Agenda item

Purpose:

The purpose of the report is to provide a case for the realignment of the Team Around the Family service within the wider structure of family support services to better meet the needs of the local population and to contribute to Monmouthshire’s delivery of the Social Services and Well-being Wales Act (2014) (SSW-bWA).

Key issues:

1.  Currently the TAF team consists of a TAF Co-ordinator and three TAF Project Workers. The function of the team is predominantly one of care co-ordination, assessing families referred for a service, liaising with service providers and coordinating TAF meetings with service providers and families where a package of support is co-ordinated. The TAF team remain involved for between 6 and 12 months with each family, chairing meetings at which progress is reviewed. They currently work with approximately 60 families a year.

2. The TAF Team is funded through Families First. Monmouthshire has a small population.  Although it has pockets of deep deprivation, it is generally considered to be an affluent community, this means that grant funding such as Families First, is relatively small, and it is essential that resources are focussed so as to achieve the greatest return on investment.

3.The report proposes the focus of the team on TAF is retained, as per Welsh Government policy, but that the activity is re-aligned so that the work of the team focusses more on working directly with vulnerable families on the cusp of statutory intervention to prevent them requiring statutory support. The team will be tasked and supported to delivery brief interventions that are outcomes focussed around what matters to children and families in line with the Social Services and Well-Being Act (SSW-bWA). Working in this way should increase productivity from 60 families a year to 150 families a year.

4. The importance of preventive work and early intervention is well-recognised. It is a fundamental principal of the SSW-bWA. It recognises that providing support at an early stage may well reduce the need for more intensive, and potentially invasive, intervention at a later stage.

5. The value of intervention throughout childhood and adolescence.  The arguments for prevention are particularly associated with children and young people, especially under-fives. The social and emotional foundations established in the first three years of a child’s life, to a large extent attributable to the standard of parenting, are arguably the biggest determinants of positive outcomes throughout the life course. The benefits of promoting the Welsh Government’s aim of giving children a flying start in life are important for all generations. Older people who have experienced positive foundations (e.g. good education and health, strong social networks), are more likely to have a healthier transition into independent old age. However, recent research into adolescent neuroscience indicate that adolescence offers a unique window of opportunity to significantly ameliorate the impact of early trauma and poor parenting.

6. Adverse Childhood Experiences

There is a growing body of evidence that shows how profoundly health throughout

the life course is negatively affected by adverse childhood experiences (ACEs) such as verbal/emotional, physical or sexual abuse and neglect, parental separation, incarceration, mental illness, drug and alcohol use or domestic abuse. These stressors are cumulative, the more adverse experiences a child faces, the more likely they are to experience poor outcomes.

7. What Works?  Empirical research provides evidence of the value of intervening early, before difficulties become entrenched and long-standing. Macdonald’s (2005) research indicates that therapeutic interventions are more likely to be successful if they take account of the broad range of factors outside the family that also have an influence on family functioning.

8. Whilst there is not an extensive literature on the effectiveness of specific interventions, the provision of services such as play therapy, educational support and speech and language therapy may help address specific deficits around social skills, education and learning and communication (Howe, 2005).

9.  In summary, the following features are significant in terms of interventions that are effective and evidence suggests that these features of effective practice are more important than fidelity to a specific model.

·         Early-intervention – before difficulties become long-standing

·         Early-intervention - attachment-based

·         Strengths based

·         Relational

·         Bespoke – designed around a families individual needs

·         Fidelity to specific models where these are used

·         Ecological/systemic models

13. The Case for Prioritisation

Whilst it is recognised that there are numerous interventions that would be of benefit to the children and families of Monmouthshire, it is essential that scarce and increasingly limited resources are prioritised to fund services that are judged to provide the greatest impact for the investment. In light of the pressures Monmouthshire faces, the policy and practice imperatives created by the SSWbWA and Well-being of Future Generations (Wales) Act 2015, Monmouthshire has undertaken a review of children’s services. This paper draws on evidence from research and evaluation undertaken by Cordis Bright (2013) and IPC (2016).

14. Welsh Government guidance on Families First and the continuum of support recognises the importance of the whole network of services in supporting families, and in particular identifies a differentiation between services and support for children and families needing early intervention and those needing intensive intervention. The framework is based on research evidence which indicates that different forms of intervention require very different levels of support and skill on the part of those undertaking assessment, care and support.

The IPC analysis identified that whilst there are services available to support families in Monmouthshire, they are fragmented, lacking in an underpinning practice approach or theoretical framework and therefore risk duplication and delay in families accessing the right support at the right time. In particular there are gaps at the edge of statutory intervention (insufficient services to reduce risk and scaffold those families who are not quite managing without support to prevent them coming into statutory services) and the edge of care (insufficient support to reduce risk to families who could, with some time-limited, intensive intervention be supported to enable them to parent safely to avoid their children coming into care).

Recommendations:

The following recommendations are made:

1. To realign the activity of the existing TAF Team which currently facilitates the TAF process and undertakes only limited direct work, into a team that predominantly delivers programmes of early intervention family support and undertakes a smaller amount of facilitation of the TAF process.

2. To reconfigure the existing Co-ordinator post into a team-leader post using the anticipated cost saving to provide the necessary capacity to administrate an Early

Intervention and Prevention Referral and Intervention Pathway.

3. To locate the service within the Face to Face Therapeutic Service and Intervention Pathway Including the Realignment of the Team Around the Family (TAF) service

4. To move the Face to Face Therapeutic Service to within the Children’s Services management structure to bring increased coherency to the ‘windscreen’ pathway

of family support and intervention.

5. To create a multi-agency Early Intervention and Prevention Referral and Intervention Pathway to manage referral and allocation of children and families seeking pre-statutory services family support (see Appendix 1).

6. To develop a step-up/step-down protocol and referral pathway which enables vulnerable families accessing support at both a pre-statutory threshold level and a post--statutory threshold level to have their needs appropriately met and ultimately reduce the numbers of children requiring statutory support and in  particular the need to be Looked After.

Member Scrutiny:

A Member asked for an explanation of Families First funding, and secondly, questioned what regard had been taken of other authorities’ LA best practice.  It was explained that it is a specific grant which funds the TAF team in entirety to provide the early help/prevention role.  The grant does not fund any statutory services, has stringent terms and conditions but funds a range of activities e.g. Acorn Centre.  It was confirmed that officers looked extensively at other authorities’ best practice and also the systemic IPC review of family support to build the vision based on provision of a key worker for vulnerable families.

In response to a question, it was clarified that ‘step up and step down protocol’ refers, in this context, to the where a family needing help passes from non-statutory to a statutory level of intervention.  The term is also regularly used more generally to define passing between different services. 

The Chair commented that effective multi-agency working can be difficult to deliver and queried if any issues are anticipated and how these will be managed.  It was agreed that good multi-agency working underpins an early help and support system and some mechanisms are already in place (e.g. Children and Young People Strategic Partnership meeting) to strategically consider outcomes.  This work is ongoing.

Considering the changes to the TAF Team, it was questioned if the right staff are in post to deliver the new role.  In response, confidence was expressed that the service is staffed by motivated, skilled and well trained individuals.