West Cheshire Integrated Early Support Strategy

Our Definition of Integrated Early Support

Intervening in a joined up way at the earliest possible stage to tackle problems emerging for children, young people and families, or with a population most at risk of developing problems. Early support is a process and may occur at any point in a child, young person or vulnerable adult’s life.

STRATEGY/ POLICY APPROVAL

Title / Name / Date / Signature
Senior Performance Manager / Sonia Bassey / 10/06/2015 /
Head of Service / Helen Brackenbury / 10/06/2015 /
Children’s Trust Independant Chair / Gerald Meehan / 10/06/2015 /
Next review date / June 2017
Chapter / Content / Page
Introduction / 3
1 / National Policy Context / 6
2 / Local Policy Context / 8
3 / The basis of our Strategy – a ‘whole system’ approach to
early support / 10
4 / Joint Intelligence - understanding vulnerable children,
families and Communities / 13
5 / Describing Levels of Need in Cheshire West & Chester / 15
6 / Universal Provision and Targeted Services – a new Integrated Early Support system / 17
7 / Acute Services – effective support and step down / 24
8 / Evidenced based interventions / 24
9 / Workforce Development and training – developing
skills for integrated early support / 26
10 / What success looks like - key measures of impact / 27
11 / Where are we now? / 28
12 / Review and Evaluation / 29
13 / Essential links / 29

Introduction

All partners across West Cheshire have agreed that Integrated Early Support matters. We know that:

  • Effective prevention and early intervention work can avoid escalation of problems that people face and can improvetheir life chances
  • It can enable the effective ‘stepping– down’ of work with families and individuals which have been managed by acute services (such as Children’s Social Care Services) preventing the re-escalation or problems
  • It is crucial that we do everything possible in the current economic climate to support people and ensure they can be socially and economically independent
  • As Public Service budgets reduce, we need to reduce demand for acute and emergency services – which are much more costly than preventative work

Our strategy aims over a 3 year period to:

  • Improve the physical and emotional health and wellbeing, behaviour, emotional resilience, safety and security, literacy and numeracy and social development of children and young people and families and vulnerable adults within West Cheshire.
  • Deliver a much more co-ordinated response to cases requiring multi agency support below the thresholds for acute and emergency services.
  • To ensure the right help is given at the right time and right place across all levels of service provision, to ensure earliest possible identification and prevention of escalation.

The Strategy for Integrated Early Support is based on a number of key principles:

  • A progressive approach that pays particular attention to key points in the lives of children and families.
  • A focus on enabling independence and removing reliance on support services – building on family’s capacity to help themselves.
  • Integrated Early Support will work for all families, communities and services in West Cheshire – not limited to early years
  • A focus on the needs of all children and young people, especiallythose with additional/complex needs who are vulnerable and at risk of poor outcomes;
  • A proactive approach and co-ordinated response to identify, support and respond to domestic abuse and it effects on children and adults.
  • To reduce the incidents and impact of domestic abuse on communities by challenging perpetrators.
  • Building on the strengths of our existing provision to support children, young people and families and filling identified gaps in service provision in an innovative manner, designed around the needs of individuals and their families.
  • To use innovative, integrated commissioning approaches to service improvement and redesign which looks at service user led pathways
  • Taking a developmental approach to support young people as they make the transition into adulthood.
  • Ensuring that people who ‘miss out’ in the early years are offered an integrated early support offer to address issues such as neglect, substance misuse, poor housing, domestic abuse, crime and anti social behaviour.
  • All services will work within,or support, an agreed, co-ordinated case management model with clear pathways between services and the voice of the service user at the centre.

Public Services in West Cheshire have committed to and invested resources to the Integrated Early Support approach as a major part of our work to improve outcomes for residents and in turn reduce demand for services. This investment comes through individual agencies investment in services and through a joint investment of resources in the new Integrated Early Support Model, outlined in section six.

Partners have agreed to evaluate the strategy and measure its impacts on outcomes, efficiency and potential savings year on year and more detail on the arrangements for review are set out in sections ten and twelve.

  1. National Policy Context

Since taking office in May 2010 the Coalition Government has established two independent reviews covering early intervention and prevention:

  • The Foundation Years, Independent Review on Poverty (December 2010) Frank Field MP.
  • Early Intervention: The Next Steps (January 2011) Graham Allen MP followed by Early Intervention: smart investment, massive savings (July 2011).

Community Budgets are also an important part of the Government’s drive to help troubled families turn their lives around. They give local authorities new freedoms to pool resources breaking down bureaucracy and find joined-up solutions for troubled families.

