C4EO theme: Early Intervention
A multi-disciplinary approach to early intervention family support for vulnerable children and families, Hammersmith and Fulham
Themes this local practice example relates to:
- Families, Parents and Carers
- General resources
- Local area early intervention strategies
Priorities this local practice example relates to:
- Improving the safety, health and wellbeing of children through improving the physical and mental health of mothers, fathers and carers
- Improving children’s outcomes by supporting parental and carer couple relationships and reducing conflict within families, including domestic violence
Family Support Team - part of Early Years and Childcare Service
London Borough of Hammersmith and Fulham
The context and rationale
Background details to your example
The Family Support Team (FST) was developed and implemented in Hammersmith and Fulham using children’s centre funding to focus on targeted family support and the needs of children under 5 and their families. It has been operational since October 2007, but from October 2009 the age remit has expanded to include children aged between 5-13 and to link with the borough’s targeted youth service team, who support young people from the age of 13. The Family Support Team has been developed to provide a period of intensive home-based support for families who are either not accessing children’s centres or other universal services, or are vulnerable families known to be causing concern who would benefit from additional support.
The initial concept for the service evolved from a recognised need to target vulnerable and traditionally excluded families with one of the objectives that early or earlier intervention with these families should contribute to the eventual savings of more costly interventions that might be required through statutory intervention, e.g. child protection, and also improve life chances through educational attainment and well-being. The service originally supported the borough’s five Phase 1 children’s centres and is now involved in supporting and coordinating delivery with the 15 Phase 1-3 centres across the borough. Initially the team were supporting referrals of Tier 2 cases, but now increasingly Tier 3 needs and referrals are also being managed by staff.
The FST was set up as a multi-disciplinary team with co-location of health staff, including professionals from midwifery, clinical psychology, health visiting and primary mental health, and it aims to utilise the skills of a range of practitioners. In addition, the team has from its inception aimed to:
• Develop links with other agencies to allow for better identification of support needs and coordinated service delivery for families.
• Identify vulnerable groups within the local area who may find it difficult to access support.
• Support clearer referral pathways and lessen duplication.
• Promote the use of the Common Assessment Framework (CAF) to universal children’s services and FST staff as a positive and effective tool for assessing children who may have additional needs or require coordinated support from a range of agencies.
• Provide targeted family support that draws on parental engagement as well as family strengths and achievable outcomes.
• Promote a Think Family, inclusive approach to working with families where both parents and children may require support, and make links with relevant adult services.
The team is now co-located with the borough’s wave 3b Family Nurse Partnership (FNP). As families leave the support offered by the FNP, there will be a smooth transition to either the FST or local children’s centres. The team forms part of the early years and childcare service and again the co-location within this team strengthens the joined up approach to services for families in the 0-12 age range.
The FST also aims to assist in the borough objective of reduced the number of referrals and re-referrals into children’s social care and to develop an integrated approach to support, including statutory and voluntary/third sector partners and health services.
FST receive referrals from Tier 1 services, such as children’s centres, health services and schools, where families have been identified as requiring more intensive support, and from Tier 3-4 services, including children who may have been subject to a child protection plan and now require a lower level of transitional support to enable them to access universal services (step down approach).
FST aim to support children and families with emerging difficulties in areas such as parental mental health, family conflict, effects of poor housing and poverty, self esteem and emotional wellbeing, school-based issues, and other family crises.
There is widespread recognition of the importance of outreach to support vulnerable groups. This model is used in both the borough’s children’s centres and the Family Support Team, which employs a more intensive home visiting model, i.e. weekly visits, to engage and support families. It is understood that families may have anxieties or resistance to engaging with services and as a result the team only works with families who give their consent to support. The initial aims of intervention were for 16-week interventions and linking back to universal services, but, increasingly, referrals have become more complex or present with longer term issues in terms of vulnerability or complex needs, and interventions and support timescales have altered accordingly.
Further details about the practice
The Family Support Team accepts referrals from professionals working with families through the completion either of a CAF (Common Assessment Framework) form or the team referral form, and also from families themselves who may contact the team directly. In addition, referrals may come from statutory children’s services as part of a child protection plan, core group or identified need for ongoing support as high level needs diminish.
An initial assessment is undertaken by a member of the team identifying the needs of the family from the parent’s perspective, and from this a programme of support is developed, including Positive Parenting Programme-based one-to-one training, health visiting input, and child development and counselling.
The team will carry out intensive home visiting and outreach support with the aim of linking families back into universal support services, especially children’s centres.
Whilst the borough’s children’s centres have their own family support practitioners, their support is mainly at Tiers 1 and 2 and they are the first contact when transitioning parents from the FST into universal and targeted services, which vary from centre to centre. The FST is a centralised team of multi-disciplinary professionals to which children’s centre staff can refer vulnerable families.
