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

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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