Integrated working (Kent)

Themes this local practice example relates to:

  • Early Years
  • General resources
  • Local area early intervention strategies

Priorities this local practice example relates to:

  • Narrowing the gap in outcomes for young children through effective practices in the early years
  • Improving children’s attainment through a better quality of family-based support for early learning
  • Improving development outcomes for children through effective practice in integrating early years services

Basic details

Organisation submitting example

Kent County Council

Local authority/local area:

The local area where the practice has been undertaken concerns those localities covered by the Dartford East and Dartford West Local Children’s Services Partnerships.


The context and rationale

We wanted to establish an integrated working model to deliver a high-quality integrated service to our children and families. This was consistent with the initial Sure Start Local Programme (SSLP) requirements and subsequently the Every Child Matters (ECM) outcomes. It was reinforced by a commitment to improve the accessibility and satisfaction parents had with local services in an initial evaluation of the Dartford Sure Start local programme in 2002/03. 

Strong arguments in favour of better integrated services for children and families emerged from inquiries into child protection cases, particularly those into the deaths of Victoria Climbie and Caleb Ness. These inquiries concluded that a lack of integration, a lack of collaborative working and poor information sharing contributed to the suffering and deaths of these children. Such cases and other examples where people have ‘fallen through the net’ have provided strong evidence that services should be working better together and have contributed to the current policy emphasis on integrating children's services, made expressly clear in the Every Child Matters programme. (Van Eyk, H., Baum, F. (2002), ‘Learning about interagency collaboration: trialling collaborative projects between hospitals and community health services’ in Health and Social Care in the Community, Vol. 10 No.4, pp.262-9.)

The initial partnership governing the fifth-wave Sure Start Local Programme, established in Dartford in 2002, was determined to ensure that integrated service delivery was our primary delivery mechanism. It incorporated local parents, statutory partners in health, education, employment and social services and non-government organisations working in early years, health, social care and community development.

This model could be transferred to other service contexts if they are able to secure the strategic commitment of key service providers in health, early years and social services to configure core elements of their service delivery to a locality model. The transfer is more likely to be straightforward if staff are located together regardless of their host employer.

The practice

We have developed integrated teams that incorporate health visiting services, speech and language, early years and social care services for families and children. We also incorporate directly into our service offering nursery provision, adult education and access for families to JobCentre Plus and Shelter at all of our children’s centres. 

Our external review of integrated working sets out the key remodelling that has occurred. This is summarised below:

• PCT-managed health visitors, staff nurses and nursery nurses are co-located within children’s centres, working alongside social care and early years staff, and working with a caseload representing the children’s centre catchment.
• The local Children’s Services Partnerships support a project where a principal social worker based in Social Services provides professional supervision to social care staff working in children’s centres and acts as a focal point for children’s centres in facilitating effective assessment processes for Social Services and for working with children’s centres to establish maintenance and support strategies for families exiting tier three Social Services support.
• A public health midwife works across the children’s centres, with close links to Darent Valley Hospital, and community midwives are also reconfiguring to the geographic catchment model.
• Kent County Council has moved key locality early years’ staff to the direct management of the Dartford Children’s Centres Locality Coordinator, offering the chance for a strong coordinated focus to support the Early Years Foundation Stage (EYFS) work. This ensures inclusive provision and promotes approaches that raise the quality and achievements of inclusive pre-school education for all children.
• All children’s centres have commissioned jointly a cost-effective speech and language service to support early intervention, awareness raising and skills development of practitioners and parents in their interactions with children. This service links with and can offer home-based enhancement to the service delivery of the statutory Speech and Language Therapy Service.

We also offer weekly adult education at each children’s centre (with crèche), monthly or six-weekly JobCentre Plus and Shelter surgeries, and either direct or aligned nursery provision at each children’s centre.

Costs
140 children went through an integrated service programme that incorporated local parents, health, education, employment and social services partners, along with non-government agencies. This improved development outcomes for children through effective practice. The cost of this intervention amounted to £559,342 per annum, which equated to £92.91 per child per week. The social return on investment indicates that for every £1 spent £1.95 is returned over a two-year period. 

Evidence and evaluation - making a difference to children, young people and families

Early Years Foundation Stage results for 2008/09 have shown improvement in Dartford (we are in the process of distilling these to the ward levels relevant to individual Children’s Centres). 

Contributory factors to this improvement are the earlier identification of, and support to, children’s speech, language and communication issues; the better quality of our early years settings and nursery staff; and the increased take-up of relevant services by local families as a result of our integrated working model.

The changes and improvements to practice outlined below operate across all children’s centres:

Monthly casework meetings draw together staff across the integrated team to discuss individual cases. Usually, these are attended by community midwives and Special Educational Needs Coordinators (SENCOs) from most children’s centres. These meetings commenced in 2005 and were rolled out to other children’s centres as these were established.

All integrated team staff work on single records concerning the individual children and families that receive support and services.

