How Early Help is organised and delivered in Cambridgeshire How are early help services organised? Early Help describes the response from preventative services and processes which aim to identify and support vulnerable children, young people and families early enough to prevent their needs escalating. The Enhanced and Preventative Services Directorate (EPS) (within the Children, Families and Adults Services in Cambridgeshire County Council) has the majority of the responsibility for coordinating and delivering the early help offer across Cambridgeshire. The Directorate provides a bridge between specialist services such as social care and student assessment and universal services such as schools and the NHS. This paper refers primarily to services provided by EPS but acknowledges that some early help services are provided within other directorates as well as other organisations. Enhanced and Preventative Services includes the following areas of service delivery which come together to provide a tiered service to children and families depending on needs. The Directorate works with approximately 24% of under 19s at any one time (including Children s Centre registrations). Children s Centres are mostly managed as part of Locality Teams but some Centres are managed by other providers including schools and the voluntary sector. They provide a single point of information and access to services for children aged 0-5 and their families. Locality Teams are 14 multi disciplinary teams based around clusters of schools with each team linking to one or more secondary schools and their cluster primaries. Locality Teams operate as the delivery arm for preventative work (parenting, behaviour, attendance and youth support) with children, young people (aged 0-19) and their families and act as a local hub for identifying need and supporting children and young people. Family Intervention Partnership (FIP) is an intensive support programme for families with very complex needs. FIP provides a dedicated worker who provides practical help and coordinates support around the family for around 12-18 months. The FIP is a key delivery arm of the Together for Families (Troubled Families) programme in Cambridgeshire. Support for Learning (Special Educational Needs and Inclusion Support) including SEN support services for early years, primary and secondary schools, Sensory Services and Early Support. Community Educational Psychology Service provides advice and training to schools and settings and direct interventions with children and young people to support children with SEND to access and progress in learning and overall development. Youth Support Services which includes alternative education, the Youth Offending Service, Teenage Pregnancy, Drug and Alcohol Services and Domestic Abuse, Multi Systemic Therapy and strategic leads in relation to integrated youth support services, attendance and inclusion. 1
Commissioning Mental Health and Supporting People commissions services for people with mental health problems and their carers and leads the commissioning of Housing Related Support through Supporting People. How is the early help offer coordinated and accessed? The Model of Staged Intervention (MOSI) is a key part of the integrated early help offer and provides a shared language for practitioners to discuss levels of need and agree an appropriate response. It describes 4 levels of need (with level 1 being children with emerging needs and level 4, severe needs). These are compatible with speech and language descriptors, SEN code of practice, Social Care thresholds, CAMH levels of need and reflects the work of early years professionals. Early help works across the levels according to need but with a focus on levels 2 and 3 and at level 4 this is usually in conjunction with another specialist agency. 4 3 Children with severe needs/ protection Children with complex needs 2 Children with additional needs 1 Children with emerging needs Cambridgeshire has made a commitment to the early help offer being built on the use of the Common Assessment Framework (CAF) as the main tool for assessment when needs are unclear or when the needs identified are greater than the organisation undertaking the assessment can meet alone. Following a comprehensive audit of the use of CAF in Cambridgeshire in 2009, a revised strategy was implemented in September 2010 across the children's workforce. A review of CAF was completed in June 2012, which included external analysis by C4EO and has shown that in the main, the route to access early help is clear for those services that were part of the initial rollout of CAF, i.e. SEN Support Services, school nurses, health visitors, midwives, early years settings, schools, Educational Psychology, CAMH, and voluntary organisations working with children and families. The report concluded that the average cost of completing a CAF was 2,505 per CAF with an average saving in terms of costs avoided of 36,355 per family. A key principle underpinning this strategy has been an acceptance that flexible use of a CAF by the professional who initiates it is acceptable, assuming that it is a live 2
working document and other professionals will contribute. There is an expectation that arrangements for support and intervention will be set out within one integrated plan, which has been developed through a team around the child/family approach with an identified lead professional. Children, young people and parents/carers who gave feedback as part of the CAF review were overwhelmingly positive about their experience of CAF, both in terms of the process and the impact. Data is currently collected to measure the impact of CAFs when CAFs are closed. 83% indicate that outcomes have been met. In response to ongoing evaluation and quality assurance processes further developments include the recent launch of an e-form, a shortened route for simple requests, more guidance for lead professionals and a family CAF. Work is now focused on including further agencies in particular those within adult services. The CAF is one part of the integrated early help offer in Cambridgeshire and it s impact is closely linked to the system of Team around the Child (TAC) and Locality Allocation and Referral Meetings (LARMs) that take place at Locality level. There are examples of excellent practice identified through the evaluation of Locality Allocation and Review Meetings (LARM) where problem solving has taken place, involving a wide range of professionals, relating to complex cases or cases where a clear way forward has not yet been identified. Work has also been developed with School Nursing teams to integrate work received and allocated with Locality processes to facilitate improved information sharing and more