The future of early intervention: roundtable debate

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The urgency to reduce pressures on children's services has never been greater. Research published by the Association of Directors of Children's Services in November 2018 showed that in the past 10 years, initial contacts with children's social care rose by 78 per cent. The number of children subject to child protection plans has increased by 87 per cent and the number of children in care was up by 24 per cent. Early intervention - identifying and providing early support to children and families at risk of poor outcomes - has the potential to alleviate the strain on children's social care. Yet these figures suggest early intervention is unsupported or not delivering the desired outcomes.

CYP Now hosted a debate with directors and assistant directors in December 2018 in central London to discover what can be done differently. The debate took place in partnership with Capita One, which supplies management information systems to local authorities to manage data on children and families.

AROUND THE TABLE

1. Helen Brackenbury, Director of Early Help and Prevention Services, Cheshire West and Chester Council
2. Lucy Butler, Director of Children, Education and Families, Oxfordshire County Council
3. Ravi Chandiramani (Chair), Editor-in-chief, Children & Young People Now
4. Tim Eyres, Head of Integrated Commissioning, Norfolk County Council
5. Anna Feuchtwang, Chief Executive, National Children's Bureau
6. Tilly Flanegan, Head of Child Wellbeing, Staffordshire County Council
7. Kathy Marriott, Area Director, Children's Services, Isle of Wight Council
8. Donna Molloy, Director of Policy & Practice, Early Intervention Foundation
9. Ali Omar, Head of Innovation and Improvement, Havering Borough Council
10. David Anderson, Chief Product Officer, Capita One
11. Deborah Green, Product Manager, Capita One
12. Martin Miller, Sales Specialist, Capita One
    
    

One of the biggest challenges facing early help provision, according to Early Intervention Foundation (EIF) director of policy and practice Donna Molloy, is the short-term nature of funding and the length of programmes. This was a finding in EIF's Realising the Potential of Early Intervention report, published in October. To secure longer term investment, the sector needs to step up its ability to evidence what works. But collecting data and making evidence-based decisions is proving difficult for local authorities in the current climate. "Evidence for early intervention in the UK is still, arguably, at quite a depressing stage," said Molloy. "We rely too much on evidence from overseas, and the evidence sits largely around manualised, discrete programmes. We know very little about the wider system conditions, or questions of workforce practice, which are a much bigger part of an early intervention offer locally.

"If we're trying to achieve a step change in the quality and availability of evidence, while some of that might come from nationally commissioned big studies, the real way forward is improving capacity and capability for evaluation locally. Local authorities and partners who are delivering this stuff need access to the resource, know-how, and technical expertise in order to measure the impact of the things they're delivering. In the current context, that's really challenging."

LONG-TERM GAINS

All directors around the table agreed that short-term funding and political cycles impeded their ability to demonstrate the impact of early intervention. Havering Borough Council head of innovation and improvement Ali Omar described how elected members only have a four-year administration cycle in which to commission and fund research, which is too short. "There's a mismatch between what we feel we should do to get those meaningful outputs so that we can show early help works, against what some of our political members will feel about the time it takes," said Omar.

Anna Feuchtwang, chief executive at National Children's Bureau, suggested part of the problem in securing long-term funding stemmed from historic claims to central government that early intervention could deliver short-term results. "I think we have, in a way, shot ourselves in the foot by only going down the ‘it reduces demand' data," she said. "Perhaps we as the voluntary sector in particular went too far in trying to make claims about: ‘if you spend money here at this end of the street it will prevent it being spent down there' instead of making the case - which the EIF has consistently made - that if you look at the evaluation of individual programmes you can demonstrate good long-term outcomes for each of them."

When programmes do receive funding, resources to properly evaluate them are often lacking, argued Feuchtwang. She said two projects currently funded by the Big Lottery Fund, A Better Start and HeadStart, were unusual in having a large amount of money for measuring and evaluating whether they led to systemic change. "Unless that is taken on by government as well as seen as a proper evidence base, those programmes will come to an end in the next 10 years and they'll be a great legacy for the area, but they won't build into national change," she said.

BRINGING EVIDENCE TOGETHER

Oxfordshire County Council director of children, education and families Lucy Butler agreed the sector should work more collaboratively. She pointed out that government initiatives tended to focus only on a few local authorities, such as the What Works Centre for Children's Social Care, which has 21 councils and trust partners. "We're all dealing with the same things, yet we're all on our own trying to go through this morass," she said.

Norfolk County Council head of integrated commissioning Tim Eyres said central government should provide direction around "logic modelling" in relation to impact and outcomes, as even areas receiving Better Start funding were doing this individually. "If you add up the amount of resource and time that's being used, not just in Better Start, but actually in local authorities generally, and the work we're doing around early intervention and early help, it's an incredible amount," he said.

