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West Midlands ADCS Conference
14th November 2014
Welcomehttp://www.wmadcs.org.uk/live-page-adcs-conference-2014/
Welcoming comments
WM ADCS Chair, Laura Johnston
Keynote 1
Gloucestershire, Linda Uren – managing demand through a
commissioning approach
Linda Uren
TheDCS
Headache!
Comprehensive understanding of need Customer Insight Managing expectations & demand Raising thresholds
Commissioning OutcomesCommissioning Outcomes
DeliveryDelivery
• Improved knowledge of need and better engagement with customers as part of the commissioning process will inform disinvestment decisions i.e. we stop providing services we no longer need
• Greater diversity of delivery models can drive down costs
• Improved knowledge of need and better engagement with customers as part of the commissioning process will inform disinvestment decisions i.e. we stop providing services we no longer need
• Greater diversity of delivery models can drive down costs
5
The Theory……
• New provider models• Driving efficiencies• Delivery innovation• Managing markets
Cost Avoidance Cost Avoidance
Cost ReductionCost Reduction
Our ContextGloucestershire Low funded, low spend,
variable performance Low-average numbers
CLA High referral/ initial
assessment Urban centres of high
need Front runners in CAF
roll out but…… 2004
1
2004
7
2005
1
2005
7
2006
1
2006
7
2007
1
2007
7
2008
1
2008
7
2009
1
2009
7
2010
1
2010
7
2011
10
20
40
60
80
100
120
140
160
180
200
Star...
2013 2014 2015 2016 2017 2018 2019 2020 20210
50
100
150
200
250
0
20
49
79
107
137
165
202
243
0 2 5 8 10 13 16 20 23
0 39
1419
2429
3542
Children In Need (3.00%)Children with CP plans (0.29%)Children in care (0.52%)
Addit
ional num
ber
of
CYP
fro
m 2
013 b
aseline
Projected increase in numbers of vulnerable CYP from 2013 baseline, based on national estimates of need (2009-10)
My Target: Save £20m and Make it Better!
Looked After Children
2003/04
2004/05
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
2012/13
2013/14
2014/15
2015/16
2016/17
2017/18
0
100
200
300
400
500
600
700
800
900
451 441
399 399 391
465492 482
461
522
827
451 441
399 399 391
465492 482
461
522
742
451 441
399 399 391
465492 482
461
522
398367
Current LAC trend con-tinues
Adoptions increase, children continue to come into care at the same rate
Desired trajectory to reduce numbers of LAC by 100 by 16/17
275 extra children over the next 5 years (increase of 22%) would need to be diverted from entering the Care system
185 extra children over the next 5 years (increase of 20%) would need to be returned home
Demand for social care services as a whole has been assumed to remain the same.
8
Benchmarking – LAC per 10,000
2010 2011 2012 2013
National 57.3854330230539 58.0694443139217 59.1451130529186 59.7568026070494
Statistical Neighbours
43.1246003539191 42.561983471074 39.5686437163003 44.6959682749509
Gloucestershire 39.630866783672 38.7096774193548 37.6432078559738 42.4489795918364
5
15
25
35
45
55
65
Rate of LAC per 10,000 CYP – trend 2010/13
NationalStatistical NeighboursGloucestershire
9
Number of Care Leavers - c320. Rising with a bulge to 2018
What Have we Already Done?
Integrated leadership partnership
Community offer Multi disciplinary,
targeted service Includes YOS and council
post 16 Care service Award winning for
public;private partnership!
Example 1: Youth Support
0-17 offendersRate per 100,000
Joint commissioning framework across levels of need Aligned c/centres/ primary care Turnaround Children Team inc FDAC Growing Great Futures Parent champions
and Domestic Abuse support, PODs, arrest + diversion, disabilities, FFT
Example 2: Early years
So Where Next?
Nationally,
12/13 – 593,000 children received an IA, cost £297m
Of these 198,000 children received no social care service (£176m)
74% received second referral + assessment - £48m cost
Some Quite Shocking Facts
Not included: maternity services, acute hospital services, and therapies, community nursing No data from agencies such as DWP (benefits), housing or adult mental health/ substance misuse.
