matthew scott presentation at tonic's complex families conference

7/28/2019 Matthew Scott Presentation at Tonic's Complex Families Conference

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Safeguarding Children of Parents

with Substance Misuse Problems

and Other Vulnerabilities in Essex

Presentation to ESCB19 October 2010


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INTRODUCTION

PROJECT BACKGROUND Responding to issues raised in JAR, by NTA

and in SCRs

Project funded by EDAAT, overseen by aSteering Group, to: Raise awareness

Develop better understanding and improvepractice

Build a case for changing the approach tocomplex families

Methodology Interview programme frontline

practitioners, team leaders and seniormanagers across the partnership

Listening to parents and children affected bythese issues in Essex

Online survey for practitioners

Data analysis

Literature review

Visiting evidence based programmes

POLITICAL CONTEXTGovernment Commitment

Coalition agreement to investigate a new approachto families with multiple problemsfocusing on50,000 high need families e.g. 400 mostchallenging families in each authority

Government Priorities Strip away obstacles that stop disadvantaged

children succeeding

Safeguarding children at risk

Improving the cost effectiveness of childrensservices

Building capacity and resilience within families andcommunities

Local policy commitments

Ensure that all children thrive Parents are supported

Families affected by substance misuse receive moreintegrated help


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DRIVERS FOR CHANGE

(from DfE)

Challenge

Find a more sustainable approach to funding for familyintervention/support services using evidence and costeffectiveness

Solution DfE/ADCS cost-effective childrens services project

focus on family intervention to reduce entrants ofolder children into the care system

Financial Context Decisions about investment (and achieving savings) will

be made locally. BUT there is a strong case forcontinued investment in family intervention


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WHAT IS THE PROBLEM? Key parental vulnerabilities were identified as

Drug & Alcohol misuse

Domestic violence

Offending

Mental health problems

These parental vulnerabilities have been shown to be

Intergenerational

Overlapping, Mutually reinforcing & Long-term

Impact not just on individual but also whole family and wider community

They often impact negatively on children

Immediate safety, with clear links to child protection Long-term outcomes

Parents with multiple vulnerabilities can create complex families, which

Cost society a lot of money (250k-350k per year)

Are a challenge to services

Evidence shows we do not do well in improving their outcomes


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LOCAL NEED

In Essex, we estimate that there are:

7,300 children (under 16) who have at least one parent who is

a dependent drug misuser

57,902 children who have at least one parent misusing alcohol 46,636 children with at least one parent with a mental health

problem

2,620 children who have at least one parent with drug misuse,

alcohol misuse AND mental health problems 26,200 children experiencing parental domestic violence

5,240 families with four or more vulnerabilities

732 births to substance misusing mothers per year


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CHILDREN LOOKED AFTER

Of the 1,465 children looked after in Essex, from

our study of cases, we conservatively estimate

that there are:

492 have a substance misusing parent

527 have parents involved in domestic violence

211 have alcohol misusing parents

421 have parents with mental health problems

386 have parents involved in offending


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Overlapping Parental Vulnerabilities (PVs)From case file audit of CLA

ALCOHOL14%

DRUGS33%

DV 36%CRIME

26%

MH 29%

Most CLA in Essex

have parents with more two

or more vulnerabilities


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Young Persons Substance

Misuse ServiceDRUGS: 13%ALCOHOL: 19%

DV: 8%MH: 15%

CRIME: 8%

Adult Substance MisuseServices

DRUGS: 50%ALCOHOL: 25%

DV: 9%MH: 8%

CRIME: 15%

Childrens Social CareDRUGS: 48%ALCOHOL: 33%

DV: 39%MH: 52%

CRIME: 0%

Family Services

ALCOHOL: 16%DV: 46%

MH: 52%

CRIME: 0%

Permanency

DRUGS / ALCOHOL: 58%

Children Looked After


DV: 36%

MH: 29%

CRIME: 26%

CAMHSDRUGS / ALCOHOL: 25%

MH: 50%

Adoption


Essex Prevalence Estimates by Team

As cases become more severe,we see a rising prevalence of parental substance misuse

