improving the quality and use of serious case …...improving the quality and use of serious case...
TRANSCRIPT
Improving the quality and use
of serious case reviews in a
changing landscape
Amanda Edwards, Deputy Chief Executive Social Care Institute for Excellence
16 March 2016
A time of change
• SCRs have potential to drive improvement in child protection • Building on past activity (Munro Review, establishment of National Panel) • Numerous recent developments, including:
• Intended centralisation of SCRs • Marian Brandon’s latest review • Learning in to Practice Project
• Also changes to wider landscape: • Alan Wood’s review of role and function of LSCBs • Proposed What Works Centre for Child Protection
Today’s conference
• Bringing people together who are involved in differing, related developments in the field of Serious Case Reviews
• Sharing information and encouraging discussion with key stakeholders – LSCB Chairs, LSCB members, lead reviewers
• Afternoon – workshop sessions based on learning from LiPP but also to stimulate discussion about ‘what next’ for improving quality and use of SCRs
The Learning into Practice
Project: Improving the
quality and use of SCRs
Sheila Fish, Learning in to Practice Project and Head of Learning Together, SCIE
Improving the quality of SCRs and
how they are used
•An ongoing journey…
• Funded by Department for Education’s Innovation Programme
• 12 months (Apr 15 to Mar 16)
• NSPCC and SCIE
• Working closely with the Association of Independent Chairs
• Involving the sector
SCR Quality Markers
The idea
• A consistent approach to SCR process, report and response
• Based on best available knowledge
What we did
• Developed set of quality markers
• Consulted stakeholders • Applied to SCRs in 5 areas
What we learned
• Widespread support • Useful for commissioning
and managing the process • Useful for reviewers • Especially useful for less
experienced • Concern a support tool
does not become a compliance exercise
Potential future use: central commissioning body, and/or local commissioners and reviewers
SCR Master Classes for reviewers
The idea
• Lead Reviewer expertise critical to the quality of SCRs
• Currently limited training or ongoing CPD
• Further professionalization needed
What we did
• Identified 4 areas of knowledge relevant to SCRs but not yet systematically applied
• Developed & delivered suite of 1 day master classes
What we learned
• Those who attended very positive
• But acknowledged do not amount to ‘systematic training and education’ which is needed
• Roughly 2/3 reviewers did not respond – is voluntary adequate?
Potential future use: least clear; ? contribution to a more comprehensive training and CPD requirements for lead reviewers
Testing a new process for using
SCRs
1. National collation of SCRs with
detailed focus on practice
issues
2. Addition of practitioner knowledge
3b. National professional
and leadership bodies
collaborate to further address priority issues
3a. Local areas address issues where
relevant
Using SCRs that are not your own
The idea
• Unrealistic for all local areas to
keep on top of all SCR findings • Learning about practice issues
and their causes, could trigger ‘health check’ and improvement work where identified as necessary
• A need to make accessible, information on practice issues and their causes identified across SCRs
What we did
• Developed a new method to
identify and map practice issues and their causes from SCR reports
• Added practitioner and manager knowledge through 3 summits
• Developed an overview map and set of detailed briefings
• Tested use of briefings with managers in 2 pilot sites
• This approach works to unpack high level themes like ‘information sharing’
• Support for this being done centrally rather than by all local areas
• People liked issues being closely grounded in practice
• This approach focuses dissemination on senior mangers and leaders
Potential future use: useful methods for the What Works Centre
Establishing an Alliance of
professional and leadership bodies
The idea
• Professional and leadership bodies have a key role in improving practice
• Currently not a systematic mechanism for SCRs to inform their work
What we did
• Established an ‘Alliance’ of professional and leadership bodies, e.g. ADCS, RCPCH, College of Policing
• Held three meetings to test out the idea
What we learned
• Support for this as a concept
• Need to be clearer about mandate and governance
• Could their role be wider than just considering learning from SCRs?
