Introduction

The first wave of the Children’s Social Care Innovation Programme which ran from 2014 to 2016 received investment of £100 million in 57 projects and their evaluations. The overall aim of the programme is to inspire whole system change to achieve better life chances for children receiving help from the social care system, stronger incentives for innovation, experimentation and replication of successful new approaches and better value for money.

The Rees Centre acted as evaluation coordinator and was responsible for the over-arching evaluation and production of thematic reports.  Five topics were identified for thematic reports.  These were:

1. What have we learned about good social work systems and practice?
2. Adolescent service change and the edge of care
3. Child sexual exploitation and mental health
4. Systemic conditions for innovation in children’s social care
5. Informing better decisions in children’s social care

This briefing is on the first three of these reports which were published in July 2017.

The briefings can be found at: http://reescentre.education.ox.ac.uk/about-us/thematic-reports
-evaluation-of-childrens-social-care-innovation-programme/

The link for all the evaluations published by Department for Education (DfE) is as follows:
https://www.gov.uk/government/publications?keywords=Children%27s+Social+Care+Innovation+Programme&publication_filter_option=all&topics%5B%5D=all&departments%5B%5D=all&official_document_status=all&world_locations%5B%5D=all&from_date=&to_date=

Further information on all the projects including brief descriptions of what they are about and a link to their evaluation is available at: http://springconsortium.com/evidence-learning/how-projects-are-being-evaluated/#p5

All the reports include recommendations which are given in full in this briefing. The recommendations have been developed into a template which can be found as an appendix on each of the reports, for local authorities and partners to use as a self-audit tool.

Thematic Report 1: What have we learned about good social work systems and practice?

This report is based on a synthesis of the evidence from evaluations of 17 wave 1 projects in this area. The projects started in early 2015 and ran for 10 to 18 months which typically provided time for some early outcome but rather more information on process. For some projects, there were difficulties in recruiting a project team and setting up interventions which shortened evaluation time.

Though varied these projects had some common features and goals. Core principles reflected in virtually all projects were:

• Maintaining clarity of purpose with a clear focus on the child;
• Taking a strengths based approach;
• Engaging with families as partners in defining and resolving their own difficulties;
• Seeing the role of the worker as an agent of change;
• Enabling practitioners to work directly with families and equipping them with the skills, tools and specialist expertise to do so;
• Recognising the role of the wider organisation in creating conditions and culture in which good practice can be maintained.

The report discusses existing evidence on improving children’s social work which shows there is considerable agreement on the issues which need to be addressed. It references the recent ISOS[1] report which identified seven enablers of improvement in children’s services which are:

• Clarity of vision and a well thought through strategic approach;
• Stable, consistent leadership and governance;
• Support and engagement of the workforce;
• Partnership working;
• Building the supporting apparatus (having strong core systems and processes in place);
• Fostering innovation; and
• Judicious use of resources.

The projects each developed their own theories of change which set out the outcomes they wanted to achieve and how they believed they could achieve them. Amongst the common themes of what needed to change were:

• Social workers spending too little time in direct work with families;
• Social workers lacking the skills and confidence in effective models and tools for assessing and achieving change with families;
• Family’s needs not met, frequently resulting in repeat referrals;
• Problems escalate and families need higher levels of service;
• Interagency communication is not as effective as required.

The approaches taken by the projects either through adoption of an explicit model or informed by particular principles were:

• Systemic practice;
• Motivational Interviewing;
• Signs of Safety;
• Restorative practice;
• Family Group Conferencing.

Core principles reflected in virtually all projects were:

• Maintaining clarity of purpose with a clear focus on the child;
• Taking a strengths based approach i.e. viewing families as having strengths and capacities as well as difficulties;
• Engaging with families as active partners in defining and resolving their own difficulties;
• Seeing the role of the worker as an agent of change;
• Enabling practitioners to carry out effective direct work with families and equipping them with the skills, tools and access to specialist expertise to do so;
• Recognising the role of the wider organisation as responsible for creating the conditions and culture in which good practice can be maintained.