The first 16 community budget areas (covering 28 local authorities and 20 per centof the country) became operational in April 2011, with a further 50 plus local authorities being offered the opportunity to develop one from April 2012.

Both of these, along with the Tickell (2010) and Munro (2010) reviews showed that services that support children and families during their early years are generally not well co-ordinated or integrated either at a strategic or local level. This has then impacted on children throughout their childhood.

The Munro Review of Child Protection (May 2011) recommended a duty on local authorities and statutory partners to co-ordinate an early help offer for families who do not meet the thresholds of children’s social care to address their needs before they escalate to child protection concerns. This ‘early help’ duty is enshrined with the Children and Young People Act 1989 and S.4 of the Children Act 2004.

The NICE guidance: Social and emotional well being – early years, aims to define how the social and emotional well being of vulnerable children under 5 years can be effectively supported through home visiting, child care and early education.

In November 2011 the Prime Minister set out his ambition to try to turn around the lives of every troubled family, with the Department of Communities and Local Government (DCLG) being identified to lead the programme, establishing a Troubled Families Unit headed up by Louise CaseyCB - Director-General, The DCLG defined a troubled family as:

“ one that has serious problems - including parents not working, mental health problems, and children not in school – and causes serious problems, such as crime and anti social behaviour. All of which costs local services lots of time and money routinely responding to these problems”.

Research shows that children from families with multiple social, economic and health problems experience the worst outcomes and make significant demands on a wide range of local services. Intensive family support of the type pioneered by family Intervention projects (or FIPs) has been shown to turn these families lives around and delivered impressive reductions in family problems.

In June 2013 the Government announced plans to expand the Troubled Families Programme for a further five years from 2015/16 and to reach an additional 400,000 families from across England. £200million has been committed to fund the first year of this five year programme to take the work of the current programme to a greater scale, to further transform local public services and reduce costs for the long term.

In September 2011 the Department for Education published data showing that up to March 2011 over 10,000 families had been supported through intensive family interventions and that these had resulted in significant reductions in the problems they experience.

The report indicated a need for:

  • Increased investment in the kind of support that helps turn around the lives of families with multiple problems
  • taking advantage of new funding mechanisms and investment
  • breaking down barriers that prevent services and practitioners working together to deliver solutions which address the complex problems these families face
  • spreading evidence-based practice and support on evaluation and monitoring of provision and family outcomes.

Following Graham Allen's Review of early intervention support will also be extended to 20 areas who have intentions to reduce the number of vulnerable families who go on to develop complex problems in the future.
2. Local Policy Context

Partners have agreed to reform public services

As part of Cheshire West and Chester’s approach to the Community Budget (known locally as Altogether Better andFamilies Together programmes), the Authority and Partners have agreed how we will reform public services in a way that meets the needs of local communities, enhancing local services, eradicating duplication and inefficiency. Ensuring that children and young people get the best start in life is a pivotal theme of Altogether Better and it is integral to families being supported, enabled and empowered to make this happen.

Altogether Better was originally focused on the five key themes: Starting Well; Living Well; Working Well; Ageing Well and Smarter Services. As part of this innovative approach to policy making and establishing new ways of working to transform public services, CWAC is also one of the leading authorities engaging in the groundbreaking approaches to working with Troubled Families, children, young people and households where domestic abuse is prevalent.

The Children’s Trust have agreed the followingStrategic Outcomes:

  • To promote and improve the emotional health and wellbeing of children, young people and their families (Emotional Health and Wellbeing)
  • To support our Children in Care and Care Leavers to enable them to achieve their full potential (Children in Care and Care Leavers)
  • The needs of children and young people with Special Educational Needs and Disability are met (SEND)
  • Intervening in a joined up way at the earliest possible stage to prevent problems escalating with children, young people and their families (Prevention)
  • To promote the development of children in the Early Years so that the gap in outcomes between vulnerable children and their peers is closed (Early Years Closing the Gap)

Families Together support families with complex needs or ‘Troubled Families’ who depend on public services by providing an integrated package of support, incorporating a range of new approaches to working with families and existing public and voluntary sector services. Families Together is our approach to delivering the Department of Communities and Local Government ‘Troubled Families’ Programme. The Families Together team was embedded into IES in February 2014 achieving outcomes for all 525 families that were part of the first programme. Cheshire West and Chester Council is now part of the five year Expanded Troubled Families Programme which will support a further 1730 families across West Cheshire.