Potential future use: To be discussed further
Overall learning
• Ongoing challenges of ‘getting the most’ out of time and financial investment in SCRs
• Systems principles in statue have not translated into SCR practice across the board - not enough analysis of the underlying reasons to inform improvements
• Plurality of approaches, including report structure, makes it difficult in many cases even to find the analysis and findings in SCR reports
• Many commissioners and reviewers wanting very detailed guidance and support - really struggling with the basics
• Challenges of informing and involving the family in a meaningful way, and respecting their privacy
• At leadership level SCRs seen as feeding the negative view of services provided - something of a ‘toxic brand’
Where next?
• Learning in to Practice products will be available from end March – email to be sent round with links
• Products are: • Mapping and set of briefings based on SCR analysis, for use in
management teams/LSCBs • Quality markers – document and app • Masterclass slides • Evaluation report
• But also hope learning will inform/contribute to wider developments in SCRs
Learning into Practice Project
A DfE perspective
Learning into Practice Project
A DfE perspective
Since the LiPP was first initiated……. A great deal has happened including:
The commissioning of the Triennial Review of SCRs
A change of administration following the general election
The closure of The College of Social Work
An announcement about the centralisation of SCRs
An announcement about the establishment of a What Works Centre
A review by Alan Wood – now nearly completed – on the role and functions of Local Safeguarding Children Boards.
Where are we now? The LiPP’s work and findings will support all these developments, for example:
The Quality Markers work - will feed into the thinking on centralisation of SCRs
The work on national learning from SCRs and the Alliance – will be important for the What Works Centre developments
Many different interested parties, including colleagues leading on the LiPP, have been able to feed into Alan’s review.
What’s next? Work is ongoing on:
Alan’s review – he will update you shortly on progress. It is due to be completed by 31 March but we have not yet confirmed the publication date
SCR centralisation: we are beginning to think about this, and it will also be informed by Alan’s review
The What Works centre – my colleague from DfE will explain a bit more about this later today
The Triennial Review – again, more to follow on this later today. We still need to confirm a publication date.
Alan Wood
Pathways to Harm: Pathways to Protection A triennial analysis of Serious Case Reviews 2011-14
Marian Brandon and team (UEA)
Peter Sidebotham and team (U of Warwick)
WHAT’S NEW, WHAT’S DIFFERENT?
Better access to SCRs
• 3 years of SCRs to study rather than 2 years (SCRs initiated 2011-2014)
• Better availability of SCR reports in this period (publication?)
• More robust information about patterns and trends, eg in or out of the child protection system at the time of the death or harm? known to children’s social care? Etc
Learning for practitioners and professional groups
• Collaboration with Research in Practice Briefings to be available for: - Children’s social care and early help - Health - Education - Police and criminal justice - Local Children Safeguarding Boards • Will be available on line (on website), together with an introductory
film
Overall structure for practitioner briefings
Pathways to harm, pathways to protection: Rethinking Systems Analysis
Child seriously or
fatally harmed Context Harmful actions/
omissions by perpetrators or carers
Predisposing
risk
Predisposing
vulnerability
Preventive actions by
society
Protective actions by
parents/carers
Preventive actions by
statutory/other agencies
Protective actions by
statutory/other agencies
Systems and processes to support prevention/protection
Pathways to harm, pathways to protection
Is the model a helpful way to think about both the research task and practice?
Does it help convey a positive shift to recognising opportunities for improvement?
Does it help in setting the overall structure of the report?
The report structure
1. Introduction
2. and 3. Patterns and characteristics of serious and fatal maltreatment
4. and 5. 6. Pathways to harm child; parents; environment
7. Adolescent suicide and CSE
8. 9. 10. Pathways to protection: managing cases; working together; agency structures, processes, culture
11. Quality of SCRs
12. Learning over 10 years
Appendices
Quality of SCRs
Working Together requirements of a final SCR report
Provide a sound analysis of what happened in the case, and why, and what needs to happen in order to reduce the risk of recurrence;
Be written in plain English and in a way that can be easily understood by professionals and the public alike; and
Be suitable for publication without need to be amended or redacted (HM Government, 2015: 79)
Critique from independent SCR panel
too much detail making it hard to read and hard to understand what happened
too much listing of what happened without asking why
failure to look at human motivation and the impact of fear, overwork, timidity, wilful blindness and over optimism;
reports that fail to centre on the child
unclear, unfocussed recommendations.
