Multi-agency service reduces need for care in Manchester


A jointly-commissioned, multi-agency, early intervention service for pre-school children and their families living in Manchester.

  • Targets families with children experiencing emotional and behaviour problems.
  • Has some of the highest retention rates of families in parenting programmes in the world.

ACTION

Manchester has some of the highest rates of child poverty in the UK - 45 per cent according to statistics published by the End Child Poverty Campaign in May. At least 20 per cent of the city's population of 34,000 under-fives is at risk of having or developing behavioural problems. But over the past five years, Manchester University NHS Foundation Trust's Children and Parents Service (CAPS) has delivered parenting courses, among other interventions, to this target group, resulting in measurable, positive outcomes.

Service head consultant clinical psychologist Caroline White set up the approach 21 years ago. At first she ran it part-time, but it now employs 55 whole-time equivalent members of staff and receives around 1,000 referrals a year. The group includes 25 clinical psychologists from the health service and 25 family support workers or group leaders from other agencies, including charities Family Action, Barnardo's, Big Life, and Manchester Home Start. Manchester City Council provides three quarters of the service's funding, while children's mental health funds the rest, with an annual budget of around £2m.

CAPS works in partnership with community outreach workers, such as children's centre staff, health visitors and midwives to identify families that might benefit from its support. If parents agree, a member of the team visits the family in their home to undertake three standard assessments. The service uses "robust, gold-standard measures", says White. The team repeats the assessments at the end of the parenting programme, and three months after its end. "Research suggests if parents are going to relapse, that usually happens within three months," says White. "If they do, we can pick them up again."

CAPS delivers the Incredible Years parent programme - an internationally-recognised approach that focuses on strengthening parent-to-child interactions, nurturing relationships, reducing harsh discipline and promoting parents' ability to support children's social, emotional and language development. The group sessions last 14 weeks for parents of children aged two to four, or 10 weeks for those aged up to two. CAPS staff are all accredited in the method, which includes using Video Interaction Guidance, where families reflect on video clips of interactions with their children.

CAPS' success has meant it has not only maintained funding, but received more since austerity hit in 2010. "Our commissioners said: ‘We've hardly got any money left, and what we have got, we have to put into evidence-based work, and yours is the most effective service we've ever commissioned'," says White.

White is rigorous about data collection, hiring a permanent information analyst 10 years ago to ensure she could always answer commissioners' questions.

Despite staff being spread across different agencies, day-to-day they are managed by psychologists at the NHS trust. They hold weekly meetings where workers hand in families' data, which assistant psychologists input into databases. All information is held centrally. "When the Care Quality Commission inspectors came they said they'd never seen anything like it," says White. "It's massively time consuming, but the reality is we've survived 21 years because we have a robust evidence base."

IMPACT

Between September 2017 and August 2018, CAPS delivered 75 Incredible Years parenting courses to 989 parents of children aged under four. As a result, the proportion of families at risk of neglect or abuse fell from 86 per cent before the intervention, to 56 per cent afterwards. Parents presenting signs of clinical depression fell by almost three quarters from 68 per cent to 19 per cent.

The proportion with clinical stress fell from 72 per cent to just 12 per cent. The proportion of children with clinical behavioural problems also dropped by more than half from 69 to 32 per cent.

The programme achieves high parent retention rates of around 81 per cent. Three months after completing the course, 24 per cent of parents were back in work, 21 per cent were attending college and 10 per cent were doing voluntary work.

Although White says it is difficult to prove a long-term cost saving to public finances, she points out that while a looked-after child costs Manchester City Council an average £60,000 per year, and an unemployed adult costs the state about £500,000 in benefits over a lifetime, the parenting services costs just £1,600 per family.

Parent Kelly says CAPS helped her keep her youngest two sons. "I didn't know how to interact with TJ," she says of her son. "Now we play, we laugh. His schooling is amazing. Before the services my bipolar was up all the time. But now it's like I'm constantly calm. It's been absolutely heaven to our family."

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