The development of effective early support and prevention services is critical at a time of reducing resources across the public sector and a rising demand for specialist services. More effective early support services should result in fewer inappropriate referrals to children’s social care (and other specialist services, such as health services) and families receiving support earlier and at a reduced cost.

The focus for Early Support services are those children and young people whose needs are either at level 2 (early intervention) or level 3 (targeted intervention) on the Cheshire West and Chester Continuum of Need – see diagram below to explain this. However, there is also a need to ensure that our universal services are co-ordinated, focused on prevention and early intervention and deliver clear outcomes. Some services work across these thresholds, delivering important Universal Services as well as more targeted work, for example Health Visitors.

Our Childrens Trust has responsibility for delivering our Early Support Strategy and our Local Safeguarding Childrens Board challenges the Trust on delivery, quality of support services and outcomes for children.

  1. The basis of our Strategy – a ‘whole system’ approach to Early Support

Through work on Altogether Better, partners in West Cheshire have developed an approach to Early Support that goes further than the focus on the early years of life for children and young people, which was the main concern of the first version of our strategy for Early Support.

This enhanced approach still absolutely sees support for children and young people and their families as critical to improving people’s life chances, and extends the range of partners who are actively engaged in this work.

The revised approach also extends how we see the concept of prevention and early intervention being applied at later stages in life for children and young people, families and vulnerable adults. This will go much further with the level of integration between partners and systems that they use to identify risk and provide support.

This is a very welcome development that can help achieve our aims of improving outcomes and life chances and reducing demand for acute services, enabling greater focus on prevention over time.

The revised strategy for Integrated Early Support retains the focus on understanding the continuum of need, and how needs can change over a period of time depending on circumstances. In turn this requires clarity about how all public services can support the delivery of effective Early Support, whether they are services that operate on a universal, targeted or specialist basis.

The table below illustrates this point, which makes clear that Integrated Early Support operates across the whole system of public service support.

Table 1: A whole system approach – Integrated Early Support across levels of need

Level of provision / The role of Partners in West Cheshire
Universal – a quality offer and experience of life in West Cheshire for all individuals and families /
  • Ensuring all families in West Cheshire have access to good quality public services and private goods and services. For example; attractive and affordable offers for housing, childcare, education and health care, safe, vibrant and supportive communities, quality open spaces and recreational facilities, access to labour market opportunities and good transport links, quality and accessible shopping and leisure opportunities.
  • This level of support is effectively the ‘first line’ of prevention and early intervention, and is the aspiration for how all individuals and families should be supported.
  • It is important that universal services recognise their role and play their part in identifying risk, assessing and preventing escalation of problems.
  • Examples of services working at his level are Childrens Centre 0-5 development services, schools support including breakfast and after school clubs, Health Visiting and midwifery services etc.

Targeted – additional support that can anticipate and respond to individuals and families additional needs /
  • Jointly identifying risk and providing prevention and early intervention to avoid escalation of concerns.
  • Supporting self - help solutions – using the assets and strengths of individuals and families to resolve problems in an innovative way, supported by developing technology.
  • Where problems do escalate, working together to avoid them becoming acute and repetitive, providing joined up support and sustainable solutions where possible.
  • Receiving cases ‘stepped down’ from acute levels of support to prevent re escalation and a capacity to ‘step up’ cases to acute support where required.
  • Examples of services working at his level are targeted Youth Work, Education Welfare, NEET support and Family Case work services.

Acute/specialist – for cases which become severe and/or complex, requiring more urgent and integrated protective action /
  • A capacity to quickly and jointly identify that problems have escalated to this stage and to then plan and deliver rapid and effective support.
  • This includes arrangements for safeguarding and ‘Level 4’ cases in Children’s services, but also applies to other circumstances where joint action is needed to deal with acute problems – for example in offender management and continuing health care.
  • A capacity to effectively ‘step down’ cases to targeted support services, in a way that secures a clear arrangement for preventing re - escalation.
  • Examples of services working at his level are Independent Domestic Violence advisors, inpatient services for Mental Health or Drug treatment and care, Criminal Justice action including Prison or Community sentence.

To ensure the ‘whole system’ is able to contribute to Integrated Early Support as outlined here, we have set out a range of actions that build upon our initial approach. These are designed to significantly strengthen and deepen the work between partners to identify risk and intervene early to improve life chances.

The scope of our key actions are illustrated in the diagram below, and then explained in more detail in the following sections of this document.

Fig 1: Strategy for Integrated Early Support in West Cheshire