Almost all the projects were successfully implemented and most evaluations reported some positive change in social work practice and improvements in the experience of families.  Assessment of outcomes was limited in the timescale available. There were positive indications, including reductions in numbers of children looked after and in the use of child protection plans.  Some projects showed promising signs of cost savings.

The evaluations provide a rich source of intelligence on what constitutes good social work practice and how this can be developed. The key ingredients include:

• A shared understanding of good practice – usually supported by a clearly communicated model or set of principles, skills and tools to assess and work with families;
• An ability to engage the whole family in ways which combine empathy, authority and clarity of goals;
• Cultural competence.

The common features of projects which appear to be successful in developing these ingredients include:

• Multi-disciplinary team combining children’s social workers with workers who have expertise on issues affecting adults in families such as substance misuse or mental ill health;
• Flexible use of non-social work qualified staff including highly skilled administrators and family support workers. They have also developed their use of volunteers;
• Effective supervision and support including the availability of consultancy and group case discussion;
• Work allocation so that practitioners have caseloads which are manageable and managed;
• Opportunities to develop skills, through a combination of training, a shared practice framework, management expectations, peer and group supervision and coaching.

The conditions which help to establish and sustain these features include:

• A culture of leadership embedded in the system;
• Strong multi-agency commitment, effective communication and promotion of a shared ethos;
• Alignment of processes such as IT and recording systems; and
• Good use of data for planning and performance monitoring.

The report makes the following recommendations:

1. Innovation is most likely to be effective if all key parts of the system have shared aims. This means staff at all levels and across all relevant agencies, including those concerned with governance and inspection;
2. Leadership is critical but needs not to rely on a single dynamic leader or team. Embedding innovation depends on mobilising leadership at all levels;
3. Organisations are more successful in achieving culture and behaviour change when they have a clear model to communicate, motivating people around a shared ethos with clear messages;
4. Most models of good practice combine empathy and collaboration with purpose and authority. There could be value in articulating a model to which all social workers could subscribe, embedded in training and performance management;
5. There is good evidence of the value of multi-disciplinary working including adult specialists alongside children’s practitioners in integrated teams. Integration should also avoid repeated assessments and ‘passing on’ of families to other teams and services;
6. There is also good evidence of social work practice being supported by supervision, group case discussions, access to clinical expertise and senior social work experience;
7. Training has a valuable role but is unlikely to result in change by itself. An overall strategy for skills development needs also to include supervision, coaching, co-working and performance management;
8. Evaluation suggests that highly skilled administrative support can substantially increase the amount of time social workers spend on direct work;
9. There is also evidence of the potential to increase the resources available to families via the deployment of non-social work staff and volunteers;
10. Attempts to reduce bureaucracy can be hindered by a lack of attention to the details of systems such as IT and electronic recording;
11. Plans for sustaining innovation need to be built in from the start and be one of the key criteria for assessing applications for such funding;
12. There is more work to be done in supporting everyone in the system to make better use of data, including from evaluation. 

Thematic Report 2: Adolescent Service Change and the Edge of Care

This report presents an overview of nine projects funded through the Children’s Social Care Innovation Programme, which explicitly targeted adolescents at the ‘edge of care’, but is informed by findings from across the wider innovation programme. The projects included short term residential provision and sometimes their families (4 projects) and a variety of multi-professional teams (5 projects). A feature of several projects was the use of non-social work professionals to work directly with young people and their families using non-traditional methods to build positive working relationships.

The report sets the context for this service area by setting out that 62% of children looked after were 10 years or over in 2016 compared with 56% in 2012 and that these children often have more complex needs. Many of the projects planned to safely reduce the care population by working more effectively with those on the edge of care.

The evaluation highlights the risk that ‘edge of care’ is used to describe too broad a group of children. It discusses how to define ‘edge of care’ and identifies that though the projects being evaluated planned to work with children on the edge of care the evaluations revealed that most worked with a broader range of adolescents. The evaluation suggests that in most cases projects focused on preventing cases escalating to the point where care was necessary rather than diversion from the point where care was imminent.

