Positive FuturesAchieving well being for children and families

Sydney 2006

Beyond Looking After Children:Using a framework for assessing,

planning intervention and review of all children involved with social services

What was happening to children’s services in the UK

as we entered the new millennium?

• Early intervention• Focus on outcomes• Performance measurement• Increasing inter-agency working• Information sharing• Increasing use of IT

…The Policy Context

• Reduction in preventative services• Increased specialisation• Outsourcing of services:

– commissioning and partnership arrangements with voluntary sector agencies

• Increased inter-agency working:– joint initiatives– joint teams

• High vacancy rates and use of locums• Difficulties in allocating cases

…The Practice Context

• Looking After Children: research informed practice tools designed to improve the outcomes of children looked after subject to a programme of research, implementation & audits in England and Wales (1989-2002)

• Assessment Framework: research informed practice tools for children in need designed to support assessments using the Framework for the Assessment of Children in Need and their Families. Subject to a programme of implementation and research in England and Wales (2000-2002)

…The Practice Tools

• Both LAC and AF materials supported practitioners to gather and record information about the needs of children and improve confidence in decision making and the ability to monitor progress

• The materials increased the involvement of families in social work processes through clarifying the processes and development of information for families

• Materials strengthened inter-agency working through an increased understanding of the roles and responsibilities of agencies, increased communication, a shared approach to undertaking assessments and improved collaboration in assessments of children

The Tools…

Throughout late 1990s into early 2000s…

• Extensive research lead by Universities of Loughborough and Royal Holloway College, London

• Extensive consultation with carers, voluntary organisations, young people, representatives from different ethnic communities

• Extensive feedback from practitioners and managers about the tools in practice

What did this tell us… ?

That….

• No link between Looking After Children materials and Assessment Records:– Different conceptual framework for different

parts of children’s services, but often the same children and families;

– Duplication and repetition of information. Practitioners can feel overloaded at particular points

– Difficult to measure a child’s progress or the impact of services over time

• Materials did not facilitate the transfer of key information

Furthermore...

• Not responsive to changes in children’s needs and circumstances:– Research has demonstrated the large degree of

change experienced by children from birth and not just as they enter the looked after system

– Information about children and young people’s needs should be collected and reviewed in the same way regardless of the services received

• Little information on services:– Important to know what services a child receives

from all agencies and not just social care– The need to gather information about services

planned or provided

And Also…

• Confusion about the purpose of the Assessment and Action Record: – tool for direct work or professional record?– Assessments still often incomplete or completed

inappropriately

• Core Assessment thought to be unsuitable for all practice contexts:– too complex for many family support cases

• Practitioners are generally good at gathering, recording and summarising information, but quality of analysis and its relation to planning is often poorer

Extensive development work was undertaken which lead to..

…the birth of the ICS in 2002

“..a conceptual framework, practice discipline and business process that helps frontline social care staff undertake work with children and families in a systematic manner. It should help them and their managers to collect and use case information systematically, efficiently and effectively.”

Department for Education and Skills (2005)

The Integrated Children’s System

• Brings together LAC and the Assessment Framework

• Is focused on outcomes for children

• Gathers the information systematically that is necessary to plan for children at both individual and strategic levels

• Links assessments of progress more closely to reviews and all children to be reviewed regularly

Integrated Children’s System

• Records designed to allow the transfer of information - including single data entry

• Facilitates analysis

• Information about services is collected more precisely

• Facilitates sharing of information across departments and agencies

Integrated Children’s System

The ICS aims to:• Ensure that necessary information is gathered and

recorded systematically across services through the key processes of information gathering, assessment, planning, intervention and review

• Provide a common and coherent set of processes from first contact with a child and family through to assessment, decision making and subsequent interventions to review

• Build a picture of a child and their needs within the context of their family and environment

• Contribute to a common language to describe children’s needs and circumstances which can be used by all those concerned with children’s well-being

In summary

Integrated Children’s System

• Components:– Process Model – maps the core business processes

of children’s services– Data Model – codifies the data items identified in

the Process Model that local authorities must collect to plan for children at both individual and strategic levels

– Exemplars – practice tools designed to demonstrate how core information about a child could be gathered for each of the key process

– Outputs Model – describes how information, once recorded and stored in an IT system, can be retrieved and used in practice