The team is made up of:
• Deputy Manager
• Family Support Early Years Officer
• Social Worker and Senior Social Worker
• Family Counsellor (x2)
• Child Development Advisor
• Family Mentor (x2)
• Family Outreach Worker
• Senior Community Development Officer
• Integrated Working Advisor
• Connexions Teenage Pregnancy Advisor
• Health Visitor
• CAMHS Primary Mental Health Worker
The FST’s approach has a preventative focus through the provision of early intervention in respect of longer-term health, emotional, education and social problems. These may include mental health issues, drug and alcohol issues, and other physical and psychological health problems of parents or additional needs of children. The aim is to reduce vulnerability and isolation and to increase life chances, whilst also reducing the need for a range of health and welfare services over the course of a child’s life.
The FST has developed its evaluation model based on the five Every Child Matters outcomes in order to provide clear measures of success. Qualitative feedback from parents is gained through a short telephone evaluation at closure where they are asked to comment on their experience and give feedback on the following areas:
• Increased child development knowledge by parent
• Improved parental/child relationship
• Child’s resilience has increased
• Decrease in risk (child protection/domestic abuse)
• Increase in parental confidence/capacity
• Improved financial management
Enjoy and Achieve
• Appropriate play and stimulation
• Improved readiness for school
Make a Positive Contribution
• Decrease in isolation
• Improvement in child behaviour
• Increase in adult confidence/self-esteem
The team also look at:
• The level of appropriate referrals being made to the team, in keeping with the team’s remit to support mainly Tier 2 and 3 cases.
• Families’ geographical location in correlation to the Income Deprivation Affecting Children Index (IDACI) of the Index of Multiple Deprivation (IMD) 2007.
• Numbers of families linked into children’s centres or other suitable services at closure.
• Numbers of isolated families linked into children’s centres or other suitable services at closure
In addition, the team now play a central role in the borough CAF coordination which includes monitoring and quality assurance, advice and consultation, training and support in facilitation of lead professional role and multi-agency support plans. The team also provides support via the two year pilot and a practitioner is involved in supporting families through this provision; support is provided as part of the Child Poverty Pilot with a third sector provider in terms of advice and consultation and the team has recently taken on the coordination of nursery placements for vulnerable children (funded through Social Services) to ensure integrated early support as appropriate for a child’s learning and holistic development.
Evidence and evaluation - making a difference to children, young people and families
Evidencing your practice has made a difference to children, young people and families
Please see the evaluation section
As a result of the Family Support Team being developed and subsequently expanded in terms of staffing and remit, the following differences have been achieved for services involved:
• Promotion of the Family Support Team as a successful multi-disciplinary model that offers complete packages of support to families.
• Decreased pressure on the borough’s statutory child protection teams due to involvement of the Family Support Team with families, although since the team’s inception, referrals into local authorities have increased potentially as a result of issues Public Law Outline (PLO) and the impact of the Baby P. case which has been represented in other local authorities.
• Improved referral process between the Family Support Team and other agencies involving service overlap to ensure families are not left without a support service.
• Increase in integrated working with other professionals, resulting in joint working and ease of workload.
• Improved information sharing between agencies, resulting in early identification of any intervention that is not proving successful or additional support needed. This ensures that families receive appropriate and timely intervention.
• Regular evaluation of multi-agency working to reflect on any areas of improvements identified through casework reviews and service delivery with children’s centres.
• Increased links with the Primary Care Trust (PCT), resulting in greater information sharing as to the range of agencies available to support families.
• The team offers secondment opportunities to share knowledge of the team and develop skills in a range of professionals. This has been available to health professionals and has now expanded to social work staff within children’s services to encourage integrated working.
• Access to advice, information and consultation regarding referrals, interventions and services that support children and families across the borough.
• Improved confidence in the use of the CAF and in the role of lead professional by universal services as well as practitioners within the FST.
It is anticipated that many of the benefits that have been highlighted above will continue to be sustained and developed and that, as the team continues to evolve and it becomes more well-known within the borough, additional achievements and changes will be actioned. The team is currently in the process of devising a yearly action plan which is to include developments in the area of training to universal services, as well as some focused inter-agency partnership working on the specific areas of mental health, domestic violence, and working with schools.
The Family Support Team is still a relatively new service within the borough but is developing in its effectiveness in supporting vulnerable families, as well as being able to deliver a more robust set of interventions and support at an increasingly more complex level. The team has had a process of evaluation to measure difference based upon intervention, which has been focused primarily through the use of a feedback questionnaire at the conclusion of support. There has not been a consistently high return rate using this methodology and therefore the team has planned to implement a range of evaluation models and feedback which would include follow up with family and referrer 3-6 months after closure, monitoring referral rates back into service and developing a child friendly feedback process. This feedback will assist in individual family action planning as well as providing a more robust set of data to measure impact and service delivery objectives.
A new measure that will be introduced into the team from May 2010 will be the use of Strengths and Difficulties Questionnaires (SDQs) as a standard measure of effectiveness (to be used as an initial assessment/mid-point evaluation and at the completion of work). These can also be used with agencies such as schools now that the age remit has increased, with particular reference to children who may present with behavioural and emotional difficulties. This will also be suggested as a method that can be used by the children’s centres, and support in its implementation will be offered through senior staff in the team. Additional scales to be used will include scales such as the Parenting Daily Hassles, Life Events and Family Activity scales.