AMinority

Half

AMajority


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PARENTS IN TREATMENT

Essex has an estimated 3,486 crack &/or heroin users

1,603 (46%) of these will be parents

Those in treatment had 2,990 children a minority were in care

Analysis of treatment data shows

Those parents outside of treatment were more likely to be chaotic

than non-parents

Those parents entering treatment were more likely to be stable

Parents were more likely to have dual diagnosis

Parents stay in treatment less than half the average duration

Parents were less likely to complete in a planned way

However, those parents that completed treatment had similarly

good outcomes


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0

20

40

60

80

100

120

1 2 3 4

%

ofTreatmentPop

ulationperstage

Treatment Progression

How do Parents and Non-Parents do in Treatment?

Male Parents

Female Parents

Male Non-Parents

Female Non-Parents

Parents

Non-Parents

Parents do not engage in treatment as well as non-parents


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ISSUES

We heard that services did not feel able / allowed to work with

whole families and many were clear that their priority was the

adult or child who was their client

Members of complex families are often dealt with as individuals

& their vulnerabilities often dealt with in isolation

Services often wait until a crisis has occurred before taking action

with complex families

Essex has not identified the priority, high-cost complex families

nor costed their impact

There are some excellent family & parenting projects across the

county, but these are not well enough joined up, many are short

term pilots or geographically limited, making it difficult to have a

consistent system across Essex


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GAPS & BARRIERS

Services do not habitually record these vulnerabilities

Subsequently we do not know actual numbers of children

affected

No system to flag families with multiple parental

vulnerabilities

No systematic approach to listening to and involving complex

families in designing and evaluating services

No clear, consistent strategy for complex families, so we tend to

deal with each family on an ad hoc basis

Failing to future proof families once a child is taken into care

Working with complex families as whole families is not a priority

for everyone

Some adult services are not set up to be family friendly


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WHAT WORKS

EFFECTIVE PRACTICE High quality key-workers with low caseloads

(e.g. 4-6 families per worker)

Ways of whole family working that areempowering and build on family strengths

Respectful, persistent working styles.Flexibility to use resources creatively.Incentives/rewards and focus onconsequences secure families engagement

Support that is not time-limited (average 12-18 months) and is available out of hours

Effective multi-agency relationships (co-ordination, clear arrangements for jointworking e.g. with CSC, adult services)

Parenting support through evidence-basedparenting programmes

EFFECTIVE PROGRAMMES Family Recovery Project (Westminster)

Average saving per family is 13,883

Family Intervention Project (Essex and otherareas) The average saving per family peryear is 81,624 some research estimates it

could be up to 200k per year Option 2 (Cardiff + other areas) on average

each appropriate referral saved the localauthority 1,178 per child

Families First (Middelsbrough) The meanaverage cost saving

Substance Misusing Parents Project (Kent)Cost-benefit associated with these

outcomes was between 15,094 and90,940

FDAC, M-PACT, Family Pathfinders


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THE CHALLENGE

The challenge in Essex is to Do better for complex families

Improve practice and public services

Save taxpayers money / cost avoidance

Improve family outcomes

Evidence tells us that it can be done, a number ofprogrammes show that by Working jointly with whole families

Taking an approach to build strengths & reduce risks

We can keep children safe, keep families together,improve long-term outcomes and avoid future costs


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NEXT STEPS

Report findings & recommendations to ESAB / ESCB

Identify & cost priority complex families across Essex

Introduce a staged model of improvement:

1. Joint working protocol

2. Training, Support and Co-location

3. Evidence-based Programme

Better join-up of safeguarding for adults & children

Activate senior level champions


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CONCLUSION

If we can see these families coming and knowthat they are not likely to do well in our

normal service responses, then we have a

duty to do something different with them in

future

Now is the right time to look again at families

with complex needs and use the evidence and

policy direction to change our approach forthe better

matthew scott presentation at tonic's complex families conference

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