Integrated Children’s System

Development of a research programme

• 30 month study lead by Royal Holloway, London University in partnership with Loughborough, Cardiff and Open Universities

• 24 month study lead by University of York

• The 30 month study had four distinct stages:– Stage 1: selection of four local authorities

• 4 local authorities (3 English and 1 Welsh) were selected from 28 applicants to participate in the study

– Stage 2: gathering of baseline data• a range of methods included: an audit of social work

case files, a scrutiny of blank recording formats used agencies other than children’s social care, and interviews and questionnaires with service providers from all the participating agencies

Integrated Children’s System

• The 30 month study had four distinct stages:– Stage 3: provision of training on the ICS

• 5 training or familiarisation days were provided by the research team involving 700 professionals from the four authorities

• development of a Training and Resource Pack

• All four local authorities experienced setbacks and delays to their planned implementation timetable.

Integrated Children’s System

• The 30 month study had four distinct stages:– Stage 4: gather follow-up data at least 6 months

after authorities had been implemented the ICS• only 3 local authorities were able to participate

in the follow-up study• methods included: a second audit of social work

case files; multi-agency workshops where attendees completed short questionnaires; questionnaires completed by staff in children’s social care, looked after young people, and the each authority’s ICS and the IT lead; and field trips involving a demonstration of the authority’s ICS IT system.

Integrated Children’s System

• Each pilot site implemented differently and followed a different timescale: – 1 in February 2003; 2 in November 2003; 1 in

November 2004– Some implemented the exemplars as word documents

only, whereas others developed hybrid systems storing the most frequently repeated information as data which is used to pre-populate exemplars

• Pilot site 1:– Implementation led by admin staff who entered the

data. Teething problems were experienced by a small group of staff rather than wider workforce

– Some of the early problems have been resolved and enhancements made before social workers access the system

Pilot Sites

– Social workers focused on the practice issues– However, there was concern that:

• implementation was viewed as process/admin. led not about practice

• the process lost sight of the child or young person

• Pilot site 2:– Last to implement which meant that data

gathered through the audit at a time when staff were still familiarising themselves with new practice processes and IT systems

Pilot Sites

• Pilot site 3:– implemented the earliest due to external

pressures resulting in a focus on IT at the expense of practice issues and ‘hearts and minds’ due to the external time constraints imposed on the authority

• Pilot site 4:– implementation was delayed beyond the timescales

of the research due to difficulties in some of the negotiations with software suppliers

Pilot Sites

Impact on organisational culture

• Develop a multi-agency focus• Managers need to have an understanding of

practice based in reality• Attitudes need to change for some staff: in

terms of practice and IT• Careful balance of whether systems developed

to support practice meet the needs of IT requirements or practitioners

Early Messages

Impact on practice

• Practice temporarily deteriorates in the early stages of implementing the system

• The depth and breadth of plans has improved; the focus of plans has broadened from health and education predominantly to include emotional and behavioural development, identity, and family and social relationships, particularly for young people leaving care

• The reaction to the new reviewing formats is more mixed across practitioners, but that generally the process of completing reviews is taking longer

• Of concern, is the suggestion that there is still no consistent and regular assessment of the progress of children who are looked after long term

Early Messages

Impact on professional collaboration

• Difficulties experienced: – Professionals can be unwilling/unable to share

information• Health often raise concerns of confidentiality• SSDs rarely feedback the outcomes of referrals

or early assessments: “Often no information passed on unless we request it [from SSD]” (Education)

• Education processes can be unwieldy for sharing information

• difficult to contact some agencies out of hours: “Schools not always able to return calls because of the structured day” (Health)

Early Messages

Impact on professional collaboration

– Lack of agreement from parent to share information– Delays in receiving information– Different priorities– Differences in language across professions sharing

information• Name of the child: 20 different forms including pupil’s

name, patient’s name, forename, your name, young person’s name, child’s name, name of young person

• Child’s gender: 6 different terms were used including: Male; Female; Male/Female; M/F; Boy/Girl

Early Messages

Impact on professional collaboration

– Differences in language across professions sharing information

• Child’s health: there was little consistency in how these terms were to be interpreted. For example, immunisations could relate to all immunisations or to immunisations relevant to the child’s age. Developmental checks included: developmental checks relating to the child’s current age, developmental checks, health surveillance, developmental history, developmental assessments

