huge difference in caseload and that can only be because of Building Bridges.”
Health Visitor

Which of the changes will you maintain to sustain your achievements and how will you do this?

Sustaining the achievement will mean ensuring the service is recommissioned. In addition we believe financial sustainability of Building Bridges is justified by the cost benefits to society listed below:

1 The Building Bridges team normally comprises three to four paid NVQ Level 3 qualified staff working with a qualified social worker. A typical contract would be for between £120,000 and £150,000 a year to work with up to 40 families where an adult has a more severe or enduring mental problem for intensive periods of between three and six months. This works out at an average cost of between £3,000 and £4,000 a family.

2 The cost of a foster care placement alone for one child is £489 per week (The House of Commons Children, Schools and Families Select Committee, Spring 2009).

3 The average cost of accessing mental health services is just over £2,000 a year and with the cost of employment lost through poor mental health, just over £9,000 a year (King’s Fund, Paying the Price, 2008).

4 A study for the Ministry of Justice examined data collected through a detailed examination of a random sample of court files relating to applications made in 2004, in 15 Family Proceedings Courts (FPCs) and 8 county courts (Care Centres) (Masson et al., Research Summary 1: Care Profiling, March 2008). In almost a third of cases (31 per cent), including those not resulting in a care order, the mothers had mental health problems. Nearly 60 per cent of cases involved children under the age of five years and 25 per cent of all applications involved newborn babies. 75 per cent of the cases involved neglect as a basis for the action, 45 per cent physical abuse, and 60 per cent of cases resulted in a care order. Only 8 per cent resulted in no order or action.

5 Last year Ofsted revealed that large numbers of young children were being excluded from school because of aggressive and sexual behaviour resulting from their complex and disadvantaged backgrounds. The National Behaviour and Attendance Review has estimated that the cost of permanently excluding a child from school could be up to £300,000. These include the cost of educating the child elsewhere and the bill from deploying services such as social care, benefits and probation service. The estimated cost to the individual ranges from a reduced chance of securing stable employment to the risk of getting involved in crime and substance abuse.

If you are not yet sure what difference has been made, what new measures could be introduced, or what could be improved, to allow you to determine the difference made?

Evaluation

How have you evaluated progress against outcome measures?
How have you evaluated the improvement in outcomes for children, young people and/or families?
Do you have any information on the cost of your programme? This would be really useful information for other areas who might wish to implement a similar programme.

Please provide evidence of the learning that has occurred, of how systems have changed as a result of the practice being implemented, and of how outcomes have improved.
We are interested to hear about how you have evaluated the practice and how you have encouraged feedback from children, young people and their families. The results of this feedback and evaluation can include external evaluation reports, internal reviews, children, youth or parent feedback surveys, other surveys/data, anecdotal evidence, budgetary and/or statistical information, and plans/timelines.

What ‘hot tips’ do you have from your experience for others?

We are particularly interested in any barriers you encountered and how you overcame these and in your views regarding the potential for replicability of your practice example.

Analysis of interviews with project managers and support workers indicates that the Family Action projects exhibit characteristics which have been found to be key to successful interventions. These include: close attention to ‘getting’, ‘keeping’ and ‘engaging’ parents; a strong theory base; more than one method of delivery; and working with both parents and children. This conclusion is confirmed by the very striking positive feedback from both other agencies and from parents themselves about the work the Building Bridges projects does.

In the 2007 evaluation of Building Bridges only five out of 31 parents interviewed expressed any degree of dissatisfaction with the service provided. The overwhelming message from parents was their appreciation of practical support, support to their children, and in particular the warmth and understanding of Family Support Workers. They thought that Building Bridges helped prevent a deterioration in family relationships, helped their children to understand about mental illness and assisted in their relationships with other agencies.

Analysis of the quantitative data from this evaluation indicates a statistically significant improvement with parents’ satisfaction with their family relationships and with their parenting over the time that Building Bridges projects were involved with families.
For children, there was a statistically significant improvement in levels of depression amongst children aged 11 and under.

The complex evaluation of Building Bridges services was important to Family Action in informing the organisation what it needed to do in terms of investing in data management, reviewing its performance management processes to embed tasks associated with monitoring and evaluation, and how evaluation should be resourced more generally. An updated monitoring and evaluation system will be implemented by Building Bridges and other Family Action services from this spring.

Further details of the evaluation can be found at
http://www.family-action.org.uk/uploads/documents/FA%20Building%20Bridges%20Evaluation.pdf