Directors around the table agreed that the kind of data collected to demonstrate impact in early intervention could be better. Many cited using results from the government's Troubled Families programme as foremost in decision making. "Because it's around payment by results, you've got to show all the evidence," said Staffordshire County Council head of child wellbeing Tilly Flanegan. "It's our most robust and reliable source of data." According to the ADCS report, 75 per cent of local authorities said their early help services would be cut or reduced, in some cases significantly, when the Troubled Families programme funding ends in 2020.

Oxfordshire's Butler said she believed the evidence she received had an emphasis on trying to hit Ofsted targets. "It fuels that [notion of] ‘let's keep children out of care, let's keep children away', rather than actually, as a whole system, ‘what's going on?'"

Isle of Wight Council children's services area director Kathy Marriott concurred, suggesting local authorities had become too focused on outputs and short-term outcomes. "We don't spend as much time looking at the trend data over time - some of those bigger, wider determinants," she said. "The Ofsted regime has a huge part to play in that."

ROLE OF CHILDREN'S CENTRES

Many agreed that opportunities to evidence the impact of early intervention delivered by children's centres had been missed because of poor data collection. Around 1,000 - just over a third of the total - have closed since 2009 according to research by the Sutton Trust, largely as a result of government funding cuts. "Who knows if they work?" asked Eyres. "I can find a research report that says they do, and one that says they don't." Eyres said performance frameworks around children's centres were unfocused. "They were chasing so many different indicators, most of which were being chased by other bits of the system." He suggested children's centres should focus on three or four impact areas alone.

Molloy agreed, adding it was important to distinguish outcomes that are based on processes from more tangible outcomes that improve lives. "When the [EIF] team goes out to local areas and asks for a description of the local offer, there's a multitude of things that the early help architecture is going to achieve, which often feels quite unfocused, unfeasible," she said. "The first step is how you boil that down to a key set of outcome areas, and then, what are the things in a one- to two-year timescale which are upstream of improving attendance or attainment - what are the valid measurements that aren't just process outcomes? We tend to measure our assessments, referrals, step-ups and step-downs. If local authorities were applying these methods collectively, that builds up a broader picture to take to government and say: ‘this isn't just about children's social care, this is about movement on all these key areas of development'."

Changes to national education policy have had a detrimental effect on early help support delivered in schools, the panelists suggested. Eyres said since vast numbers of schools had converted to academies, and were no longer under direct local authority control, it was harder to work with school staff. Butler described how shortages in schools funding had led to reductions in welfare officers and pastoral services.

But the directors agreed the government's mental health green paper, which includes plans for mental health support teams in every school, provided opportunities for new ways of delivering early help. "It's quite a game changer," said Butler. "We're using that to say to schools, ‘can we occupy this space in a different way?' It's always helpful when you've got a bit of compelling money."

Flanegan described how Staffordshire County Council had brokered with schools to spend some of their budget on early help services, to replace money formerly top-sliced from the local authority dedicated schools grant. "That brought back some of that relationship with schools that we'd sort of lost," she said. "It has meant schools have become more engaged - because it's their money, they feel they own it."

In Cheshire West and Chester Council, director for early help and prevention services Helen Brackenbury said the authority had changed thresholds for referrals to early help case work or statutory assessments, which had driven schools to engage better with them.

Omar explained that Havering was starting to remove the need for schools to send the council referrals. Instead they could speak to key people on the phone. "That's been successful in engaging schools," he said. "If you've got troubles, give us a ring and we will get people around the table."

Eyres said it was unsurprising schools found it difficult to engage with early help assessments, such as the common assessment framework. He suggested, to widespread agreement, that early help provision needed to be simplified and presented in a way that was easier to understand, as it was "alien to the world of education".

Marriott said discussions about early help had become particularly difficult with secondary schools. She said it needed to create a "team around the school" to build trust with the local authority. "We've identified an emerging gap around emotional wellbeing for young people," she said. "The green paper is helping us to galvanise and have some ins into secondary schools where we've perhaps had some issues before."

However, Flanegan described the green paper as a "very medical model" that would not help young people develop long-term resilience and grit. "It's just about stopping people going into child and adolescent mental health services," she said. Instead, she advocated having more lessons about mental health.

COMMUNITY DEVELOPMENT

Several directors suggested going back to the roots of community development work as a way to deliver more effective early intervention provision. Marriott used the phrase when describing how the Isle of Wight had introduced family group conferencing earlier in its early help process. "Most local authorities are doing that on the edge of care, as part of your Public Law Outline process - but actually, we need to get that right up front," she urged. "A lot of it has become over-professionalised. The team around the family is a team of professionals. But how do we actually support community resilience? It's good old-fashioned community development work."

Butler pointed to the Early Help Locality and Community Support Service created by Oxfordshire County Council, whose offering includes providing advice to community professionals with concerns about a child or family that is not an immediate safeguarding concern. "It's been really successful," said Butler. "We've put some of the service in our multi-agency safeguarding hub to triage back to early help. It's inhabiting that very early help space."

