Presentation to the Shadow Health & Wellbeing Board by:

• Paul Greenhalgh (Executive Director of Children, Families and Learning)

• Paula Hassall (Payment by Results Project Manager)• Paula Doherty (FRS Manager)

9 February 2012

SUPPORTING FAMILIES WITH COMPLEX NEEDS

Supporting families with complex needs: presentation to Health & Wellbeing Board

• Support to families with complex and multiple problems when their children are very young through Family Engagement Partnerships and Payment by Results for Children’s Centres

• Support to ‘troubled families’ and families with complex problems through the multi-agency Family Resilience Service

• Longer term savings strategy that these initiatives could help make in terms of reducing the take up of later interventions and acute health services

Num

ber of childre

n

Vulnerable Complex Acute

Cost

Early Identification and Early Help

Universal Services & early identification

Social Care System

Family Resilience

Service

Family Engagement Partnership

Early Intervention

‘Intervening early and as soon as possible to tackle problems emerging for children, young people and their families or with a population most at risk of developing programmes. Early intervention may occur at any point in a child’s life.’ (C4EO definition and research)

• Early in a child’s life• Early in the development of a problem

Information services – Around £34 via telephone helplineAround £2 via digital services

Cos

t pe

r ch

ild /

fam

ily

Severity of assessed need

Cost

Family Intervention Projects – £8-20,000 per family per year

Family Nurse Partnerships – £3000 per family a year

Child looked after in children’s home – £125,000 per year placement costs

Child looked after in foster care – £25,000 per year placement costs

Schools - £5,400 per pupil

Children’s Centres - around £600 per user

Costs increase as children get older.

Increasing related costs such healthcare and the criminal justice system make it clear joined up working is a core part of cost effectiveness

Multi-dimensional Treatment Foster Care – £68,000 per year for total package of support

Child looked after in secure accommodation – £134,000 per year placement costs

Parenting programme (e.g. Triple P) – £900-1,000 per family

PEIP – £1,200 - 3,000 per parent

Multi-Systemic Therapy – £7-10,000 per year

The disparity in cost between the cheaper provision and more intensive support shows how important it is that children and young people receive the right services at the right time.

The escalating costs of intervention

These figures are intended to be illustrative only. Costs have been estimated from a range of sources and will not always be directly comparable. For example, the MTFC figure includes the package of support, social workers etc. that is needed whereas the foster care figure only includes placement costs.

Support at Level 2

Family Engagement Partnerships with single

pathway (vulnerable <3’s)

Early Intervention Consultant (health)

Children’s centre family support teams (0-5) &

commissioned services

LOW/VULNERABLEChildren & Young People with low

level additional needs requiring single agency support or an integrated response using a

common assessment.

UNIVERSALChildren & Young People requiring

personalised universalservices

COMPLEXChildren, Young People &

Families with high level needs.

These children/young people include ‘Children in Need’ (Section 17) who require

integrated, targeted support

ACUTEChildren, Young People &

Families with complex additional needs requiring

specialist/statutory integrated response; includes child

protection (Section 47) and children whose needs /

safety cannot be managed in the community

Early Intervention: Complex & Troubled Families

Support at Level 1

Information, trainingadvice and guidance to universal settings and

practitioners

Support at Level 3

Family Resilience Service

Health & CAHMS input assessment and key

Family Engagement Partnership Model

Family Engagement Partnership

Higher Progressive risk; 12 week booking; scan;

new birth visit; DNA,

Virtual Team/Partnershiphealth; children’s centres,

social care, voluntary sector, community etc

Early Identification: GPs; HVs; Mid-wives;

children’s centres; housing; social care;

Voluntary/faith groups etc

Family Engagement: Partnership agree family engagement

plan (2 yrs) inclCommunity Mothers/

local services

Payment by Results (PbR): added value of health and children’s centres; joint outcomes between centres and healthy child programme

Small school basedcentre

Voluntary sectorcentre

Funding formulafor each

children’scentre:

weighted - nos /disadvantage

Strategic Collaboration Board – statutory/local partners & parentsPbR funds success of the Collaboration Board as measured by key

indicators that best represent Croydon’s ambitions

Family Engagement Partnership

• Single Pathway for vulnerable families (-9mths – 3 years)• Referrals from GPs, midwives, health visitors, settings,

voluntary sector through Children’s Centre collaboration• Early Intervention Consultant (health) - leadership,

breakdown barriers, expertise and safeguarding• FEP focus on progressive-higher risk families• Engage families, link with commissioned services• OUTCOMES: healthy child indicators – linked to the

Payment by Results for children’s centres

Issues likely to emerge

• Numbers of families to be supported• Unmet demand – 630 higher progressive risk • Sufficiency of services and support• Breaking down the barriers – integrated locality

based approach – build on what works …• Realistic expectations – all start by Sept 2012• Cost avoidance/savings … estimates/futurisation

Community Budgets & ‘troubled families’

• Driver: Pooled Budgets – currently pooled resources• At the cusp of the cost curve – ‘cost avoidance service’

… link to capacity to change• Key worker & high quality engagement (Dfe research)• Up to 10 hours per week; av 15months – research shows

longevity has impact• Research shows health as one of intransigent factors• Target population 772 (now est 785)• Making and reinvesting savings

Universal Services1

Education - £580m

Child benefits - £110m

GP/NHS costs - £30m

Targeted Services2

Welfare benefits - £750m

Mental health treatment - £20m

Parenting support - £50m

Drug misuse treatment - £10m

£0.7bn universal spend/yr

£0.8bntargeted spend/yrReactive spend3

Children going into care, hoax fire calls, nuisance behaviour costs, juvenile criminality costs, truancy costs, alternative education costs, vandalism, evictions due to ASB

£2.5bn reactive spend/yr

46,000families

All of these families access universal services…

…and specialist services, (often repeatedly for many years) 

but family breakdown and crises still leads to very poor and costly outcomes

NOTE: INDICATIVE COSTS ONLY - do not include costs of criminal justice services pending further analysis by MoJ.