Where to Invest?
Need
Demand
Supply
Thinking About Demand
Test thresholds
Better targeting?
Identification, research, practice
Does this happen?
Aim to Eliminate
1
2
34
5
6
Compare and contrast: SEN and Safeguarding
Work with universal services
Where do we Want to be?
Supply
DemandNeed
E.g Seasonal Flu Vaccination
Supply
DemandNeed
Demand Management Strategies
PreventionScreening
Early helpCAF
Gatekeeping Thresholds
EnablingCommunity offer
Data analysis
iMpower surveySEND reforms
Community s/wsLocal partners
Evidence basedFFTJIP
Reunification
Getting it in Proportion
138,000 ChildrenTotal population
4500Children
Safeguarding/Care
10,000Children‘at risk’
?Focus LA spend here
Child in Care£3.2k per month(c500)
Every NFA referral Costs £500 (c£1.5m per yr)
FFT Programmecosts c£3k
Partner spend
Programme ManagementData, practice development, quality assurance, specialist support
District PartnershipsLocal Commissioning
Community SupportCommunity connectors, volunteers, peer support, wider VCSLOW
HIGH
An Investment Model
Intensive Family Intervention based in Children's Services, Youth Support Teams, Housing,
Police, VCS, Community Safety
Commissioned Services CCP, Independence Trust, Info Buzz, Community Family Care,
Family Lives etc
Level of Need
Summary - Local Demand Demand for children’s social care + specialist services is mostly
professionally (+ nationally) driven Local demand looks to be average or low Behaviour, confidence and belief is important. Recent survey:
◦ most professionals believe in helping families early◦ confidence is very variable (and low amongst some)◦ behaviour changes will be important
Main factors in requesting specialist help are:◦ The toxic 3 (Parental substance misuse + mental ill health + DA)◦ School exclusions
Reducing preventive services has a knock on effect (1 in 5 come into Care)
Lots of evidence and belief that early intervention will decrease demand for things like Care – challenge getting the savings out
22
Managing Demand
Reduce Demand
forCYP
Social Care
Harness communi
ties/universal
Reduceprocess
KeepTeens out of Care
Better Early help
Develop targeted early years offer
social care referrals + repeats
Protect safeguarding
Better interventions e.g.:TF,FDACParenting
Reunification/adoption
GCC Children’s Social Care
Contractors
CAMHsYouth
Support
Community Health Trust
Joint projects / services
L&D
FFT PODs
TACS
EYs
What is Best Shape for Future?
Facing Both Ways…..
DCS or Commissioning Director????
Background Slides
No additional
needs
One or two
additional needs
Several additional
needs
Multiple complex
needs
Acute or highly
complex needs
Universal Services
Targeted Services
Targeted/ Coordinated
Services
Specialist Services
Children in Care(750)
Child Protection Plans (980)
Child Protection Investigations
(1600)
Children in Need Plans
900
Referrals 4500
Youth Support (6 to 9000)
CC Families in Greatest Need
(908)
Social Care Activity
Exclusions(1500)
CYPS(1500)
SEN (4800)
Social Care Activity Youth Support Children Centre NHS School
CIC CP Plan
CP/CIN Activity
SC Referral
Youth Offending
Substance Misuse Missing NEET Family in
Greatest NeedHealth Visitor
Need Level CYPS Exclusions BES Needs
1 1 1 1 1 1 1 1 1 1 1 12 1 1 3 1 1 4 2 3 7 1 1 5 1 8 1 16 1 1 1 7 2 2 4 1 1 1 8 1 1 9 1
10 1 1 11 3 1 12 7 1 1 113 2 3 14 2 15 1 ! 1 1! 1
15,000? 1 TOTAL
•Identify the size of the cohort who have acute/complex/additional needs and currently receive services/support
•How many children are receiving a number of services?
•Identify who steps up to specialists service and who steps down?