A finding related to issues of identification of need was that while projects’ theories of change had begun with needs and devised models of intervention to meet them, in practice, once the interventions and teams had been put in place, the cohorts of children were selected to a greater or lesser degree to match interventions.

There were common approaches across the projects which included:

• Developing relationships with children and families;
• Youth work approaches were valued by young people and families and delivered positive outcomes;
• A variety of approaches to using short term residential responses to meet the needs of adolescents and their families;
• Case holding, management and planning with many projects expecting all members to act as lead professional;
• Professional development where workers responded well to training in common models of practice and that supported multi-professional working including for co-located staff;
• Strong strategic leadership and partnership was seen in the most successful projects;
• Multi-professional working which was strengthened where it involved co-location of the professionals.

All the evaluations presented some evidence of impact even if it was only in relation to staff training and their capacity to undertake new models of practice in the future. Multi-disciplinary teams were demonstrated to have had a positive effect on outcomes in four projects. Two of these showed measurable cost benefits. All of the evaluations reflected the short time available for development and evaluation of the projects. This was especially true for the three projects developing a residential service where the lead time to develop the resource limited the size of the cohort of children subject to evaluation.

Common elements of the most successful projects included:

• Strong and consistent leadership and management;
• Effective multi-professional staff development; and
• A focus on building positive relationships with children and within children’s families.

The evaluation makes the following recommendations:

1. Project developers should define what they mean by ‘edge of care’ by placing their proposed intervention on the child’s journey into and through care to ensure transparent understanding of the expectations of a project that would strengthen accountability as it is implemented;
2. Longitudinal studies should be encouraged to explore if the more preventative interventions deployed in most of these projects can delay entry into care indefinitely, or simply delay it, compared to interventions targeting the point at which adolescents are imminently at risk of entry to care;
3. Those children and young people closest to the edge of care remain the hardest to engage, so where interventions focus on them, regular monitoring of information and strong leadership and management on the ground are essential to avoid ‘mission creep’ to less complex cases;
4. Though innovations are often designed to meet need, once implemented managers must ensure there is sufficient flexibility in the service offer to enable referrals to be needs-led rather than service-led;
5. The Department for Education, Department of Health, and the Home Office, with support from the Information Commissioner’s Office should facilitate the development and dissemination of appropriate models for data sharing agreements that would reassure local partners currently reluctant to make such commitments;
6. Multi-professional co-location should be encouraged as it leads to genuine multi-professional decision-making, rather than multi-agency inputs into a system, and provides a single channel of communication likely to increase engagement of the young person and family, and better outcomes;
7. Multi-professional working that includes qualified social workers is more likely to increase the confidence of non-social work professionals who are managing safeguarding risks;
8. Short-term residential placements can be effective in helping young people to engage. However, the provider needs to resist pressures to reduce the unit cost by filling places from outside the target cohort; empty beds may sometimes be an appropriate opportunity cost. They should also consider the holistic needs of the child and ensure there is sufficient robust education (and health and well-being) provision available alongside any innovative residential care intervention;
9. Training should be multi-professional (and extend to carers where appropriate) as it is more likely to raise managers’ confidence that it is making a difference irrespective of professional background, while also bolstering worker confidence.

Thematic Report 3: Child Sexual Exploitation and Mental Health

This report presents an overview of eight projects in the Innovation Programme that focused specifically on groups of young people who were experiencing or at risk of experiencing child sexual exploitation (CSE) or mental health issues.  CSE and mental health are covered in one report because of common features and areas of overlap across these two issues.

The projects took differing approaches to support young people with complex needs, including testing residential facilities as an alternative to secure accommodation or mental health inpatient settings, working with family members and specialist foster carers to increase their understanding of CSE and their ability to manage risks, developing a new service model based on building supportive relationships, a bespoke outreach service, and out-of-hours support for families that included access to psychiatric and psychological services.

