Organisation submitting example
Children North East, Families Plus
Local authority/local area:
The context and rationale
Children North East was commissioned by Northumberland County Council through Action for Children in 2009 to deliver their Hidden Harm intervention. The initiative, known as Families Plus, delivers intensive support to families where there are substance misuse problems and where either children have been placed into local authority care or are at-risk of being removed from their families. The children are either subject to a Child Protection Plan or are Children in Need. Families Plus became operational in November 2009 when it started to accept referrals.
Background The service was established in November 2009 to tackle the effects of parental substance and alcohol misuse on children and young people, often referred to as Hidden Harm. The need for the service arose from the findings of the Advisory Council on the Misuse of Drugs’ Hidden Harm Reports (ACDM 2003 & 2007) which estimated there are up to 350,000 children of problem drug users in the UK. It is further estimated that up to 1.3 million children and young people are living with parents who misuse alcohol in the UK (AHRSE, 2004). Parental substance misuse causes serious harm to children at every age from conception to adulthood. Figures for Northumberland? Can you ask the submitter to insert please
Nationally, 75% of Serious Case Reviews (SCRs) have included Hidden Harm issues. In Northumberland there have been several SCRs over the last two years relating to parental substance misuse. There have also been increasing numbers of children being taken into the care system, who had to be accommodated outside of the county (at huge additional costs). These were the key drivers behind the need for the new service.
The aims of The Families Plus Hidden Harm Service are:
1. To eliminate the risks of harm to children and young people rather than children and young people being removed from their home;
2. To create positive change by supporting vulnerable families to develop parenting skills and capacity;
3. To improve outcomes for children, young people and their families affected by domestic abuse;
4. To improve outcomes for children of problem drug and alcohol-using parents;
5. To improve access for vulnerable families to universal provision and other appropriate services, and their engagement with the services;
6. To develop a family-centred model of service delivery across children’s and adults’ services, promoting approaches and learning within the FACT partnership and adult services; and
7. To contribute to building the capacity and skills of the workforce to be more focused on families, and building the capacity and skill sets of practitioners working with vulnerable families within this arena to support and maintain behavioural change.
Children and young people were involved in the commissioning process and will continue to be involved in the development of the service to ensure understanding from a young person’s perspective of living in a family with complex issues.
The support offered to families by the service is unique: both as an early intervention programme aimed at supporting families and a crisis management service. The assumption was that the building of resilience will result in children and young people who are more able to deal positively with issues that they have to face in the future. Applied in Northumberland, the service helps parents to identify and understand their own behaviour and its impact on their children. It will provide parents with skills, knowledge and understanding of parenting in general and help them reflect on their own parenting experience.
Families Plus delivers intensive, regular support and challenge to families where substance misuse threatens the welfare and safety of their children. It provides a level of support that is not provided by Social Services or indeed other agencies and it has proved to be effective at removing children from the Child Protection Register.
Families Plus operates a two tiered approach to family intervention:
• Crisis intervention: Staff use the Option 2 model, this is intensive support of up to 25 hours a week and is used either to prevent a child going into local authority care or to prepare a family for the return of a child from a short spell in care, usually after a crisis.
The Option 2 model was originally developed from research into a successful “homebuilding” approach being delivered in a number of States in North America and has since been adopted in the UK. The service was designed to address immediate issues and to build resilience within the lives of children and young people.
• Early intervention: this is a less intensive option and consists of up to 15 hours’ support each week and is targeted at families where there is an active Child in Need Plan or there is a risk that the child(ren) may be removed.
When families are referred to the service and the referral is appropriate, families are allocated to either an Option 2 “crisis management”or early intervention service and assigned a support worker. An element of the support is to ensure that each family has access to maintenance support and, through this, is given access to universal services with the aim of sustaining the positive changes and progress made by the families. Referrals into the project come through the Council’s Families and Children’s Trust (FACT) teams and have mostly been put forward by social workers. Referrals have come from eight out of the 11 FACT teams across the county.
The service opened the Cramlington office to referrals on 18 November 2009, the Berwick office on 19 April 2010 and referrals were accepted into the service until 26 July 2010.
The team in Cramlington consisted of 3 Senior Family Support Workers (PT), 1 Family Support Worker (PT), and 1 Policy and Strategy Officer (PT). The Berwick team comprised 1 Senior Family Support Worker (FT) and 1 Family Support Worker (PT). A secondment was agreed from the Berwick FACT Team for the Senior Family Support Worker post. A Lead Practitioner (FT) and Administrator (FT) based in Cramlington supported both projects.
Crisis intervention: The Option 2 service is delivered over a four to six week intensive period, supporting families using a range of tools including motivational interviewing and cognitive behavioural therapy to challenge and help change behaviour. Families accessing the Option 2 programme receive an initial visit within 72 hours of the referral and develop a safety plan with an allocated support worker. The service is delivered between 7.30am and 8pm, 7 days a week. Following each visit family members and referrers receive a letter detailing progress being made. A maintenance period follows with visits made at 1, 3, 6 and 12 months to monitor progress.