•Profile changes over the past 3 years and establish baseline data and methodology to track future progress in achieving saving targets and monitoring outcomes
•Establish prediction of the future cohort that will require specialist services (and cost this)
•Agree predictive indicators that could demonstrate CYP may require specialist support into the future
•Establish the size and profile of the cohort of CYP and their families that have the above predictive factors and explore costs to provide early help and targeted support to this cohort
This work will be broken down by age group and district and profiled against assets within their local community
Benchmarking - Referral Rate
31
2013 2012 2011 2010
National Statis-tics
520.7 533.5 556.8 551.657729206068
Statistical Neighbours
408.897884996695 387.814184985483 373.528925619835 389.137557561427
Gloucestershire 408 456.5 424.435483870968 460.041571970463
50
150
250
350
450
550
Rate of Referrals per 10,000 children - trend 2010-13
National StatisticsStatistical NeighboursGloucestershire
Cost of referral leading to initial assessment 2012: £2.5k
Refreshments
Keynote 2
Essex and Wolverhampton, Alastair Gibbons, Emma Bennett
– managing demand
The Essex Journey
Alastair Gibbons14th November 2014
www.itv.com/essex
Historical Context
2004–2008 significant structural change in response to Children Act 2004
2008 – 2010 ECC Children’s Services rated as Inadequate for safeguarding in JAR; then by Ofsted
GOVERNMENT INTERVENTION
System shock
Whole-scale system and culture shift
OFSTED INSPECTION 2014 rated as Good
37
Essex Context – What were the Challenges?
• High numbers of children in care• Culture of the use of in-house residential units • Predominance of high cost residential placements • Lack of investment/focus on in-house fostering (our best value care)• High proportion of older adolescents with behavioural issues • Poor parenting support in particular around managing behaviour• Under developed early intervention and family support services• Costly externally purchased High Level Family Support; social workers
acting as commissioners rather than undertaking direct work with families
• Lack of intensive interventions and limited resources to establish them• Recruitment and retention problematic• Vicious circle - wrong service offer, pressure on budgets, reducing
available investment, staff leaving, poor agency staff, increased cost
Measure Mar-12 Mar-13 Mar-14Number of referrals 13274 10307 12550Number of Children in Need (not CP or CIC) 5102 4821 4680Number of Children with a Child Protection Plan 788 549 425Percentage of Children seen at Initial Assessment 77.4% 81.5% 89.0%Percentage of initial assessments for children’s social care carried out within 10 working days of referral 76.7% 76.9% 74.5%Percentage of core assessments for children’s social care that were carried out within 35 working days of their commencement 77.4% 81.3% 79.1%Percentage of single assessments for children’s social care that were carried out within 45 working days of their commencement N/A N/A 99.0%Percentage of children seen under s47 enquiry 90.1% 94.9% 98.4%Child protection plans lasting 2 years or more 4.0% 3.2% 1.5%Percentage of children becoming the subject of a Child Protection Plan for a second or subsequent time 9.9% 15.5% 18.2%Number of Children in Care 1483 1265 1147
Percentage of Children in Care who are adopted each year New 10.9% 21.3%Percentage of Children in Care placed within 20 miles of their home address New 67.8% 81.1%
Effective Support Windscreen
Essex County Council
40
41
42
4343
Strategy•Whole system change•Reduce children in care numbers•Invest in social workers •Invest in family support - D-BIT (Divisional Based Intervention Teams) •Lead – don’t manage•Act and sort!•Be brave and principled•Respond to the inspections
Systems•Reduce processes and procedures….Slim down protocol forms / revisit what really needs authorisation•Family focussed assessment tools•Turn decision making on its head•Take bureaucratic burden away from social workers•Work to avoid duplication
Skills•Systemic approaches•Evidence based interventions•Joint working – get things done quickly•Access to highly skilled supervision•Learning circles (assessments, care planning etc?)•Invest in skill development•Essex Social Work Academy •Effectively use supervision
Style• Risk management not risk adverse• Role generosity• Allow for difference• Take responsibility• Be a learning not a blaming service• Actively model behaviours,
performance and thinking required to reshape our service and champion the necessary culture change
• Be positive and supportive whilst demanding high performance, flexible and supportive team work
Staff• The most valuable resource• Spend time recruiting the right people• Remember the complexity of the task
social workers do• Help move on those for whom its not
working• Support, nurture, develop and enthuse• Make active use of HR procedures
Structure • Move to the quadrant model • Keep your best social workers
practising • Bring in develop the next generation,
each team having at least 2 students per year
• Design to facilitate partnership
44
About Children in Care?• How do you use it? Do you know your trends?• Is it always planned and purposeful?• Is it always time limited?• Do we understand the emotional impact on a child of removal from their family? • Do we have an agreed position on permanency? (care is never permanent) • Do we talk about over intervention? Do we recognise it? • Are our staff bullied by other agencies to take children into care? What do we do
about this as a senior management group?• What are the unwritten rules about how social work decision making operates? Do
they reinforce care or promote engagement?• How well do we engage with families in crisis? Do social workers say to families how
can I help? Do they quote legal duties to families?• Do we know our outcomes for those in care? What difference have we made? • How many children and young people left care to return to their family ?• WHAT VALUES AND BELIEFS DO YOU PROMOTE?
