In search of alternatives to care

Education Secretary Michael Gove delivered his most notable speech on child protection last month, arguing that the system too often put the interests of adults first by not taking children into care fast enough. “Because of what has been called optimism bias – the belief that with a little more help and support the family will, at last, at long, long, last mend its ways – we leave children in danger for too long,” he said.

Gove used the speech to urge social workers to be more assertive in rescuing children from squalor and abuse at home by putting them into care. At first glance, the Redirect and Reinvest programme under way in Gloucestershire, Sandwell and Warwickshire appears completely out of step with the Education Secretary’s thinking. Nevertheless, the realisation of the best possible outcomes for vulnerable children lies at its heart.

Redirect and Reinvest explores alternatives to care by asking whether being removed from their family is the right solution for particular groups of children and young people. Unlike some past initiatives, Redirect and Reinvest started with a blank slate. It had no idea which children it hoped to help, no vision for revamped child protection practices and no snazzy new service to build. All it had was a question: is there a better way?

The project started life in the Social Research Unit in Dartington. The charity’s researchers were analysing looked-after children data and noticed an oddity that had long been unanswered. While there is a link between the number of children in care and deprivation levels in an area, that did not explain why areas with similar needs would have major differences in the size of their looked-after children population that could not be explained by organisational differences alone.

The unit wondered if vulnerable children were better off in local authorities that take more children into care or those that take fewer. But when it looked at the studies into the impact of care, it found no answers. “The research on children in care tends to look at how these children were doing before they went into care and how they have done,” says Louise Morpeth, co-director of the unit. “But you don’t know the effect of something unless you have something to compare it to. As a result, we do not know if we should have more children in care or fewer. We felt we needed to understand better what we should be doing for them.”

Consequently, the unit instigated the Redirect and Reinvest project 18 months ago, which has seen Gloucestershire, Sandwell and Warwickshire councils create services that act as alternatives to care and test them to see if they lead to better outcomes. With guidance from the unit, the three authorities delved into their looked-after children case files and fished out details on the characteristics of children’s lives at the moment they came into care.

Circumstances and needs
This information was then crunched to identify groups of looked-after children, not by the usual age and gender measures, but by their circumstances and parental needs. These included children whose parents use drugs or have learning disabilities; homes where children were suffering chronic neglect; teenagers with severe behavioural problems set to enter the criminal justice system; and families blighted by domestic violence.

That children in care came from these groups was no surprise, says Helen Price, the lead commissioner for families at Gloucestershire County Council. “We knew anecdotally that things like very young children experiencing chronic neglect was an issue, but we didn’t have really robust evidence about it,” she says. “Through the Matching Needs and Services analysis, we were able to break it down, not only by age but by parental need. That allows you to be much clearer in terms of what sort of service might address that.” Armed with the data, the councils picked out groups they believed they could help with new or improved services. In Gloucestershire, the analysis supported the idea of creating an early years specialist service offering intensive support to parents with the drug, alcohol and mental health problems that often lie behind the neglect of under-fives. As a result, Gloucestershire became the second place in England (after London) to establish a family drug and alcohol court.

In Sandwell, the council also found neglect was an issue, but parents with learning disabilities and domestic violence also featured. Sandwell trained several social workers in the Parenting Assessment Manual model to help them work with parents with learning disabilities in ways in which they can understand. To deal with neglect, Sandwell has set up a family intervention project that will see staff work all hours to help parents address the problem. “It might be going to the home at seven o’clock in the morning to make sure the kids have had breakfast, or going in at night to make sure they are getting bathed,” says Helen Smith, service director for children and families at Sandwell.

The council has also rethought its approach to families where domestic violence occurs. “We’ve established a new model about to launch,” says Smith. “We’re developing a virtual team of a senior social worker, family support workers, health staff, police and probation. The idea is that when we screen, we will identify the most appropriate response. It may be a joint visit by a social worker and a police officer or it might be the health professional that picks it up. It’s about having that integrated approach so that we make a better judgment at the point when we are notified about a domestic violence incident and make the most of the resources we have to deal with domestic violence.”

Teenagers with challenging behaviour
In all three councils, however, one group has stood out: teenagers with challenging behaviour. “These are adolescents who are in conflict at home, probably in conflict at school and who would likely have poor outcomes if they were to come into the care system,” says Phil Sawbridge, head of service for children in need at Warwick­shire. “They are likely to have poor relationships with their peers, their parents, their social worker. They are disaffected, angry and disengaged.”

After the councils identified this group, the unit suggested they tried functional family therapy (FFT), an approach developed at the University of Utah and supported with plenty of evidence of its impact. FFT offers several advantages, says David Ward, the Redirect and Reinvest project manager. “These are hard-to-engage families who are often at their wits’ end and the relationships between the parents and the young person are extremely poor,” he says. “It’s very difficult to intervene effectively to bring about a supportive and nurturing relationship within the family. FFT has this persistent quality that helps the family to understand why they are behaving in the way they do, and gives them opportunities to learn how to develop different approaches that are going to be more functional.”

It is also an approach that, if it works, could deliver major savings. The cost of providing FFT is estimated to be about £3,000 per family, compared to £30,000 or more to have a child in care – and that is before longer-term savings to police, criminal justice and health services are factored in. The Social Research Unit and the councils it is working with, however, insist the potential savings are a welcome bonus, not the motivation, despite the current budget pressures on local authorities. “We’re not interested in saving money for the sake of finding efficiencies,” says Morpeth. “We’re interested in whether the money that is there can be spent to have the maximum benefit for as many people as possible. Hopefully, if we can support children well and get good outcomes, it will mean more money can be spent on other children.”

But with FFT still new to the UK, there are no existing providers for the councils to draw on. To get the service up and running, the three councils involved in Redirect and Reinvest intend to jointly commission a provider. “Individually, we wouldn’t have enough need to have a large enough commission to attract a major partner to invest in developing FFT,” says Sawbridge, who describes FFT as the flagship initiative of the programme. “It needs to be scalable to be worthwhile and, collectively, our need adds up to something we think will be well worth doing for providers.”

Gloucestershire is leading on the commission, expected to go out to tender imminently. The big, unanswered question is whether the councils will find suitable providers willing to create their FFT service. “We’ll have to wait and see who bids because there aren’t many providers in this country,” says Price.

It is far too early to tell what difference the approaches born out of Redirect and Reinvest will deliver. It will take another six months before everything is in place and then another couple of years until the evaluation is complete. As Sawbridge says: “We’re not claiming any results. What we are claiming is that we think, on the b