Volunteers were being trained up in Havering, Omar explained, to deliver community programmes. He said many were families formerly supported by the council that wanted to "give back".

"My concern is we might start leaning on that a bit too much," he cautioned. "But we're upskilling and providing them with the ability to deliver." The borough is also looking to early years providers as a source to deliver early intervention, in place of potentially reducing services at children's centres. "There is a lot of opportunity through the community to pick up some of the things we perhaps can't prioritise," said Omar.

YOUTH WORK ‘RENAISSANCE'

Butler also asserted there was an emerging "renaissance around the youth agenda", which required professionals to have community-based skills. Adolescent early help services have been cut sharply across the country, as funding for youth services is not ringfenced. But Butler said growing cases of issues such as child sexual exploitation and child criminal exploitation were provoking a return to "real targeted expertise in working with adolescents around community safety".

Havering, situated in East London, is a route for children exploited in county lines drug dealing into neighbouring Essex, Suffolk and Norfolk. "A lot of what's happening in Havering and across London is very politically driven by this agenda," he said. The borough has recently designed an adolescent safeguarding service, which will be multi-disciplinary and focus on interventions for children aged from 11.

Brackenbury said more targeted work was also a feature of early help for adolescents in Cheshire West and Chester. They had placed council anti-social behaviour officers within police units to deliver detached outreach work alongside the youth service, which led to around 100 more young people accessing youth provision.

Marriot agreed with Butler's assessment, and said the renaissance should include a rebuilding of youth services. Eyres added that it was not just services, but also the understanding of adolescent development that has been lost. "That cognisance of the special nature of adolescence as a period of development is missing not only in terms of youth service-type provision, but in relation to the way we engage with adolescents in the care system," he warned.

Around the table, colleagues voiced hope that, again, the mental health green paper might provide opportunities to address gaps in youth services.

INTEGRATED WORKING

Integration of services was an aspect of early help delivery all directors agreed local authorities must improve. "It's really important we keep the message that early help is about all professionals," said Marriott. "It's not just about social care or children's services." In the Isle of Wight, she described her work in getting partner agencies to commit to the early help assessment process, including schools, health services and voluntary and community services.

"We've got huge buy-in from partner agencies," she said. "I only have two co-ordinators in-house in my service that support all of the lead professions out there in the community. They do quality assurance, training, make sure plans are on track. If cases are a bit more complex they come in and provide assistance. We've got three localities on the island and they go out to each locality once every month and all those professions are brought together for support, training and network meetings."

Flanegan agreed, citing how in Staffordshire the health visiting and school nursing offer had recently been combined into a family health and wellbeing service, with children's centres coming on board in 2020. "The biggest partner we've had missing around the table has been health - our clinical commissioning partners - because they are so focused on the elderly and stopping people ending up in accident and emergency," she said. "However, 50 per cent of spend in accident and emergency is actually on children. There are lots of links to make."

Some felt that integration was a shortcoming of the government's funded childcare places for disadvantaged two-year-olds. Molloy cited EIF research that showed in its first few years, the policy had not delivered the results government hoped. "The evidence suggests what we should be delivering in order to close those development gaps between the most disadvantaged two-year-olds and their better-off peers is high-quality childcare, so we should look again at the two-year-old offer, combined with interventions to support positive parenting, or speech and language skills," she suggested.

Brackenbury said her local authority had ensured those parents who did not take up their two-year-olds' childcare places - who were often the most vulnerable - were offered a six-week package of home learning. "It's enabled us to drill down a little bit with those [parents] and get them into nursery provision or address unmet need," she said.

Finally, the group considered whether artificial intelligence, where robots can be programmed to act and react, taking on tasks undertaken by humans, could have a role in delivering early intervention. Several colleagues were already overseeing similar work, such as Eyres who said Norfolk was delivering a digital platform to provide information, advice and guidance to residents, essentially "a robot at the end of the phone responding to those initial enquiries".

But all cautioned that it was important such technology should never be used in place of professional judgment. Marriott in particular gave the example of software that might try to predict what support families were likely to need based on data held by local authorities. "It can lead to lazy decision making," she warned. The table agreed such approaches could result in people falling through the cracks, or being escalated to services inappropriately.

RECOMMENDATIONS

1. Evidence - Local authorities should rethink what data they collect to prove early intervention's impact, how they collect it, and share it better with other authorities and government.
2. National evaluation - Central government has a role to play in drawing together evidence and backing early help approaches by providing funding alongside new policies, as in the example of the mental health green paper, as well as funding programme evaluation.
3. Joined-up approach - Early intervention is not just a matter for children's services or social care. Heath, education and the voluntary sector, among others, must all align to deliver provision. Local authorities must find ways to forge relationships between agencies.
4. Community development work - Local authorities should consider investing in more local provision, and use trained volunteers and youth workers to deliver services.