The context for ‘Think Family’ and ‘Troubled Families initiatives

1. 'What works (and doesn't) with families with complex difficulties: implications for 'payment-by-results’ June Thoburn UEA Centre for Research on the Child and Family j.thoburn@uea.ac.uk www.uea.ac.uk/swp/people

2. The context for ‘Think Family’ and ‘Troubled Families initiatives Psycho-social family casework (relationship based helping to the family as a whole) has a long tradition in child and family social work in USA and European ‘welfare democracies’ In UK legislation (from 1948 Act to 1989 Act as amended) In practice (FSU, Family Action, Action for Children, neighbourhood family centres, and practice in Children’s Departments post 1963 CYP Act) led to unified SSDs prior to adult – children’s services split and now back to ‘Whole Family’ approaches but even more governmental splits (DCLG, DWP)

3. The re-discovery of the ‘problem’ family as ‘the family with multiple problems’ or ‘troubled family’ Teams initially located (FIPs) not within Children’s (social work) Services but in housing, schools, neighbourhood policing (attempt to make ASBOs ‘work’) and most recently ‘back-to-work’ agencies The 15 ‘Think Family’ projects more likely to be in located in Children’s Services More complexity around joined up working in non-unitary authorities

4. Unpicking ‘complex families’ needing high intensity targeted services Complex - a range of interacting difficulties/ types of maltreatment/ at risk of ‘coercive’ (formal child protection or out-of-home care or criminal justice) interventions Hard to reach Hard to help / change ‘Troubled families’ or ‘troublesome families’ or families where there are child protection concerns/ children on the edge of care. To what extent do they overlap?

5. The evaluation Both • A (modest) evaluative study • is the work of the team effective? • is it more effective with some sorts of families and in some circumstances than others? • does it make good use of scarce resources? and • a process(descriptive) study • what are the components of the work that may be contributing to more or less successful outcomes? • 1/3 ‘intensive’ sample taken from first 100 cases

6. Central elements of FRP ‘team around the family’ (TAF) approach A multi-disciplinary, inter-agency team Combining experienced social work managers, intensive outreach workers (IOW); adult and children’s service specialists; intelligence analysts Given that the target group is families with complex problems and risk of statutory intervention, important that team is based within Children’s (social work) Services Overarching ethos is a social work one with strong emphasis on inter-disciplinary practice

7. Central elements of FRP ‘team around the family’ (TAF) approach Accurate information and analysis (family history, present circumstances, and intervention history – what has worked and hasn’t in the past) (a ‘strengths-based’ approach but differs from some ‘strengths based’ approaches which concentrate on now and future- avoids ‘start again syndrome’) (information analysts – including police- are key team members) Relevant record keeping, including recording of Team around the Family (TAF) and professionals’ meetings, family’s views, analysis and transfer summaries (access to ICS but not used for day-to-day practice)

8. Agreement of parents based on clarity of aims, efforts that will be required of different family members, clarity about rewards and consequences, and a phased case plan negotiated between lead professionals and family members At least 2 lead professionals – FRP IOW and usually child’s locality team or CP social worker, but ‘pull back’ others at initial stage Most of the work is in family home or community 3-weekly key professionals’ meetings and 6 weekly TAF meetings to review case plan and progress – family members choose whether to attend or not - most parents do but some prefer to discuss with key workers before and after

9. Examples of TAFs 1. Mainly FRP: IOW plus FRP specialists and co-ordinating network meetings

11. Essential elements of intensive outreach practice (common to most FiP/ Think Family projects) • Empathic casework relationship • Clarity about what has to change BUT - ‘Start where the client is’ – assume parents will know their family best so respectful of their views about what is likely to help • Paramountcy of children’s protection and welfare • Flexible combination of practical help, support, educative approaches and therapy • Variations in composition of ‘multi-disciplinary’ team • FRP draws on specialist team members as needed to advise IOW or parents- ‘Salad not soup’ approach

12. The families • Between October 2008 and the end of April 2011 • 306 families were referred to the project. • 135 (44 %) were offered and accepted a service • 167 (56%) were rejected or did not take up the service (with 4 cases still being screened)(critical point re willingness to engage – crisis theory) High relevance of ‘intention’ and ‘motivation’ (spotting crises/ turning points) • As of 1 May 2011 • service ended to 92 families (43 still open)

13. Broad Grouping of needs/ problems (one third sample)

14. Comparisons between Project families and a more ‘typical’ Children’s Services sample Project families: • more parents are older at referral • have more older children including some over 18 but still a part of household • have children across the age range • more two parent families (including both parents of all children) (may be a feature of authorities with more diverse populations) • fewer young single parents • fewer ‘single issue’ or ‘short term’ or ‘acute distress’ families

15. The services provided

16. Intensity and duration(Short: <6 months: lower intensity = FRP contacts average 2 per week or less but always with ‘peaks’)

17. Stickability – flexibility on case intensity and duration The pattern of service intensity and duration for the 7 cases used in the cost analysis