Early Intervention Service: the same principles and processes are applied in the work with families, but are less intensive and take place over approximately 12 weeks. Support enables parents to acknowledge and address their behaviours and the issues impacting on the safety and wellbeing of their children. If a CAF is already in place, staff will become part of the team around the child; if not staff will initiate a CAF process.
Participation: a monthly participation group was established for young people aged between 7 and 15, living in a family experiencing hidden harm. Their views and experiences shape not only service delivery, but policy and strategy too.
Measures: We have invested in evaluating the impact of the work, developing an outcomes pathway (attached) and commissioning external qualitative evaluation to track 20 families’ journeys.
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
The service was evaluated over a 2 year period by Helmepark, on behalf of Northumberland Children’s Fund which funded the service. The report can be found here.
The evaluation found that the service had made strong and positive progress towards achieving the year one targets for both the Option 2 and Early Intervention services. The service had received 52 family referrals during the period it was operational (over an 8 month contact timeframe) and Table 2 details the number of families who were receiving support from the service:
The referrals received by the service are broken down as follows:
Option 2 programme – 19 families (59% of the year 1 target achieved in eight months of delivery), representing 28 children and 3 pregnancies
Early intervention and prevention programme - 31 families (97% of the year 1 target achieved in eight months delivery), representing 58 children and 2 pregnancies
At the point of referral to the CNE FP Hidden Harm service, there were 20 children who were at risk of removal or had been removed from their family. The service has worked intensively with the families and statutory service providers and at the closure of the service all 20 children were still at home. This represents a significant shift in the behaviour of those families. The work of the service can be seen to directly contribute to this change and this has been supported by the comments of the families involved.
The service has also contributed effectively to 9 other cases where the children have had their risk level reduced:
• 2 children have moved from a status of a Looked after Child to a Child in Need at home;
• 3 children moved from Child Protection to Child in Need;
• 2 children have moved from Child in Need to no longer needing children’s social care involvement as families had achieved their goals;
• 2 children have moved from initial assessment to closed cases.
Feedback gathered from professional staff, who have worked closely with the service, has identified that the staff have been able to support families to adopt new behaviours and skills with regard to their parenting.
Practitioners and families have individually reported changes, for example, in relation to their confidence in being an effective parent and developing relationships in family groups, and skills and knowledge such as better time management, development of reflective practice with regard to risky behaviour and recognising negative influences and coping strategies.
One client has reported that the support from CNE FP has “boosted my self confidence as a nurturing parent – improving my relationship with my children”.
Parents and families who have engaged with the service have also highlighted the individual approach adopted by CNE FP as particularly valuable.
It is also clear that there is a need for the service. This has been demonstrated by how quickly and easily it has integrated with a host of other services and the enthusiastic welcome from these services. It is also demonstrated by referrals coming from across the length and breadth of Northumberland demonstrating the county-wide need.
Families Plus has rapidly become embedded and well known within a range of services in Northumberland including children’s and adult services, the Drug Alcohol and Action Team agencies, education and Integrated Services.
Families have made the following comments about Families Plus:
“If she hadn’t ’ve been here there were times when I was so stressed that I’d ’ve definitely used again.”
“I’ve never had this type of help before, not from my drugs worker or anyone, it makes you believe in yourself as a person.”
“The other team were nice ladies but the problem wasn’t really with the kids … it wasn’t what we needed … the problem was with me and my son. Children North East were different, they worked with both of us.”
“She taught me how to deal with [name of child]’s attention seeking behaviour, we did reward schemes … he’s my son again now … she took what was broken and fixed it.”
“They’ve been a lifeline.”
Helping others to replicate your practice
The service delivers a number of important outcomes for Northumberland County Council including saving a minimum of £502,080 per year, removing children from the Child Protection Register and a series of other important outcomes. Families Plus, by intervening at tier 3 (intensive support), stops families entering more costly tier 4 specialist provision and brings them into tier 2 supportive services and near to the desired tier 1 universal services.
An estimated cost saving can be calculated by making a reasonable series of assumptions, on the basis of a series of associated costs to the public purse which would have continued or arisen without the intervention of the CNE FP Hidden Harm service. These are based on Northumberland County Council costs as follows:
• 10 children could have been expected to go into residential care (as at the start of these interventions family circumstances were not suitable for the children to remain at home):
10 x £856 x 52 weeks = £445,120
• Eight children could be expected to move into non-funded kinship care:
8 x £63 x 52 = £26,208
• Two children could be expected to move into funded kinship care:
2 x £164 x 52 = £17,056
• Two children could be expected to return early from residential care, say two months early:
2 x £856 x 8 = £13,696
Based on the calculations outlined above, utilising the sample group above, the service has contributed a saving to the public purse of £502,080 across a sample cohort of families it has engaged with during the period November 2009 to July 2010.
This then enables a maximum cost to be derived for the delivery of services to the sample of 20 families (and 22 children), based on using the Option 2 figure in each case, which gives a delivery cost of £114,000.
t. 020 7833 6825
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