wavetrust/our-work/prevention-in-practice @ WAVE_Trust

How can my local area create a breakthrough in primary

prevention and integration?

Resource for London, 365 Holloway RoadMonday 30th June, 2014

Key Messages

http://www.wavetrust.org/our-work/prevention-in-practice@WAVE_Trust

http://www.wavetrust.org/our-work/prevention-in-practice

Dave Hill, Essex County Council

Finding the money - 1• You can both save money and improve the quality

of services at the same time• We stopped many of the services that do

firefighting• 500 fewer children in the care system than 3

years ago• How?• We worked really hard as services to identify the

earliest signs of a problem• Then as early as possible, intervened or

supported families to keep their children in the community


Finding the money - 2• Saved £30m from children in care• Invested £10m of that into early support and

early intervention• Especially early years and children’s centres• Multi-systemic Therapy funded by social finance• Why would you do this?• It’s actually a way of saving money• We’re only investing in things that really make a

big difference


Generating the will - 1• This happens at a number of levels• Leadership at the top, including directors,

councillors, voluntary sector, schools, health, police

• All these agencies coming together on a common agenda

• Also, leadership from the bottom• In Essex, strong emphasis on getting people back

to working directly with children• Changing the culture of practice important both

from top and bottom. People will get behind a shift to working with human beings directly and changing their lives for the better


Generating the will - 2• So what persuades people?• First, hearts and minds• You’ve got to persuade people this is the right

agenda• Secondly, get more serious about research and

evaluation– Show the evidence base for what you did and what you

are doing

• Thirdly, just be incredibly persuasive about the money and resources because the homework on prevention vs firefighting shows it works

• Get politicians, policy makers, and health and wellbeing boards behind this – they will understand it’s better for children to be with their families

Bill Alexander, Highland Council

How to implement - 1• The Highland Practice model• Incorporated into Scottish Govt programmes for

children (e.g. GIRFEC, Getting it Right for Every Child)

• Principles– Pathway through services with clarity of roles– Common language– Engage and empower children and families– Named person and lead professional roles– Assessment framework from birth– Assessment determines plan and service delivery– Single Child’s Plan– Fewer meetings and single Child’s Plan meeting


How to implement – 2• Integrated services officer

– Joining universal and targeted services

• Early years practitioner– Additional social work support in early years

• Children’s services worker– Additional social work support in schools

• Health and social care teams integrated as Family Teams with enhanced capacity to help children in the early years

• Increased budget for early years and prevention e.g. From 23 to 35 Early Years Practitioners


How to implement - 3• This funding from all council budgets and supported

by all council directors• It is making a difference• A range of improved outcomes across the board• More children supported, lower rates of looked after

children, fewer children at risk of significant harm, fewer re-registered within 1 year

• Fewer children smoking, using alcohol or drugs• Continued low persistent offending rates• Recent Children’s Inspectorate report confirmed

success– 7 ‘Very Good’ and 2 ‘Good’ ratings

Kim Bromley-Derry, Newham Borough Council

Generating the will – 1• Political support and effective public, private and

voluntary partnerships key• Also desire to innovate (acceptance that change

is needed), motivated workforce (winning their backing for wholesale change), resident engagement

• Health and Wellbeing Board is at the core of all this– a holistic approach is essential


Generating the will - 2A) Create sustained political support

– must get over the history of false ‘invest to save’ initiatives – must be seen to deliver

B) Effective partnerships– must all contribute to the right environment for collaboration

C) Need to engage, work in partnership with voluntary sectorD) Need to work with families, residents. Co-design essential E) Must have a motivated workforce

– this requires engagement, communication, a lot of work– build capacity of managers giving them space to go beyond

managing the essential reactive requirements


Greatest Barriers - 11. Fear of change

– we all know dealing with abuse, neglect, poor health costs more in the long run than preventing them in the first place

– but whole system, e.g. Ofsted, tends to drive to traditional reactive measures

– we have to grasp these nettles

2. Fear of the future– will we all have jobs? Will we have the services?– if we are aiming to transform the system, we have to get over

these fears and trust that our skills are transferable

3. Will the projected savings be delivered?– or will we add new spend while keeping the old?


Greatest Barriers - 24. How do we balance risk and reward in the system?