coordinated planning. The majority of requests are correctly directed through the CAF process and there is an Advisor within the Integrated Access Team who can redirect any requests not reaching social care thresholds to an early help service where appropriate. Arrangements are also in place between Locality Teams and Social Care to support children and families whose level of need changes. Step up and step down processes have been in place since early in 2012 and the process is regularly reviewed. In addition to the formal protocols any issues are resolved through discussion between Locality Managers and Social Work Managers. How is need identified and how are resources matched to need? At a county level the Joint Strategic Needs Assessment and Children s Services Strategy set the overall framework for priorities and service delivery. Our service model follows the commissioning cycle for services delivered both internally and externally, analysing needs, specifying a service delivery model and continually reviewing outcomes. Within Enhanced and Preventative Services we have some externally commissioned services e.g. drug and alcohol services and some elements of our service which are traded in particular with Academies e.g. education welfare services. Resources are allocated taking into account needs. At local level, a case load management and allocation system operates alongside the Common Assessment Framework (CAF) process and is used to ensure that worker time is being directed according to local priorities in a flexible way. Practice standards for all the professional groups concerned set out the required levels of intervention and minimum standards. 3
Early Years There are 40 Children s Centres across Cambridgeshire. 32 of the 40 are managed as an integral part of the 14 Locality Teams ensuring that a full 0-19 service can be provided. The remaining 8 centres are provided by schools and voluntary sector partners. Children s Centres are focussed on supporting families with children 0 5 and up to 11 years for children with disabilities. 70% of the resource available is used to provide a targeted service and 30% is retained for universal work. Service level agreements have been established with NHS partners and Job Centre Plus which ensure that services can be provided to families in an integrated way, including a regular presence from health visitors, midwives and Job Centre Plus staff. A centrally commissioned contract with Speech and Language Therapy has resulted in early intervention for mild speech and language difficulties enabling 204 children to be referred for an early speech and language assessment, and 17 children for a hearing assessment an early access to services with a resulting impact on waiting lists. Six Children s Centres are being established as specialist hubs for children with disabilities and additional needs. Other elements of early help that are focused on early help for children who are at risk of exclusion and or have special educational needs or disabilities include Early Support which was re-launched in 2012. Early Support is jointly funded with the PCT to ensure that children with complex needs receive an integrated assessment process, a parent held file and a coordinated approach via a Family Service Plan. Children s Centres are a key part of the offer, which is available for children whose additional needs are identified in the pre school years. Within Early Support is a home visiting service which offers family focused support and facilitates communication between the family and other agencies or settings, including Children s Centres Strengthening Integration and Partnership Locality Teams were set up 7 years ago to provide a more integrated, responsive service to children and young people. Since then they have evolved to be more focused on contributing to preventing escalation of need and therefore working more closely with specialist services. In the last three years significant change programmes have taken place to realise savings and create a more targeted service. In April 2011, the Youth Support Service was created as part of the Locality Teams bringing together Connexions and Youth Work functions. The service moved away from universal youth work and careers guidance and now offers a more targeted service for those young people at risk of not being in education, employment or training (NEET) or vulnerable in other ways. Evaluation so far shows that despite having to deliver challenging savings (1/3 of the budget) Cambridgeshire continues to perform well in terms of NEET/EET. In April 2012, reforms to the parenting workforce were implemented, 1 million was indentified from the Looked After Children placements budget to fund an earlier intervention (level 2/3) workforce to reduce escalation of need leading to children having to come into care or access other intensive specialist services. A new Family Worker workforce was established replacing the previously separate roles of Family Involvement Workers and Parent Support Advisers. There is now a more consistent and evidence based approach across Children s Centres and Locality Teams with a more explicit focus on supporting higher need families. 4
In addition Cambridgeshire primary and secondary schools have allocated 710K of Direct Schools Grant (DSG) funding to ensure the continuation of very early intervention (level 1/2) school based support for parents. In most cases this is managed within the 14 Locality Teams on behalf of the schools. There are also 3 Prevention of Offending workers in Locality Teams and 5 Senior Social Workers working across a number of Locality Teams. The Youth Offending Service has a well established programme of preventative work including work with parents and substance misuse services to prevent NEET and reoffending. Whole Family Working The County Council has expanded the Family Intervention Partnership (FIP), which is an intensive support programme for vulnerable families, with an identified worker who coordinates support around the family over a period of approximately 18 months. The original one off funding for FIP was added to through Invest to Transform funds provided by the County Council. This has been supplemented by contributions from the Police, NHS, Housing providers and District Councils through the development of joint approaches to supporting high need or high demand families. The national Troubled Families initiative is complementing these reforms. As an intrinsic element of our Looked After Children Placements Strategy, Cambridgeshire has a well established Multi Systemic Therapy (MST) Service (Standard and Child Abuse and Neglect) and evidence from case reviews is that this has reduced the number of children going into