45
Social Work Practice
• Systemic and Strengths based approach • Effective intervention, which promotes family resilience,
active engagement with families, properly exploring issues, understanding of child and parents’ perspectives and motivation, understanding of strengths and dangers
• Frontline practitioners investigate, engage and creatively enable family to identify solutions before seeking more restrictive statutory interventions
• Focused intervention with families short-term to find solutions • Focused plans to reunify families – exits from care• Clarity about levels of need and thresholds • Open and honest Partnership work
46
Let’s Talk About Risk
• Does your organisational structure, ethos and culture allow and support professionals to take appropriate risk?
• What risk tools do your staff use?- Strengths-based models?- Three Houses?- Risk/resilience matrices?- Towards safe uncertainty?
47
Alternate careSupervised contact
Evidence-based interventionWorking agreement
Multiple hypothesisMultiple points of intervention
Context, belief, behaviourMultiple types of intervention
Both/ and – risk/protective
Performance indicatorsWritten agreements
No further police reportsPassive compliance
Unallocated casesAvoidance and inconsistent
engagementNot engaging further
Missed visits
CERTAINTY
SAFE
UNSAFE
“Towards Positions of Safe Uncertainty”Barry Mason (2008)
48
Alternate careSupervised contact
Evidence-based interventionWorking agreement
Multiple hypothesisMultiple points of intervention
Context, belief, behaviourMultiple types of intervention
Both/ and – risk/protective
Performance indicatorsWritten agreements
No further police reportsPassive compliance
Unallocated casesAvoidance and inconsistent
engagementNot engaging further
Missed visits
CERTAINTY
SAFE
UNSAFE
“Towards Positions of Safe Uncertainty”Barry Mason (2008)
48
VULNERABILITIES
Identity & Spirituality(e.g. self perception,
values, beliefs)Thoughts & Feelings
(e.g. Thoughts contributingto low mood)
Physical wellbeing(incl. Risk behaviours, substance abuse etc.)
STRENGTHS
Identity & Spirituality(e.g. self perception,
values, beliefs)
Thoughts & Feelings
Physical wellbeing
HOPES & DREAMS
AspirationsHow would things look if your
goals were reached?If you could wake up tomorrow
& your dream was realised…what would you
notice?What would be different?
What building material do you have?
What other help do you need?
Danger and Harm Safety Future picture
I nstability
HELP
Building materials used in creating a pathway towards the achievement of hopes & dreams
Needs from
others -agencies, supports, etc.