Quality template for SCR final report
Timing and delay
Accessibility/readability
SCR process – proportionate?
Analysis v description
The child as a person
Learning
Recommendations and follow up
Overall messages from SCRs
Where children are in the child protection system they are faring well – on the whole
Universal services are recognizing maltreatment – but what next?
Where children are being missed is often on the borders
- out of and into the child protection/children in need services
- in the borders between child and adult services
- at age related transitions (eg leaving school)
LUNCH
What Works Centre for Children’s Social Care
Michelle Warne Child Protection and Safeguarding Unit
What is the new What Works Centre? Announced in December 2015 It will build an evidence base to identify best practice available for
social workers and other practitioners It will address the lack of single respected academic centre of
expertise or authoritative professional leadership body Up to £20m allocated to new WWC and centralisation of SCRs It will join the existing What Works Network
What will the WWC do?
3 central functions: 1. Synthesis of existing evidence 2. Identification of gaps and commissioning of new trials 3. Dissemination and implementation
It will become a trusted and authoritative voice on ‘what works’ to
support the transformation of social care practice
How will the WWC link to other programmes?
DfE are exploring opportunities to create strong links between programmes
The WWC will capture and disseminate learning from Innovation Programme and SCRs
When will the WWC be up and running?
Currently considering options for model
Further information will be available in due course
Aim to launch by end of 2016
Any comments or questions?
Workshops
Choice of 4 workshops:
• Workshop 1. Options for professionalising the lead reviewer role – masterclasses and more?
• Room: Dorset Suite (40 delegates) • Workshop 2. Articulating what good looks like for SCR set up, process and report - SCR
Quality Markers as a support tool • Room: Main conference room- Cornwall Suite (40 delegates) • Workshop 3. Who can a national overview of learning from SCRs help and how? • Room: Derby Suite (30 delegates) • Workshop 4. What could an ‘alliance’ of cross-agency professional and leadership bodies
do for safeguarding? • Room: Durham Suite (30 delegates)
Workshop 1
Options for improving the
quality and contribution of lead
reviewers – masterclasses and
more
Kevin Ball – NSPCC Keith Ibbetson – Lead Reviewer
Learning into Practice Project LiPP
Improving the
quality Improving
the use
SCRs Improving commissioning: SCR Quality Markers
Improving reviewer expertise: master classes
LiPP
Supporting national impact via Alliance of multi-professional strategic & leadership bodies
Accessible information on practice issues and causes being identified in all SCRs
Lipp SCR Masterclasses
• LiPP assumptions: • SCR Lead Reviewers have a key role in producing high quality SCRs • Currently limited opportunities for continuing professional
development • Reviewers and reviewing needed to become more professional • A number of bodies of knowledge and expertise exist that are
potentially applicable • To test this
• Developed a suite of master classes on areas of expertise that are not yet systematically applied to SCRs
Masterclass topics
1. Strengthening analysis through the application of systems thinking
2. Strengthening analysis through the use of qualitative research methods
3. Getting the best out of groups convened during the review
4. Disclosure and parallel proceedings
Uptake and feedback
• Applications for places from 35% of target audience of 147 • lead reviewers or those who had been on a SCR lead reviewers training
programme • 20 participants per session
• 43 different participants • Mostly experienced reviewers (SCR, Adult or DHR)
• Feedback from participants overwhelmingly positive • Format • Content • Likely to change their approach • Supported this as part of a future approach
Wider context
• Systems principles in statute have not translated into SCR practice
• Difficult in some published reviews to find the analysis and findings in SCR reports
• Key aspects of reports remain contested (nature of findings, recommendations, length)
• Brandon found that new potential reviewers who have attended previous training programmes have largely not become active reviewers
• not wanted to • found it difficult to be commissioned
Issues for discussion
• Is there a need for systematic education and training for lead reviewers? And if so what is the curriculum?
• In other sectors the institutional framework within which reviews take place provides this
• Teams of investigators work together to combine technical and investigative skills
• Recognised academic training and professional accreditation?
• Framework for continuing professional development?
