Family Group Conferences for Adults
Hampshire
Evaluation Report
April 2010 – March 2012
Daybreak Family Group Conferences
Registered Charity no: 1077607
Company no: 3780726
Headoffice: West Lodge, Leyland’s Farm, Nob’sCrook, Colden Common, Winchester SO21 1TH
Tel: 02380 696 Fax: 02380 696655
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Family Group Conferences for ADULTS
Hampshire
Evaluation Report 2010 – 2012
Contents:
Page
5. Executive Summary
7. Introduction
9. Referrals, FGC meetings and reviews
11. Referrals by area and client group
13. Service user participation
15. Outcomes
16. Comments from Service Users and Families
17. Working in Partnership
18. Comments from Referrers and other Professionals
19. Appendix
a) Cost benefits analysis (2007 – 2010)
b) Case studies
Executive Summary
During the period April 2010 – March 2012,Hampshire County Council provided funding for continuation of the successful pilot undertaken in 2007 – 2010 using Family Group Conferences for Adults.
With Hampshire funding, referrals could now be accepted across all client groups, for any vulnerable adult aged 18years or over, for whom there were safeguarding concerns. The majority of referrals (57%) were for older people, though in the second year the proportion from other client groups increased, as awareness of the service grew.
- 51 referrals received
- 34 had at least an initial FGC meeting (67%)
- 57% of referrals were for older persons
- 30% of referrals were for service users assessed as lacking the capacity to make 1 or more of the decisions required
- 20 referrals involved known or suspected domestic abuse
- 12 referrals involved known or suspected financial abuse
Service User Participation:
- 86% of all service users attended their FGC
- 53% were supported by a trained advocate
- 17% chose to be supported by a family member or friend
Feedback on the FGC process as experienced by service users, families and professionals, and the outcomes for service users was overwhelmingly positive, with all but 1 respondent saying that they would recommend the FGC process to others..
Although no cost benefits analysis for this period is currently available, a study undertaken by Hampshire Adult Services of recognised savings post FGC for the initial pilot of 2007 – 2010, showed total estimated savings of £77,000
(See appendix A)
Introduction
April 2010 brought many changes for Daybreak’s pioneering work with Hampshire to provide Family Group Conferences for Adults.The initial funding from Comic Relief had now finished, and the programme was now reliant on funding from Hampshire CC. The focus of the Comic Relief pilot was to address Elder Abuse, and the referral criteria reflected this in that the referred service user should be aged 50 years or over, and either have experienced abuse or be at risk of abuse.
Hampshire Adult Services took the decision to extend the scope of the programme to cover a wider range of safeguarding concerns, and to include vulnerable adults of any age. Funding had been allocated for the financial year of 2010 – 2011, but the financial cuts required from the start of the following year meant a significant decrease in available funding. Nonetheless the service continued and excellent outcomes continue to be achieved in a wide range of situations, for service users and families across all client groups.
Information about using FGC for adult safeguarding is now included in the 6 day safeguarding training programme in Hampshire, which is held 4/5 times per year and is attended by staff from adult services, police and health. This helps to ensure that new staff, and others working with vulnerable adults in a wide range of circumstances, are all made aware of the service, and it’s uses and potential benefits,
Daybreak has been working with the Social Care Institute for Excellence (SCIE) to provide information and “Best Practice” guidelines for adult FGC, and this is now available on the SCIE website, with a link to Daybreak’s website.
Interest in FGC for adults and the pioneering work done in Hampshire, is growing throughout the UK, Europe and the US. Much of this interest was generated by the “Safeguarding and Empowerment” conference organised by Daybreak in partnership with Hampshire Adult Services in November 2011. The conference was hosted by IBM at their Hursley headquarters just outside Winchester, and attracted delegates from across Southern England. The conference was aimed at directors and assistant directors of Adult Services, police commissioners and those with particular responsibility for Safeguarding adults, and the feedback was extremely positive from all those who attended.
Training/ presentations have also been given in Leeds, Newcastle and Sheffield in the UK, Stuttgart in Germany, and at conferences in Utrecht and USA. Many of these have led to further enquiries and opportunities which are being taken up during 2012/13. In particular, as a direct result of its success in Hampshire, Surrey and the Royal Borough of Greenwich in London have commissioned Daybreak to conduct pilot programmes using FGC for Adults.
During this period Daybreak achieved “Investors in People” status, and also became a registered learning centre through the Open College Network. We developed the first national qualification for FGC coordinators working with vulnerable adults, and this is delivered as one module of the Accredited Coordinator Training, which is also available as a stand-alone option, for already practising coordinators who wish to expand their skills.