Com
munity
–includ
ing work
/school
Friend
s/Peers
Family/Extended FamilyFamily/Extended Family
Nicki WeldMaggie
GreeningCYF 2003
©
Com
munity
–includ
ing work
/school
Practice Design© Child, Youth and FamilyMarch 2008
49
Resilience/Vulnerability Matrix
Resilience Good attachment Good self-esteem Sociability High IQ Flexible
temperament Problem solving skills Positive parenting Attractive
Adversity
Life events/crises Serious Illness Loss/bereavement Separation/family
breakdown Domestic abuse Asylum seeking status Serious parental
difficulties eg drug abuse/alcohol misuse
Parental mental illness
Protective environment
Good school experience
One supportive adult Special help with
behavioural problems
Community networks
Leisure activities Talents and
interests Vulnerability
Poor attachment Minority status Young age Disability History of abuse Innate characteristics in
child/family which threaten/challenge development
A loner/isolation Institutional care Early childhood trauma Communication differences Inconsistent/neglectful care
Resilient Child High Adversity
Resilient Child Protective Environment
Vulnerable Child High Adversity
Vulnerable Child Protective Environment
Variables Timing and age Multiple adversities Cumulative factors Pathways Turning points A sense of belonging
Interventions Strengthen protective
factors and resilience Reduce problems and
address vulnerability Achieve initial small
improvements
5050
51
Risk models are not a solution … they are tools
52
Organisation style and context..
• Organisations need to develop a culture and environment that allows and facilitates good practice to take place
• Building that environment involves:• Leadership• Support and innovation• Culture/style• Managing risk anxiety• A partnership approach
Doing To
VS.
Doing With
53
Level Stage Characteristics How Knowledge etc is treated
Recognition of Relevance
How context is assessed
Decision-making
1 Novice Rigid adherence to taught rules or plans Little situational perception No discretionary judgement
Without reference to
context
None
Analytically
Rational
2 Advance Beginner
Guidelines for action based on attributes or aspects (aspects are global characteristics of situations recognisable only after some prior experience)
Situational perception still limited All attributes and aspects are treated separately
and given equal importance
In context
3 Competent Coping with crowdedness Now sees actions at least partially in terms of
longer-term goals Conscious, deliberate planning Standardised and routinised procedures
Present
4 Proficient Sees situations holistically rather than min terms of aspects
Sees what is most important in a situation Perceives deviations from the normal pattern Decision-making less laboured Uses maxims for guidance, whose meanings vary
according to the situation
Holistically5 Expert No longer relies on rules, guidelines or maxims
Intuitive grasp of situations based on deep tacit understanding
Analytic approaches used only in novel situations or when problems occur
Vision of what is possible
Intuitive
54
Conditions for success in children’s services
For children’s social care services, there are particular conditions which we believe are important to success. 1) Articulating values and vision
Senior managers and other leaders talking and acting as a team. They must have a shared approach and view about their intention to improve outcomes for the most vulnerable children and about the provision of social care for children and families. This includes being clear about what children’s social care is seeking to achieve
55
2) A whole systems approach to strategic planning and service delivery for children – from early help through protection to care and adoption – including:
a) service design and delivery based on learning from experience, including feedback from service users about what works
b) a coherent mix of interventions, available at the right time and at the right level
c) the whole system promoting a culture of meeting need in the least intrusive and most universal way, reserving specialist services such as social care for those in the highest need
d) an adequate resource envelope for each tier of services, based on an analysis of need that promotes targeted evidence-based interventions and prevents escalation of need/risk to the child
This whole system approach needs to be developed, agreed and owned by all statutory partners and all providers of children’s services.
56
3) A unifying use of theoretical models of evidence-based social work practice
Approaches should be used that are in line with local values and vision - such as systemic, strengths based, solution focused, motivational interviewing, and social learning approaches. Relational based approaches provide the skill base to enable social workers to help families to change, helping them to find solutions, so that the safety, development and well being of their children is enhanced. Having a unifying approach to social work across the organisation promotes good evidence-informed practice, a coherent and consistent operational model and fidelity to an approach that can persist over time. This will lead to embedded cultural change and improvement that is sustainable over the long term.
57
4) A relentless focus on the recruitment, development and retention of social workers and social work managers in frontline practice with children and families Clinical social work practice must be valued highly and this should be reflected in the support, qualification and career structure for social workers and their pay grades. Career progression must reflect individual performance – how learning is translated into practice and delivers better outcomes for children. A strategy must be in place and regularly reviewed to keep good social workers in frontline practice but also to achieve a healthy level of succession planning – growing high quality supervisors and managers from within the organisation whilst also being seen an employer of choice by external applicants
58
5) Social workers with a manageable workload which is regularly reviewed
Social workers can only work effectively with a limited number of families. Allocating more than they can effectively work with means workers and managers formally or informally decide to prioritise some cases and give limited attention to others. Whilst there is no ideal number because manageability depends on the nature of cases and the professional capabilities of the practitioner, a range should be set beyond which an alert should be made. Controlling workload through high-quality supervision is necessary to promote effective analysis of risk and appropriate intervention. This means that social workers get involved with the most vulnerable children, so work with few cases but more intensely and decisively.