We aim to promote the CAF through training programmes in conjunction with youth service colleagues and through advice, support and guidance from integrated working advisors and senior staff.
The use of the CAF is becoming more widespread across the borough, but the team are keen to ensure more robust use of it as an assessment and service delivery tool. The FST team now plan to ensure that referrals assessed as requiring a multi-agency approach will be supported through initial Team around the child or Team around the Family meetings. The team will use this as the model of integrated plans of support and will support other agencies in using this model, e.g. chair and facilitate initial meetings, provide support with action plans, develop and deliver CAF-related training that supports that children’s workforce in developing confidence in the lead professional role and devising action plans that focus both on appropriate support and the strengths of the child and family. This model is also representative of the team and borough’s commitment to modelling a Think Family approach to supporting families.
The team intend to:
• Develop a joint pilot parenting group facilitated by the team’s two counsellors with a children’s centre and women’s refuge for women affected by domestic abuse.
• Develop a pilot model in conjunction with Children and Adolescent Mental Health Services (CAMHS) and adult services in working with children and families affected by parental mental health using a Think Family approach and the CAF.
• Develop and implement a model of reflective practice for family support staff within the local children’s centres, facilitated by the deputy manager, that will allow for the development of increased strong practitioner peer support across the borough and build on the practice already established. This will enable sharing of practice but may also aid in the identification of families that require a higher level of support and joint working, as well as considering areas of need that may require focus.
• Look at how the Family Support Team can be a part of developing a model of a step up/step down approach to support using the CAF/lead professional model as way of integrating support for children not subject to child protection plans.
• Develop and strengthen links with other teams in children’s services, e.g. education welfare, learning mentors, educational psychology, and transition team and head teachers.
• Develop a programme of training to partner agencies including topic areas such as risk and resilience, assessment in early intervention, attachment and loss. Additional training is being piloted in Team around the Child and lead professional to support practitioners who have taken on a CAF role within their agency.
Sustaining and replicating your practice
Helping others to replicate your practice
The work of the Family Support Team is assessed in terms of both qualitative and quantitative data. In terms of identifying what success looks like for the team, the measures set out below aim to ensure that quantitative data collected shows how the team aims to ensure it meets its remit to target and support families identified as vulnerable and who are finding it difficult to access or engage with services they need.
Impact of intervention by family support case workers is measured by:
• Number of families successfully linked into other services.
• Number of referrals coming from super output areas.
• Team working to case load capacity by supporting 60 families at any one time
• Number of visits made each month.
• Number of assessed referrals, which successfully identify and address families needs.
• Number of feedback forms which express positive responses to team intervention.
• Quarterly report statistics currently collected
Data collected since 2008 show that 68% of the families worked with come from the 20% most deprived families in the borough. This has remained at the same level for 2009. We have increased the number of families linked into universal services at closure, from 89% in 2008 to 93% in 2009. Our number of unplanned case closures has risen from 37% to 40% in 2009. This is a reflection on the increasingly complex nature of referrals that we are receiving.
Feedback received from parents after case closure has been largely positive and comments from parents include:
• "The worker was very helpful and friendly. Full of advice and knowledgeable. We now feel more prepared to face the future."
• "The worker was really excellent - a really good listener. Support was really good - always felt better after talking to the worker."
We also ask parents how we could improve the service offered, and seek to improve our practice in the areas identified.
The Family Support Team hold six-monthly review days with staff from the children’s centres across the borough. The purpose of these reviews is to look at the work of the Family Support Team over the previous six months and for the children’s centres to have the opportunity to give us feedback on how they have experienced our service. We are also looking at how we can improve the effectiveness of the review days, for example, asking children’s centres to complete an evaluation form before the review day.
We are currently developing a process for gathering feedback from other professionals as part of our evaluation process, as this is an area from which we have not been getting feedback, except by word of mouth. We are also currently developing an evaluation method for those children we work with who are old enough to give an opinion.
We have recognised that there is a need for a consistent way of measuring outcomes for families and, as a result, we will be implementing the use of SDQs with all of the families that we work with. We envisage that this will provide a useful comparison of families’ situations both before and after Family Support Team involvement.
The Family Support Team is aiming to continue to increase the use of the CAF across the borough as the preferred method of assessing need and devising plans for multi-agency intervention.
It has also been recognised that the following longitudinal studies may be instrumental in highlighting the long term effectiveness of the work that the Family Support Team undertake:
• Monitoring engagement in Tier 1 service after closure (at 1 month, 3 months and 6 months).
• Parents who reported improved parenting skills after the team input who could report continuing improvement at 3, 6 and 12 months.
• Looking at the EYFSP (Early Years Foundation Stage Profile) for children of families supported by the team.
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