Workshop 2
Using SCR Quality Markers to
support quality
Sheila Fish Fiona Johnson
SCR Quality markers – what they are
Improving the
quality Improving
the use
SCRs Improving commissioning: SCR Quality Markers
Improving reviewer expertise: master classes
LiPP
SCR Quality Markers – why we need
them
To date
• Judgements about quality focused on report
• Commissioners and reviewers have drawn on individual experience alone (very little support/ practice guidance)
LiPP proposal
• Commissioning and conduct informed by the knowledge base that exists while supporting diversity & innovation
• This applies to the whole process, not just the review report.
Why Quality Markers format/mechanism
• Quality critical but contested, with no obvious agreement • Not one body or person has the authority to arbitrate • Principles in statutory guidance are broad so open to
variety of interpretations • very different outputs and outcomes in terms of quality
of review, report and learning • Approach in other sectors not an option – clarity and
prescription of methodology, accompanied by practical supports and specific training
• NICE Quality Standards approach provide a potential alternative that accommodates innovation and diversity
A collaborative process of
developing the markers
• X8 experienced Lead Reviewers • X5 pilot SCRs • LSCB Chairs & Reviewers
• via the Association • X2 summits (n57) • X2 Association representatives
• DfE • National Panel
Overall thoughts - The proposal - The stages - The structure
Feedback on individual Quality Markers: - Make sense? - Cover the right things? - Anything to add / remove? - Tone / style?
- Thoughts on ways of using the Quality Markers
- What would support their use
Test runs
Key principles underpinning the QMs
• Not minimum standards but are achievable goals that enable a Board to improve the quality of their reviews
• Capture what Boards expected to achieve while acknowledging some will require a development journey to do so, and can use the QMs to help – designed to stimulate discussion and dialogue
• Focus on real world challenges because SCRs are a complex field of activity where simple rules rarely apply, so judgement is often needed
• Identify obstacles that can in principle be overcome, as opposed to the inherent complexities of the task that will always need to be worked with
• Articulate good practice principles for reviews while leaving the Board to decide how to achieve them
• Support variety, innovation and proportionality in approaches to case reviews and accommodate a range of models and approaches
Breaking down the
SCR process
1. Referral
2. Decision making
3. Advising board members
4. Informing the family
5. Clarity of purpose
6. Commissioning
7. Governance
8. SCR management
9. Parallel processes
10.Assembling information
11.Practitioner involvement
12.Family involvement
13.Analysis
14.The report
15.Improvement action
16.Board written response
17.Publication
18.Implementation and evaluation
Setting up the review
Running the review
Outputs and outcomes from the review
Nb. Not a process map
Structure of each Quality Marker
• Quality statement - a summary description of the quality marker • Rationale - an explanation of the marker and why it is important and necessary • How might you know if you are achieving this QM? – questions to consider
and discuss in your Board when undertaking reviews • Knowledge base - established knowledge about investigation/review, practice
experience, and ethical principles underpinning the marker • Equality and diversity– any specific equality and diversity issues that are
important to consider • Link to statutory guidance & inspection criteria – any relevant regulations,
statutory guidance and national minimum standards • Tackling some common obstacles – some key issues to anticipate that have
been identified by the Lead Reviewers and LSCBs during the LIPP project
How they help
To stimulate dialogue and discussion
To support informed judgements
To enable transparent decision making
Not a handbook, not a check list
How they might be used
Current landscape • a tool for LSCBs to commission,
manage and quality assure SCRs and case reviews
• a tool for new lead reviewers to aid clarity about expectations
• An aide memoire for experienced lead reviewers
• other?
Future landscape? • A tool for the new central body
to commission, manage and quality assure SCRs?
• A tool to support local learning e.g. non-SCR reviews commissioned locally?
How exactly they might be used
When Which quality markers For what purpose At the beginning The full set of markers To create clarity and
transparency of what is being commissioned
At the beginning The full set of markers To support practical planning and preparation
Progressively over the course of the review
Individual markers To manage and quality assure the process
At the end The full set of markers To structure reflection retrospectively on the review and identify improvements for future SCRs
SCR Quality Markers
Will be available on: nspcc.org.uk/lipp and scie.org.uk/lipp • Sheila Fish Fiona Johnson • [email protected] [email protected]
Pdf Webpages App Internal
evaluation report
Independent evaluation
report
Workshop 3
Who can a national overview of
learning from SCRs help and
how?