18. Continuity of relationships when case closes to FRP • Professionals taking over/ continuing with family benefited from goodwill during FRP service • When risk of lack of continuity IOW maintains low intensity of service until successful handover The case wasn’t with the social services when it was referred [by the duty team] then it was reallocated, then the social worker changed. There was a lack of consistency. The FRP offers consistency until the family are secure with a social services team. IOW

19. Casework approaches - NB flexibility Around half: broadly psychosocial Around half: broadly solution-focused/ problem-solving In only 6 of the 31 cases was a specific ‘model’ programme followed by IOW (in 4 other cases group parent training provided by another TAF member at later stage) In 12 cases aspects of model programmes were used and adapted in the home In 11 no evidence of a manualised programme

20. Were specific methods or programmes used? That is the joy. So many different individuals with different background into the melting pot. It is all about the ethos. Facilitating the family’s journey. So all those different approaches come together very well. Sometimes a specific programme or intervention is right for the family but that is part of a bigger mix. When I’m working with families, my different- whole gamut of skills, are used as needed - whether it is CBT or reflective. Mental Health Specialist Social Worker

21. Professional Relationships • On the multi-disciplinary team base I loved it. It was an extraordinary experience. It was a real blessing to come and work here - away from silos - having the resource within the project to work in a multidisciplinary way. Specialist worker recently joined project

22. Sorting things out- making things less messy • On other professions feeling about FRP I think they feel glad that FRP are involved so we can do some of the coordinating that they would not get around to. We can do the intensity that families need [other social work teams] do not have the time to do this or the capacity. The social workers value the role FRP can play. IOW

23. Was a helping relationships established? Yes- trusting 13 Yes - ambivalent 11 No 5 Mostly with IOW but sometimes with a specialist FRP worker (especially welfare benefits worker) and sometimes with FRP as a whole

24. Outcomes at case closure to FRP Is the team reaching the families they aim to reach and what are their characteristics? Are the children protected and is their wellbeing improved? Are those who still need services engaging with them? Does FRP provide value for money?

25. Troubled families unit: Target families and aims on which payment-by-results based • Reduced involvement in crime and anti-social behaviour • Reduction in exclusions/ truanting • Adults no longer on out of work benefits or (lower premium) engaging in readiness to work activities Overall aim: lower costs to the public purse (no longer ‘on the books’ of ‘targeted’ services)

26. With families with long standing/ complex problems there are no ‘quick-fixes’Children’s wellbeing at case closure

27. Overall interim outcome for family at case closure(researcher rating)

28. Targeted children’s services involvement still needed for most

29. Sorting things out, Making things less messy My experience is that social services and social workers really have found huge benefit from having FRP in place because it is such a broad multidisciplinary team.... They get a great deal of relief and support, my sense is that they are sitting here on their own working very hard under a lot of pressure but they have a unique resource that we have here [FRP] they can draw upon- it doesn’t feel separate. FRP Specialist Worker

30. % of 33 cases where this case goal achieved (% does not total to 100 because goal not relevant in all cases)

31. Is it value for money? Estimated FRP costing per family (FRP service only) during first 18 months: around £19,000 – similar to FIPs and other Think Family projects • Bottom-up costing methodology used by research team economist Only includes work of FRP team members (including supervision and training) and not other TAF members Range of £1,500 to £7,800 per family Difference between the two is mainly accounted for by non-staff overheads (premises, recruitment/ HR) high set-up costs and need to work to maintain funding and cross-agency involvement)

32. KEY QUESTION What is the appropriate balance in different geographical areas with different combinations of need: - between intensive intervention specialist multi-disciplinary teams, locality based teams and specialist duty, child protection and ‘out-of-home care’ teams There is NO single MODEL either for service delivery, practice approach or practice method BUT much common ground about the essential elements of effective (relationship-based) practice Flexibility of approach is crucial for ‘hard to engage’ and ‘hard to change’ families (The evidence in UK and USA is coming together around services ‘matched’ to needs of each family)

33. Across the USA, continental Europe, UK, Australasia, core elements from model programmes are being identified and adapted from clinical to community settings But there is consistent practice and research-based evidence across time and jurisdictions (though the terms used may change) that effective service delivery and practice with families with complex and/or long-standing problems require: Empathic casework relationships, professional discretion, flexibility to respond to family needs and wishes, ‘stick-ability’ Professional skills and values, professional supervision and enough time These are congruent with the issues tackled by Munro Report and the Social Work Reform Board

34. References Thoburn, J., Cooper, N., Connolly, S & Brandon, M. (2011) Process and outcome study of the Westminster Family recovery Protect. Norwich: UEA Centre for Research on the Child and Family Thoburn, J., Cooper, N., Brandon, M. and Connolly, S. (in press) ‘The place of ‘think family’ approaches in child and family social work: messages from a process evaluation of an English pathfinder service’ Children and Youth Services Review