Early Messages

Impact on professional collaboration

• But, overcome through: – Talking; management; contacting parents

directly; setting up protocols• Greatest impact around areas of work of priority

to agencies for particular groups of children• Arrangements between health and SSD to share

information about the health of looked after children

• Pilot of electronic information exchange with schools

Early Messages

Impact on young people

• 34 young people from one pilot authority participated in the study

• All had experienced care planning and reviews since the authority implemented the ICS

• Involved equal numbers of boys and girls• Young people were aged between 11 and 16+

years - most (79%) were 14 years or more• The majority (70%) were in residential care

Early Messages

Impact on young people

• Findings suggest some limited increase in the young people’s levels of satisfaction:– Most young people attended their reviews– Generally satisfied with the attendance at reviews of

professionals – dissatisfied with the attendance rate of parents and relatives

– Matters considered at reviews generally accepted although personal issues such as the young person’s past, friends and feelings not seen as appropriate subjects

– Approximately two-thirds of young people who disagreed with what was said at reviews were confident in expressing their dissent

Early Messages

• Children’s social care– The findings show that ICS impacted on all aspects

of recording social work practice with children and families, resulting in changes to both the amount and quality of the information

– Similar proportions of social workers thought the quality of recorded information had improved as thought it had deteriorated. The major reasons for negative views related to concerns over the amount and formality of the documentation that practitioners felt they had to share with families

– Practice developments need to ensure that changes to the amount of information reflect improvements in practice rather than inadequate IT systems that require practitioners to continually re-enter the same data

Implications for policy and practice

• Use of IT within children’s social care– Implementation of the ICS resulted in an

increase in the overall time social workers spend using IT

– There has been a shift away from using IT to carry out administrative functions towards using it as a tool to access and aggregate data in order to manage work better

– However, management information facilities are not yet well developed

Implications for policy and practice

• Use of IT within children’s social care– Need to develop IT systems to integrate data systems

of other agencies

- Decisions need to be taken about:-How much of a record is cloned across sibling

groups- Existing hardware and software provision-Who records the information?- IT hardware procurement

– Only when the IT supporting the ICS has been fully developed, embedded within children’s social care and social work practitioners are confident in using it, can social services build on existing protocols for the exchange of information about children and families across professions

Implications for policy and practice

• Professional collaboration– Findings suggest that practitioners can be overly

dependent on personal contacts to resolve conflict

– Interagency training should challenge the issues that hamper collaborative working

– A successful strategy to gain the commitment of other agencies to greater information sharing is for children’s social care to enable safe access to some of the ICS information

– However, ICS is beginning to have a positive impact on policy and practice, information sharing, clarification of roles, quality of inter-agency work

Implications for policy and practice

• Channels of communication– Language across agencies varies considerably

which can lead to misunderstandings and difficulties in transferring information

– Variety in the means of communication, therefore it is important to establish agreed channels across organisations and professionals

– It is important to ensure colleagues across agencies are kept up to date with key decisions and developments in practice and policy to increase the confidence in information sharing

Implications for policy and practice

• Where the ICS records differ little to current materials used regularly in practice, completion of the ICS records remain relatively stable

• Where new records have been introduced, the use of these records is more consistent and the quality of the information recorded is good

• Where clear systems were established and records used regularly by practitioners before implementation of the ICS, such as for child protection and looked after children, the impact of and reaction to the ICS is varied.

To Conclude

• Led to an increase in paperwork• Implications for practitioner time • Concerns that the focus is less client orientated• Concerns about the assessments for children

looked after long term• SSDs still taking the lead in situations as currently

the only agency to have implemented the ICS

On the downside…

• Generally there is a greater focus on outcomes and objectives leading to better assessments and plans:

“ICS requires more detailed planning and analysis for

children and provides clarity in linking assessment to

planning” (Social Worker)

• Plans are broader and more in depth

But, more positively…

• Easier to access information: “The flow of information has improved and

access toinformation pertaining to a particular child is

easier evenif you don’t work within the same team”

• Promoted an understanding of the roles and responsibilities of other agencies and the complexities within multi-agency working

• In time, the ICS will reduce repetition between agencies

And also…

Success is not final, failure is not fatal: it is the courage to continue that counts.

Winston Churchill