– difficult to show but not impossible if we have the will– just have to get the evidence organised and the narrative

right– the evidence is there

5. Lack of enthusiasm– to move from reaction to prevention takes enthusiasm, to

drive change– talk about improved outcomes. Focus only on cost savings

kills enthusiasm

6. The economic case– Nobel Prize winning Economist James Heckman shows

investment in the early years delivers economic efficiency, reduced spend and improved outcomes


Key components for the change processA) A compelling visionB) A strong evidence baseC) The right narrative

– communicated differently for different audiencese.g. health, community, local authority, voluntary, chief executives

– Newham has a narrative around resilience – individual resilience, community resilience, economic resilience. This is communicated across agencies.

D) Champions for the workE) Strong leadership both from the top and bottom


In Summary• Prevention and integration makes sense. We

know this.• Can we do it?

– Yes – we have the evidence– We just need to do it systematically, lobbying hard– And we need to do it now

• If we don’t we will just cut and cut. • Lack of money is not an argument for inaction.

Delay only means greater problems later• We must act now

Helen Price & Simon Bilous, Gloucestershire County Council

Finding the money - 1• Research showed large proportion of children in

care are under 5, and in care because of abuse or neglect

• Many of these parents had substance misuse or mental health issues

• Same pattern for children on child protection list• Development of these children quite delayed

when they hit statutory services• We looked for a solution with very swift

assessment and significant boost to child development through intensive intervention


Finding the money - 2• Strong preventive element including social

workers, health visitors, drug and alcohol workers, mental health workers, speech and language therapists

• New initiatives: Family Drug and Alcohol Court, Journey into Early Parenting (health visitor led)

• 100% engagement with the journey into positive parenting!

• Health visitor ‘know how’ has been key to the success

• Early identification of parents not able to interact positively with their children, inc. Language, absolutely key


Finding the money - 3• Strong outcomes• Reduced numbers and period of time in care• Reduced parental substance misuse and poor

mental health• Cash savings through fewer care proceedings and

less time in care. Placements easier because children more advanced

• Significant benefits to children – more school ready, less SEN, better speech and language, less offending in later life

• Significant cash savings from (not) instructing experts in care proceedings – work already done in D&A Court or by HVs

• Workforce more efficient through greater complementary working


Generating the will - 1• Be really clear about the problems you’re trying

to solve and have the evidence• Include the problems that are relevant to the

services you are dealing with – e.g. Chronic neglect a problem for all services

• Have to address high level service needs as well as prevention. Start at universal and work through to high end need.

• Tailor your message differently to different audiences – be aware of their own pressures and priorities


How to implement - 1• Huge gap between children doing well and those

with chronic neglect due to parental substance misuse or mental health

• Tackled other issues also but use this as an example• Looked at convergence of needs assessment and

other drivers to get support for an integrated approach to both commissioning and provision in the early years

• This won backing from CCG and County Council• Extensive consultation with parents, early years

practitioners, other stakeholders• Result: Joint Strategic Framework for commissioning

in early years


How to implement - 2• Sought to get agreed outcomes and priorities

across agencies • Gathered the evidence and the narrative first so

we could make a case• Took a very measured and long term approach –

step by step• Worked hard to align processes, timetables etc. • Now have jointly agreed high level outcomes

between commissioners and providers with jointly agreed priorities

• Agencies have shared expectations and clear understanding of how each contributes to the other – e.g. Children’s Centres to health outcomes etc.


How to implement - 3• So what?• Clear organisational benefits – co-location has led to

better information sharing and mutual understanding

• New intensive support team (Turn Around for Children Service) for children with greatest chronic neglect

• More children receiving early education offer, more vulnerable children supported by parent champions, more parenting programmes through health visiting and Children’s Centres, more children achieving good level of development by school entry, better outcomes for children on child protection plans or looked after, increased engagement of teenage parents etc.

The Staffordshire StoryFinding the money - 1• Big challenges, 5 CCGs, 25 major public sector

organisations• Public sector spend of £7.5bn, Children’s services

£170m• Important to create partnership of 25 public

sector organisations• Children’s Trust how can we spend more on

prevention?• Youth Services how can we spend more on

prevention?• Answer Look at the £7.5bn not the £170m

The Staffordshire StoryFinding the money – 2• Health and Wellbeing Board put early intervention

and prevention at the heart - stop problems developing

• H&WBB ideal point to influence– E.g. Mental health services, domestic violence services –

if these are not effective we end up with children in care

• Needed to win support of 5 CCGs / GPs• Buy-in through passion and talking as much as by

evidence• One focussed Health and Wellbeing Plan

(important to get it right)

The Staffordshire StoryFinding the money - 3• Took £200m out of hospitals• Paid for community care and prevention instead

of putting people into hospital• A lot of Children’s Services too reactive

(examples)

• KEY: Early Intervention and Prevention is not a project on the side, it’s at the core of how we operate

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