The last few years have been financially challenging for everyone working in Adult Social Care, whether in the public, private, or non-profit-making sectors. Daybreak is fortunate to have had the opportunity to work in partnership with Hampshire County Council, who were willing to try out a new approach to Safeguarding. In particular our thanks are due to Jane Duncan, Jane Selvage, Helen Eaton and all the Hampshire Safeguarding Coordinators for their continued support, advice and enthusiasm throughout the duration of this programme. We hope to continue to work with you for many years to come.
Linda Tapper
Programme Manager
Daybreak FGC
January 2013
Referrals, FGC Meetings and Reviews
Although the number of referrals was down in 2011 -2012, it is interesting to note that the number which reached an initial FGC remained the same. One reason for this could be that as referrers become more familiar with the model, they become better at identifying those situations which could best benefit from this approach.
2010-11 / 2011-12 / TOTALTotal number of referrals received / 28 / 23 / 51
Number of service users involved in the referrals / 31 / 26 / 58
Referrals involving domestic abuse (ie abuse by a partner or family member): no of service users affected / 10 / 10 / 20
Referrals involving known or suspected financial abuse: number of service users affected / 9 / 3 / 12
Initial FGC meetings held / 17 / 17 / 34
Review FGC meetings held / 10 / 9 / 19
% of referrals which resulted in an Initial FGC / 61% / 74% / 67%
% of Initial FGC which had at least 1 review meeting / 59% / 53% / 55%
On average across all Daybreak FGC programmes, 70% of referrals received and accepted progress to an initial FGC meeting and 60% of initial meetings held have at least 1 review meeting. This average tends to be lower for adults and forolder people in particular.
There can be many reasons why a referral may be accepted but not result in holding an initial FGC meeting, and not all are negative. On many occasions the time that the coordinator spends with family members, listening to their views and talking through the issues and concerns, leads directly to individuals taking action to remedy the situation, without the need for a formal meeting. However as Family Group Conferences are voluntary, sometimes the service user changes his or her mind and decides that they do not wish to proceed, and this will be respected.
It may also be the case that a decision is taken that a FGC would not be viable due to a lack of family members to attend. Although there is no minimum or maximum number of family members required, each case is considered on its merits, and a decision made in consultation with the service user and the referring social worker.
On some occasions the client’s health has deteriorated making a FGC inappropriate at that time, and in a few instances the client has died.
Rarely, but importantly, it may be necessary to decide not to proceed if the coordinator and FGC manager consider that to do so would either present an unacceptable risk, or would have a detrimental effect on the service user.
Referrals – by area and client group
2010-11 / 2011-12 / TotalTotal referrals received / 28 / 23 / 51
Havant and Petersfield / 1 / 0 / 1
Fareham and Gosport / 2 / 4 / 6
Eastleigh and Romsey / 3 / 4 / 7
New Forest / 5 / 8 / 13
Winchester and Andover / 7 / 3 / 10
Alton and Fleet / 3 / 0 / 3
Basingstoke and Aldershot / 7 / 4 / 11
Older persons / 20 / 9 / 29
Learning disability / 2 / 5 / 7
Physical Disability / 2 / 4 / 6
Other (inc MH; DV; drug/alcohol) / 4 / 5 / 9
From the above it is clear that some areas of Hampshire are more likely to refer than others. It is less clear why this should be the case. Staff changes often mean that social workers who had become familiar with the FGC model and referral process move on and are replaced by new staff who may be unaware of the service available. It was also apparent from talking to individualsthat some people were under the impression that the service had ended after the initial 3 year pilot funding came to an end.
Since the expansion of the criteria for referral to include all client groups was introduced, it is encouraging to see the numbers of service users referred with for example, disabilities or mental health problems, are increasing.
More work is needed to ensure all staff, including those working in health, social care and the policeare kept up to date, and service users from all areas of Hampshire have the same access to a Family Group Conference. Recently Daybreak has produced a “reminder” postcard which is being distributed to raise awareness of the service. The offer of a Daybreak manager attending some team meetings to discuss the use and benefits of FGC for adults will continue, whenever the opportunity arises.
Family Group Conferences –
“ensuring that vulnerable adults have a voice”
Service User Participation
2010-11 / 2011-12 / %Number of service users involved in referrals which reached an initial FGC / 17 / 19 / -
- assessed as lacking capacity to decide one or more of the relevant questions / 6 / 5 / 30%
Number of service users who attended their FGC / 15 / 16 / 86%
-supported by trained advocate / 9 / 10 / 53%
-with other designated support person / 4 / 2 / 17%
Number who did not attend, but whose views were presented at the FGC meeting / 2 / 3 / 14%
*A referral may involve more than one service user / vulnerable adult. For example if a couple are both considered to be “at risk”, or the needs of more than one person need to be considered in any plan made. For example this may be a situation where the perpetrator of abuse is a “vulnerable adult”, and the “victim” is a carer, often a parent.