Disproportionate costs on services

Can be as much as £250,000-330,000 per family per year……

DfE

Multiple funding and accountability structures make coordinating support for the families with the greatest

needs very difficult

Intensive family intervention worker/

parenting practitioner

DH

LA YJB PCTPolice

Surestart

Parent support advisers/Schools

Police officer

YOS workerCAMHS/

Mental Health Worker

Drug and alcohol team

DWP

JCP

Employment Personal advisers

VCS

Young carer support worker

Prisons

Family support workers

CLG

Housingauthorities

Housing link worker

MoJHO

Health issues: complex/troubled familiesOutcome Domains ( DfE Think Family, 2010) % reduction in no. families

experiencing risk

Poor Family Functioning 47%

Poor parenting 50%

Domestic violence 54%

Child protection issues 37%

Crime and Anti-Social Behaviour 47%

Crime 38%

Anti-social behaviour 57%

Health 34%

Mental health 18%

Physical health 28%

Drug/substance misuse 39%

Alcohol problems 48%

Education and Employment 34%

Truancy, exclusion or bad behaviour at school 54%

No adult in the family in education, employment or training 15%

Structure for Family Resilience Service (FRS)

Tracy Weight Operational Manager

15Updated Janurary 2012

Phil Rainsford

Police Officer

Paula Doherty (consultant)FRS Manager

James HillamFRS Support

Terri Dorman Operational Manager

Darron WardSenior FRS Support Officer

Bola Peters, Tricia Le Gassick, Danny

Smith, Maria Auguste, Alexia

Demetriou (1 vacant) Key Workers

Donna Darby, Alisha Musambik, Esther Brewster, Michelle

Phillips, Verna Francis and Anne Marie

Marshall Key Workers

Beth Mitchell Family Therapist

Pam Jeffers Family Therapist

Sharon Liatbeaudide

Family Therapist

Stephanie Standen FRS Support

Clara Goodwin Housing Officer

JCP YOS Parenting

DASH ASB Amaal Ally

CAHMS

Community Budgets: The story so far

• Transformation: of interventions for Families with multiple problems and multiple disadvantage

• Transactional: Working interdepartmentally and inter agency, to improve our currency and evidence shared returns on outcomes

• Transition: Community Budgets and the relationship to ‘Troubled Families’

• Troubled Families Team set up in DCLG: November 2011 with an expectation of ‘turning troubled families around’

• Government research estimates 120,000 families fitting the description ‘Troubled families’ in England ( 785 estimated in Croydon, figures based on Family and Children Service Data (2005) Child Well Being Index (2009) and the Index of Multiple Deprivation

• Announcement of £448m of investment over next 3 years

• Next Phase: understanding what the troubled families announcement means at a local level; mapping out who they are, where they are and how we can reach them in a more effective way – use the learning of partners from FRS to ‘turn troubled families around’

FRS Overview February 2012

• recruited 60 cases (2011-12), 333% increase in case-load in 2011/2012 ( 250% increase planned for 20012/2013)

• FRS referrals March 2011 – to date = 87, average of 8/9 per month ( 14 declined by service, 3 declined by families, 10 closed)

• Average duration of contact, 12 -14 months; average contact of 3 times per week

No parent in the family is working 88% Poor parenting 97%

Family live in poor quality or overcrowded accommodation

74% Truancy, school exclusion or low educational attainment

Children with SEN statements

Educated outside of mainstream school

85%

50%

47%

Parents without qualifications 76% ASB issues 27%

Parent has mental health problems

Child

53%

63%

Drugs or Alcohol abuse- adultChild

39%

37%

At least 1 parent has a long standing limiting illness, disability or infirmity

29% Family breakdown 90%

Families claiming benefitsPoverty

88%79%

Domestic Violence Child to parent violence

79%47%

Offending behaviour- adult

Child

37%

63%

Social Care involvement

On plans

80%

32%

Domestic Violence

Homelessness

Mum has no qualifications

Child has not been in school for several months

Significant debts

History of sexual abuse

Mum did not complete her education

Mum has never worked

ASB Housing Referral

Mum has depression

Child’s father has no contact

Alcohol Abuse

Intergenerational worklessness

Anti Social Behaviour

Cost

• Cost of a YOI = £54,750 • Cost of Foster Care = £20,000- £40,000• Residential Care = £ 130,000• Child on a CP Plan = £ 40,000• Problematic drug use = £ 50,000

Cost avoidance and savings: Reinvestment Strategy

• develop an efficient and effective system for dealing with referrals and assessing families’ needs.

• have a clear system for responding to these needs appropriately and tracking families as they progress through the FRS

• have an effective means of reviewing families‟ progress, and monitoring their capacity to change

• have good arrangements in place for data collection and sharing

6. Next Steps

• Clear metrics to monitor savings/cost avoidance of children’s centres & Family Resilience Service

• Payment by Results – making sure we are ‘counting what counts’ and that we can evidence this for LA funding

• ‘troubled families’ - CLG expectations – identifying and mapping out families etc

• Social Impact Bonds – opportunities and risks