Research: Commissioning – Placement Planning - Research evidence: Study 3
Mark Kerr, chief executive, The Centre for Outcomes of Care
Thursday, May 28, 2020
OOC is a research charity, founded to improve outcomes for children and families. We develop evidence-based solutions for local authorities, residential and foster care providers using ethical and scientifically robust approaches
Delivering an Integrated Adolescent Multi-Agency Specialist Service to Families with Adolescents at Risk of Care: Outcomes and Learning from the First Ten Years
L Talbot, P Fuggle, Z Foyston and K Lawson, The British Journal of Social Work, 2020
The needs of children and families are complex and require multidisciplinary input. A range of initiatives and programmes, aiming to address this, have been ineffective in reducing the numbers of children coming into care.
The Adolescent Multi-Agency Specialist Service (Amass) was established to work with families of adolescents (aged 10 to 16) on the edge of care, within Islington children’s services. Amass addresses multiple factors through an intervention model that aims to attend to the needs of both the family and the allocated social worker.
Islington specifically avoided setting up a separate specialist team, instead establishing a co-located, multi-agency team within children’s social care. Social workers could refer cases to this team when they wanted support to jointly deliver a social care, mental health or education intervention aiming to reduce edge of care risk. This approach has all the features of a wraparound approach.
The paper focuses on a 10-year service evaluation of Amass. Especially due to the length of time evaluated, this is a welcome contribution to the evidence base demonstrating how to reduce the number of children and young people coming into care.
Study findings
The service supported 181 families and had a completion rate of 85 per cent. In total, 78 per cent of the referrals were for home stability, 11 per cent for foster placement and 11 per cent for support to return home.
At the end of the intervention period, 82 per cent of families achieved “stable care” and the remainder achieved “changed/increased care”. Longer term outcomes were assessed by looking at the situation on the young person’s 16th birthday – 69 per cent were not in local authority care (or for fostering cases, were stable in placement) and 31 per cent were in care.
Positive social care outcomes for both the young people and parents in families at serious risk of family breakdown have been reported, with family or placement stabilisation achieved for eight out of 10 young people post-intervention who accessed the service over a 10-year period. There was a higher success rate for home stability packages (85 per cent), foster placement stability packages (85 per cent) and a moderate level of success in returning young people home (60 per cent).
Conclusions
Providing effective community interventions for families with multiple and complex needs requires attending to and balancing a number of elements. Services that emphasise delivering such interventions through a single practitioner (however skilled and motivated they may be) rather than by taking a team approach, are unlikely to work.
Four key factors were identified as being of significance in the outcomes obtained by Amass:
- 1. Continuity of care and the avoidance of case transfer
- 2. The integration of mental health, education and social care expertise
- 3. The explicit recognition of the role of anxiety in the work
- 4. Taking a whole team approach.
It should be noted that the trend over the decade for numbers of children looked after has steadily risen, whereas in Islington the numbers have steadily declined.
Implications for practice
- The needs of vulnerable children and families are multi-disciplinary and span multiple agencies.
- Services operating in silos (e.g. social care, health, education and criminal justice) are ineffective and will not improve permanency outcomes.
- Multi-agency working is much more than teams coming together to discuss children and families they share on caseloads – it requires a shared vision; a shift in culture, structure; and the integration of multi-disciplinary expertise into a single team.