As part of the FGC process all service users, and occasionally others involved in the process, will be offered an advocate. Local advocacy services will sometimes be utilised if available, but Daybreak also has a pool of trained advocates, mostly volunteers, who can be available if required.
Some service users prefer to have the support of someone known to them, for example a trusted friend, family member or someone known to them in a professional capacity. If this option is chosen, the coordinator will need to ensure that the chosen person understands their role, and that there is no conflict of interests. Some service users refuse any specific support, and feel confident enough to speak for themselves. The coordinator will ensure that they have the opportunity to do this, and that the meeting is a positive and empowering experience for them.
Occasionally a service user may choose not to attend, or may lack the capacity to make the decision, and it not be considered in their best interests to attend. It is the coordinators responsibility to ensure that whenever possible the service user’s views are obtained and presented at the meeting. If the service user has capacity to make the final decision about the plan, the coordinator or advocate will check that he/she is in agreement with any actions before the plan is finalised.
Family Group Conferences –
“bringing families back into decision-making”
Outcomes
There can be no single criteria for a “successful outcome”, although improved safety is always a priority. If the service user has capacity to make their own decision, they may choose to leave themselves at risk, however an outcome could still be considered beneficial if the FGC process resulted in greater awareness and understanding of risks and options, and increased support being offered, and improved communication and relationships.
Financial benefits for the local authority may also be a desired outcome, but again this cannot be a realistic aim in every case, and the needs of the service user may require, for example that a residential placement be provided if support in the home is unable to meet those needs, or if the service user prefers it. An evaluation of cost benefitsofthe first 3 years of this project, showed clear overall cost savings. A frequent outcome was shown to be much reduced social worker time after the FGC process, often allowing cases to be closed either completely or to safeguarding. (See appendix A)
Following each meeting, initial FGC or Review, all participants are sent a feedback questionnaire, inviting them to comment on the service they received, the plan developed and the outcomes achieved. The return rate for the questionnaire, perhaps inevitably, is quite low (usually around 20%), but those who do reply are overwhelmingly positive.
One of the questions asked is
“Would you recommend the (Daybreak FGC) service to others?”
Whatever the perceived outcomes in individual cases, all but one individual over this 2 year period answered “YES”
Comments from Service Users and Families
The following comments are taken from the feedback received from service users and their families and friends:
“I found it an easy relaxed atmosphere for everyone to air their views in” – step-daughter of service user
“I now have a little time to myself. My husband has time too, which helps, and my children see my family more” – service user with physical disability
“Dad is being looked after better now, as other family members are able to help and get involved” – son of service user
“I am full of praise for the professional and compassionate way Daybreak dealt with this awkward situation. I would be happy to endorse you in any way” – daughter of service user
Working in Partnership
“I had never dealt with Daybreak before, but would not hesitate in contacting them through a referral in future or recommending them to others” – registered care home manager
Daybreak’s involvement with the service users and families referred to us is intense but short-term. One of the main purposes of a Family Group Conference is to involve everyone who is concerned about the individual - family members, friends and professional service providers, and to ensure that any support plan is understood and agreed by all.
In many cases relationships and communication have broken down, and the FGC coordinator will spend a lot of time in preparation working to restore vital links and trust between all the parties.
2010-11 / 2011-12 / Average per meetingNumber of family members/friends who attended an FGC meeting during the year / 124 / 121 / 4.6
Number of Adult Services staff who attended an FGC meeting during the year / 28 / 27 / -
Number of Health Services staff who attended an FGC meeting during the year / 13 / 14 / -
Number of police who attended an FGC meeting during the year / 7 / 8 / -
Number of other professionals who attended / 24 / 39 / -
-Total number of professionals who attended FGC meetings (excluding advocates) / 72 / 88 / 3.0
Comments from Referrers and other Professionals
The following are some of the comments taken from the feedback received:
“The coordinator was very skilled in chairing the meeting and facilitated discussion in a non-challenging and direct manner that resulted in firm commitments being made to support the family” – social worker
“I thought(the coordinator)chaired the meeting very professionally, but at the same time she showed a great deal of warmth. I felt that this approach helped put people at ease”. – health professional
“Excellent service to have available. Would be useful for some complex cases when working with neurological conditions” –physiotherapist
“I think this is an effective way of resolving some extremely difficult situations. The coordinator was very professional throughout in dealing with quite a fractured family and ensuring that (the service user) was listened to”. - health professional
“Overall, an amazing service – astonishing level of resource! I wish we could have similar” – psychiatrist
Appendix
a)Cost benefits analysis (Hampshire 2007 – 2010)
As a part of initial pilot programme funded by Comic Relief in using FGC in Cases of Elder Abuse, Hampshire CC undertook a cost analysis of the first 49 referrals which reached at least an initial FGC meeting. (The pilot also accepted referrals from Southampton and Portsmouth Unitary Authorities but these were not included in the Hampshire Analysis)