The thematic report sets the context by briefly setting out the evidence of prevalence of mental health problems and CSE in England.  It notes the very high prevalence of mental health conditions amongst looked after children.

The report notes the limitations on what is known about effective interventions for CSE and mental health. It briefly reviews the role of placement away from home noting the importance of local placement and maintaining community links for most adolescents, the centrality of stability and positive relationships, the importance of stable educational placements and engagement and the importance of responsive mental health care.

All the evaluations presented some evidence of positive change.  The use of health and social care services was reduced or managed with less intensive or high-cost services in six of the projects.  There was evidence of a reduction in key CSE risk factors and an increase in protective factors in all four CSE projects. Interviewees (particularly parents / carers and other professionals) reported improvements in young people’s emotional and behavioural well-being and mental health across the projects, but the findings from standardised quantitative measures of well-being were more equivocal. Two of the mental health projects and all four of the CSE projects provided some evidence that young peoples’ engagement with education had improved.

Two of the mental health projects and two of the CSE projects revealed improvements in family functioning and relationships.

The majority of factors that were reported to work well applied across both the mental health and CSE projects.  These included:

• Staff ways of working including strong leadership, multi-disciplinary team work and inter-agency working, bringing together staff for training and supervision, clinical supervision;
• Provision of support to family members beyond the young person referred into the service. This more holistic approach helped to strengthen family relationships;
• Training for parents and carers;
• Improved engagement of children and families by enabling easier and rapid access to clinicians;
• Empowering young people and their families to develop more positive relationships and choices, promoting self-esteem and confidence;
• Provision of personalised care, consistency and stability, and respectful communication, in order to help build the relationships that were the key mechanisms of change.

Common elements of successful projects included strong leadership and inter-agency working, provision of support to family members, empowering young people and families, and a focus on building positive relationships. The four mental health projects reported encouraging cost-benefit findings, albeit with a number of caveats around their calculations. There was less financial information available on the four CSE projects, but one project reported potential annual benefits of over £1.6 million.

The evaluation report makes the following recommendations that should be considered by services looking to improve mental health and reduce the risk of CSE:

1. Projects that can support young people and families to manage their needs before they reach a crisis situation can provide benefits in terms of individual well-being, placement stability, and reduced service use. Services should consider whether they might target some resources ‘downstream’ to prevent the escalation of difficulties;
2. Multi-Disciplinary Teamwork enables the sharing of resources, experience and expertise, as well as allowing staff to work to their individual strengths. At minimum, services working with young people at risk of or experiencing CSE or mental health difficulties should bring together staff from social care and mental health teams;
3. Approaches that work with the whole family rather than focusing solely on the young person can enable the development of family relationships, provide strategies for managing difficulties without the need to involve services, and can increase the likelihood that young people remain in a stable placement. Services should offer training and support to families / carers that increases their understanding of issues relevant to CSE and mental health (as appropriate), and provide ongoing support in the way of home visits and / or telephone contacts;
4. Projects that seek to empower young people and their families to manage their own needs and life choices increase their confidence and self-esteem in the short-term. They may also help individuals manage their lives without the input of social care or mental health services in the longer-term. Services should adopt approaches to training and relational work that have an emphasis on empowerment;
5. Relationships were viewed as the key mechanism of change across projects. Efforts to develop relationships included the provision of personalised care, consistency and stability, and respectful communication. Services should explore methods that enable the development of trusting, reliable and consistent relationships between young people, families, and staff;
6. Clear approaches to referrals and discharge should be developed from the outset. Projects encountered difficulties where the young people being referred were not those originally being targeted, and where there were insufficient placement options at the planned point of discharge. Services should ensure that all partners are aware of referral criteria, and decide at an early stage whether these should be flexible. They should also identify potential placements and specialist training needs for staff and / or families / carers at the point the young person enters the service.

[1] Bryant, B, Parish, N and Rea, S (2016) Action research into improvement in Local Children’s Services Final research report, ISOS Partnership/Local Government Association.