Hannah Roscoe, Senior Research Analyst, SCIE
Overview of the session
1. How might the sector want to use the national findings of SCRs?
2. What we have tested out as part of the Learning in to Practice project
3. Possible next steps
Rationale
• Working Together 2015: the aim of SCRs is to analyse ‘what happened in [a] case, and why, and what needs to happen in order to reduce the risk of recurrence’ (Working Together 2015: 79).
• Own local SCR reports routinely used to inform improvements
• But might also want to learn from an SCR that has happened elsewhere, and make pre-emptive improvements.
Challenges to learning from national
SCR picture
• Already happening to some extent • Biennial review by Marian Brandon and colleagues • Some LSCBs do their own overviews • High profile SCRs may trigger pieces of work elsewhere
• Challenges: • Timeliness • Individual collation – lots of work, duplication? • Learning about day to day practice, not just highest
profile cases
What kind of information are we
interested in?
• Variety of different kinds of information, e.g. demographics of families, features of case can serve different purposes
Need from SCRs: an in-depth understanding of strengths and
weaknesses in practice and their causes
If the purpose is to inform improvements
to practice
Who are the audiences for the
learning?
• Some current materials aimed at frontline practitioners
• Assuming that quality of frontline work significantly shaped by organisational factors, cultural norms, local inter-agency relationships etc
• Some of this is ‘in the gift’ of managers/senior managers to change
What did we do in the LiPP project?
Testing a new process for using
SCRs
1. National collation of SCRs with
detailed focus on practice
issues
2. Addition of practitioner knowledge
Testing out products with 2 LSCBs and at 2 regional
events
Collation focused on detailed
description of practice
• Analysis of 38 SCR reports published between May 2014 and April 2015
• Test topic: Inter-professional communication and decision-making
• Focused particularly on detailed description of practice issues: 1. Starting from a ‘vivid example’ 2. What is the nature of the problem as identified by the
SCR? 3. What are the reasons underlying this problem as
identified by the SCR?
How is this different from what
already exists?
• Focus on difficulties in multi-agency practice
• Unpacking issue of inter-professional communication
• Detailed description of issue, and where/who it affects
“Referring agencies think they are making a referral
or requesting action of CSC, but CSC thinks they
are only receiving information to be logged”
Addition of practitioner knowledge
• Important in order to: • Find out whether a particular issue is more widespread
• Get a better understanding of the reasons underlying practice issues, especially ‘soft’ cultural issues
Addition of practitioner knowledge
(2)
• We did this through three multi-agency ‘summits’ attended by 194 practitioners and managers
• 98% able to discuss the practice issues openly, without blame
• 96% agreed that examples resonated with their experience
• 89% agreed it would be useful to have ongoing collation and events
Products
• Overview grid showing 44 issues we identified in analysis of the SCRs, mapped against the care pathways
• Fourteen briefings on selected issues, combining SCR analysis and practitioner input with self-assessment questions
• Is this an issue in our locality? How does it manifest? Why does it happen? Can anything be done?
What have we learned?
Positives • Useful to unpack a high level concept like ‘inter-professional
communication’ • Could be a good ‘health check’ for LSCB subgroups and others Challenges • Tension: Making the most of learning from SCRs versus not being part
of a ‘culture of blame’ • Difficulties of translating national learning to a local level – specificity,
urgency
Questions for discussion
1. What do you think of this as an idea? 2. Does this resonate with how learning and improvement works in
your area? 3. How might this fit in to the future landscape?
• National-level collation conducted centrally on an ongoing basis, focused on practice issues and their causes
• Key audience senior managers and managers
• Aiming to support self-assessment – could this be happening here and what might we do about it?
Closing remarks
John Brownlow, Head of Professional Engagement NSPCC
Reflections and next steps
• Bringing together various developments relevant to SCRs • ‘Sector voice’ in responding • Learning in to Practice products will be available from end March –
email to be sent round with links • Hope that learning from the project to be taken forward as part of
other relevant developments • Wider conversation will be ongoing
Thank you all for
attending.