59
6) Social care teams small enough to allow team managers to know both staff and families well
The complexity of the families that social workers deal with requires them to receive high quality, regular, reflective and appropriately challenging supervision and for cases to have good case management oversight with careful and thoughtful decision making in respect of risk and next best steps.
7) Service design which minimises the number of changes to key worker/transfers between teams and also respects the need for some specialism across children social work teams
There needs to be clarity about the role and purpose of each team from contact and referral through to adoption, with simple rules about the way in which cases flow between teams. Co-location and integration or secondment of multidisciplinary professionals may be appropriate.
60
8) An operational culture of dialogue, reflective thinking, feedback, learning and support.
The organisation needs to support the active management of risk and anxiety in children’s social work and to promote sensible approaches to build confidence and expertise. High quality performance should be expected from all staff and learning and accountability woven into the fabric of operating approaches. This includes having clearly understood systems, supported by a culture of delegation of decision making in casework and financial management, promoting accountability and responsibility at the appropriate level throughout the organisation
61
9) An aspirant and system-wide approach to improvement and performance
In addition to action to address specific issues identified by inspections, peer reviews, self audits and local performance analysis, a broader and long-term approach about the total improvement journey to ‘Oustanding’ is needed. This should be supported by a comprehensive performance approach, with good and timely information across a range of indicators and outcomes at individual, team and service level. A good quality case audit process will reliably look at quality of practice, management oversight, the outcome for the child and family and the business processes.
10) Appropriate practical support
Such as adequate working space, good ICT systems and strong administrative support to reduce the bureaucratic burdens on social
workers and social work managers.
62
2010/11 2011/12 2012/13 2013/14Number of Children in Care 1,608 1,499 1,257 1,140
A placement strategy has been developed and is reviewed and updated for budgetmonitoring purposes and setting the medium term resource strategy. The table below gives ananalysis of the historical spend
2010/11 2011/12 2012/13 2013/14£m £m £m £m
Internal Foster Placements 12.18 13.63 12.76 12.14External Placements (Foster & Residential) 31.01 30.22 23.61 20.61SGO's / RO's / Staying Put/ Supported Living 1.59 5.14 5.79 6.60Internal Homes 7.83 6.53 1.91 1.76Total 52.61 55.52 44.07 41.11
www.itv.com/essex
Lunch1:15pm – 2:00pm
Workshops 2pm – 3pm
Choose between:• Sandwell – Managing demand (Colmore)• Research in Practice – Analysing regional data and using
evidence to manage demand (Chamberlain)• Educational Support for LAC (Led by Jim Collins, on behalf
of Educational Achievement Network) (Brindley)• Commissioning – Examples of innovation within the West
Midlands -Viv McKay and Rakesh Mistry (Edgbaston)
Keynote 3
Ray Jones – Children’s Services in the Spotlight;and Coventry’s perspective thereon
– Sara Roach
www.coventry.gov.uk
The story after an Ofsted Inspection …..
Sara Roach
Deputy Director, Strategy and Communities People Directorate
www.coventry.gov.uk
Before the Inspection
• Coventry’s history
• Managing staff expectation
www.coventry.gov.uk
During the Inspection
• Experiencing the event
• Business as usual
• Containing the anxiety
• Preparation for the judgement
• Managing the feedback
www.coventry.gov.uk
After the Inspection
• Cascading the message
• Responding to the news
• “Picking up the pieces”
• Setting the tone
• Highlighting the improvements
www.coventry.gov.uk
Personal Reflections• Role of Director of Children’s Social
Care pivotal• Personal/emotional resilience• Professional credibility• Member interface• Public expectation• Celebrating quick wins• Risk adversion
Last thoughts and close
WM ADCS Chair, Laura Johnston
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