Since the first year of the Sure Start Local Programme (SSLP), there have been significant and varied professional development opportunities for staff working within children’s centre teams (related to the five ECM outcomes) to improve each individual’s capacity to identify potential issues and correctly signpost families to the relevant service providers. 

Referral processes have been simplified and can include significant informality. This commenced in the first year of the SSLP (intra-team referrals are monitored).

Different practitioners act as focal points for related external agencies. For example, health visitors are focal points for children’s centres’ relationships with General Practitioners (GPs); the speech and language service is a focal point for children’s centres’ relationships with the statutory Speech and Language Therapy Service; and early years teachers are focal points for a coordinated approach to the effective transition of children from pre-school and nursery settings to schools. (This was established as practice in the first year of the SSLP, and for speech and language when we established the service in 2005.)

Joint work is undertaken across practitioner groups (this was established as practice in the SSLP and continues). For example, visits to children and families, as part of our universal contact schedule, are often undertaken by practitioners across disciplines. JumpStart (an intensive term programme for children with additional needs, based on the HighScope model) involves an early years teacher, a speech and language assistant and a family support worker/social work assistant.

Joint work with external agencies has been progressively implemented. For example, joint delivery of parenting programmes in community settings, such as Mellow with Social Services; joint delivery of speech, language and communication training to nursery staff with the statutory Speech and Language Therapy Service (2006-2008 and additional training will start shortly); and follow-up home-based work of the statutory Speech and Language Therapy Service since 2005.

‘Clinics’ are available in the community context. For example, once- or twice-weekly health clinics are offered at all children’s centres (these commenced in 2005, and midwives have delivered booking and ante-natal clinics since 2007).

The health team reconfiguration presented some challenges for individual staff, and in the wider relationships of health visitors with GPs. We are revisiting some of these challenges as we support the reconfiguration of community midwifery to a co-location model with children’s centres.

Change invariably brings with it perceptions of winners and losers and there will always be some resistance to change. 

Our strategies for overcoming this are:

Ensuring that GPs receive written information from health visitors about relevant families; that health staff regularly attend each GP’s surgery to discuss cases; that contact information for health visitors working with individual families is provided to GPs; and that each GP receives newsletters from the children’s centre (similar strategies are intended to be adopted with midwifery.
Reinforcing a continuous focus on improving the outcomes for children and families in all our casework meetings, staff meetings, team building day and professional development opportunities.
Ensuring that health staff have their own health meetings with continuing professional supervision and day-to-day management through the NHS Trust), and that regular meetings also take place between the locality coordinator, children’s centre managers and the manager of health visiting (as we are also doing with the manager of community midwifery).

Working with the Kent County Council early years researcher, we are looking at the extent to which there have been other overall statistical improvements related to core outcome areas (in addition to those detailed below), particularly as we know for example, through our own practitioners, that breast feeding amongst women that we provide support to is much improved.

Helping others to replicate your practice

Evaluation

An external review was carried out by Semper Visio Ltd. 

In addition, we undertake continuous informal reviews with staff across our integrated team, particularly through professional supervision (which all staff receive); monthly staff meetings in individual centres; programmed team building in individual centres; and twice-yearly team building meetings that involve staff from across all children’s centres.

Consistent with the NFER’s impact model, which suggests different levels of impact over time, we can demonstrate Level 1 impacts relating to changes to inputs, processes and service and management structures, and Level 2 impacts involving changes to the experiences and attitudes of practitioners and service managers. We have also started to identify Level 3 impacts changing outcomes for the target population (children, young people and families).

We carry out parent satisfaction surveys on an ongoing basis. In addition to observation methods, we have children use ‘smiley faces’ to identify their satisfaction with elements of our provision.

The review report of integrated working provides evidence of manager, practitioner and service provider satisfaction with the integrated working approach. It specifically identifies that:
• Accessibility to many more services for children and families, in appropriate settings and with significantly reduced waiting times, is much improved as a direct result of the integrated working model.
• Practitioners have significantly better access to quality professional development opportunities through the integrated working model.
• Information sharing, casework meetings, the use of a single record and coordination are rated 1.6-2 (in a scale where 1 is very good, 2 is good, 3 is okay and 4 is not okay).

Joint working with external agencies has enhanced the quality of service provision to children and families. As our external review concludes, for example, the joint delivery of level 3 parenting programmes with Social Services has reduced the stigma of Social Services provision, and the follow-up home-based support offered by children’s centres augments the service provision of the Speech and Language Therapy Service to the benefit of children and families.

Our external review undertook value-for-money assessments concerning the health visiting, community nursing, speech and language and social care components of our delivery. These reveal significant cost efficiencies from our service delivery model. 

Hot tips for others
Key success factors are:
• A strategic commitment to supporting the locality model, particularly health visiting services reconfiguring to the children’s centre catchment.
• Locating as many staff as possible together and ensuring that there are formal and informal opportunities to support joint working.
• good mechanisms for information sharing, particularly monthly casework meetings, the use of single records and simple referral processes.
• A strong commitment to working with external partners, so that pathways exist for children and families to access all of the services that they need, particularly in more specialist areas.

 

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