care and those re-entering the child protection system. Last year, Cambridgeshire joined a consortium of neighbouring Local Authorities to set up an MST Problem Sexualised Behaviour programme. Additional Needs The Support for Learning (Early Years and Specialist Teaching) Teams and Educational Psychology Service provide consultation/assessment, advice and training to support inclusion, identification of need and progress for children with SEND in schools and settings who are under achieving or at risk of exclusion. SEND support services are allocated according to need and schools where needs are very low receive a minimum entitlement. Sensory Support Services provide early help to children and young people with a medically diagnosed sensory impairment. Due to well established links with local hospital eye and audiology clinics most children are referred immediately after diagnosis, which can be soon after birth. Most children referred have lifelong sensory disabilities and will need on-going support until they leave full time education. The early and ongoing help available from the Sensory Support Service results in improved attainment and emotional resilience and help for families at time of diagnosis and throughout the child s journey through school. It helps families stay together and support their child s development and learning. There are also some specialist elements of early help which are provided elsewhere such as short breaks for children with disabilities which is part of social care or through commissioning services from the voluntary sector such as young carer support. However where necessary these families can be linked into the wider multiagency processes. 5
Innovation and Impact Alternative Education, in September 2009 we devolved funding for alternative education provision for secondary school pupils (other than for students with statements), to area based consortia of schools who formed Behaviour and Attendance Improvement Partnerships (BAIPs). This was intended to allow the consortia to work together to try to prevent the requirement for education other than at school and ensure that, if required, it is of high quality. A reduced size, Alternative Education Service continues to provide education through one Pupil Referral Unit and The County School, with Learning Bases in Cambridge, Huntingdon and March. Consortia also provide or commission alternatives themselves which are quality assured by the County Council. A pilot of budget holding lead professionals in locality teams was piloted last year with very positive results and it is intended to develop this further. How is quality assured for early help? Quality assurance of early help is addressed through a number of systems that are set out in a performance and quality assurance framework. These include the following: A quality assurance process for the Common Assessment Framework Regular audit process to check case recording and supervision records Thematic audits on key topics or with other agencies (e.g. LSCB) to focus on particular areas of focus Evaluating Professional Practice - a structured process of observation and feedback by managers as part of the appraisal process Practice standards for each professional group Improvement Partners carry out thematic visits to Children s Centres to check practice and performance in key areas Feedback from service users in a variety of forms There is a Quality Assurance and Performance Board for Enhanced and Preventative Services, where all the findings from this work are brought together and changes or improvements in practice identified. How do we measure performance and what does current performance data tell us about how we are doing? The CFA Monthly Monitoring report provides an over view of performance across CFA and includes indicators which demonstrate the impact of early help services. The key indicators that are used as monthly measures of performance that are included in a performance report about early help are: Attendance Exclusions Numbers in learning NEET/EET Children s Centres registrations and involvement of vulnerable groups New entrants to the criminal justice system 6
Reoffending rates Planned destinations of children at the County School (PRU) Teenage pregnancy rates and teenage parents who are NEET CAF use and outcomes achieved Distance travelled as a result of interventions by Family Workers Cambridgeshire Children s Centres have set ambitious new targets regarding registrations and involvement of vulnerable groups. Registrations continue to improve and progress is being made towards targets for vulnerable groups. Cambridgeshire s attendance rates in 11/12 compare well to national average and statistical neighbours. Despite having made significant cuts to youth work and Connexions service NEET and in learning and the number of unknowns, Cambridgeshire compares very well to regional and national performance and our statistical neighbours. Performance needs to improve is in relation to care leavers and the number of teenage parents who are NEET, and these are key priorities although Cambridgeshire compares well at national and regional level. The Distance Traveled Tool has just been developed and is being used by Youth Support Services and Family Workers and will become a routine measure of impact for these services. We are also reporting on parenting courses for the first time this year and are working towards a target of 80% for completion, use of positive parenting strategies and increased parenting confidence. The % of CAFs where outcomes were achieved has also been monitored and having met the previous locally set target of 80% this has now been increased to 85%. The permanent exclusion rate is low (12/13, 12 pupils) and the rate for primary and secondary fixed term exclusions was1.0% for Primary pupils and 3.5% for secondary pupils. A quarterly performance report is produced for the Youth Offending Service. Cambridgeshire's Youth Offending Service has been told by the YJB that for quarter 2 they are in the top 25 per cent of performance for Youth Offending Services across the country. This puts them in the top 17 out of 162 services across England and Wales from the performance indicators on first time entrants, re-offending and custody. We have recently developed improved reporting on management information, starting with Locality Teams. This is feeding into a weekly metrics report and is also used by operational and service managers on a day to day basis to monitor new referrals and caseloads across the county. Future Developments We will continue to develop services in order to provide more targeted and more integrated provision to children and families within the context of savings targets and changes in need. 7