Agenda item

The Committee received evidence from Elaine Sheppard, Operational Manager of Family Action, during which the following main points were made –

·         Family Action is a voluntary organisation which works in partnership with the Council to deliver the Families First service.

·         The Families First service had been designed to be easily accessible and delivered in a way which removes the stigma of accessing support services.

·         The service had three teams operating in the Borough on a geographical basis. Clients could be referred to the service by the Police, Social Services, Housing, health workers, schools, GPs and other agencies; however around 25% of users had self-referred to the service.

·         As well as supporting existing clients, the service had also conducted outreach work which included visits to schools, drop-in sessions, and delivering parenting programmes in community venues.

·         The service had taken a “whole family” approach to intervention, with a particular focus on children. Service users were provided with support inside the family home, or at a community venue if more appropriate.

·         Ms Sheppard considered the partnership model to be particularly effective, as it has allowed the voluntary sector to work with the Council services most relevant to the particular family to devise a joint action plan. Families often had multiple and complex needs including educational attainment and attendance, social isolation, and difficulties with employment, housing and health, including mental health. Working in partnership had enabled Families First and Council services to take a consistent and coordinated approach with clients.

·         Each family was assigned a family support worker. The role of the family support worker was to provide practical help, advice and support to the family, and challenge clients when needed.

·         Clients and support workers jointly assessed the needs of the family on the “Family Star” assessment tool. This helps to identify the areas in which the family needs the most support and allows progress to be measured.

·         The progress made by clients on the family star had also enabled the service to evaluate its own achievements. Through this tool, Families First was aware that it had been most successful in improving the safety of children, however further work was needed to improve the social networks of clients.

·         The service had also used local authority data to evaluate its outcomes. The performance of the service was reviewed every six months and changes were made as required. Following a query, it was advised that the service had also received anecdotal information about client progress; however this was not collected or evaluated systematically.

·         The service was considered successful, with the majority of clients making good progress on the family star. The service had received positive feedback from clients; in a recent telephone survey 83% clients scored the service as 4 out of 5 or higher for overall satisfaction.

·         68% of families engaging with the service had experienced a reduction in school absences.

·         The service had exceeded its annual target of engaging with 1,000 families by the half-year point of 2014/15. Following a query, it was advised that the service was coping despite the high demand and the total number of clients was not expected to exceed 2,000 by year end.

·         A member queried how the service compared with the early intervention programme offered before 2012, when Families First was established. Family Action considered that the current service was more effective in reaching the families with the greatest need and that the service was better coordinated than the previous offering due to the partnership approach.

·         A member of the public queried how public sector budget cuts had impacted on the service. It was commented that the Families First budget had not been reduced, however changes and reductions in housing and welfare may have exacerbated problems for clients. Families First was confident that an increase in demand for its services could be accommodated through smart working and partnership work.

·         The Chair queried the reasons why some service users had not scored Families First highly for overall satisfaction. Families First suggested that some families may have hoped for a better outcome, and some may have had unrealistically high expectations. Some feedback had suggested that staff had not been sympathetic enough.

·         The welfare of Families First staff was queried, in particular if staff were suffering from “burnout”. In response, it was commented that management are supportive towards staff, and staff are given access to training and professional development opportunities.

·         In response to a member query, it was commented that the service could innovate further by developing communications and networking between families, and undertaking further outreach work.

The Committee received evidence from Lucinda Hibberd-French, Deputy Service Manager with responsibility for the Families First service, during which the following main points were made –

·         The importance of accessibility was emphasised. The Council offers a single point of contract for families requiring support; this method was considered to be efficient and less complex for service users, as they do not need to repeat information multiple times to different agencies. Once contact is made with a family, a judgement is made on which support service would be most suitable for the family.

·         It was commented that Families First can uncover further, more complex issues through their work with families and then refer these to other agencies as appropriate. In particular, it was described how Families First can escalate cases to Social Services where more formal intervention is required, and how Social Services can de-escalate cases which require more generalised support to Families First. It was noted that families are consulted on escalation or referral, unless it is considered that this would put any children at risk.

·         In cases where Social Services have de-escalated clients to Families First, a handover takes place in the form of a joint home visit to ensure continuity for service users.

·         The Families First service aimed to complete any intervention within six months. This was achieved by families completing the family star assessment tool, and working to improve any areas in which the family scored below 5 on a scale of 1 to 10. Although intervention was intended to be completed within six months, families may access the service for longer if required. Some families had completed their intervention and then returned at a later date with different issues altogether. Those returning to the service had often self-referred and it was commented that this reflects on the positive experience the family has had with the service. No data was readily available on how many clients had returned to the service. 

·         Families First had uncovered instances of domestic violence. It was commented that this is a sensitive issue and family support workers had received relevant training. On uncovering a case of domestic violence, support workers undertake a risk assessment in order to determine if a MARAC (Multi Agency Risk Assessment Conference) is required. Support workers always seek to minimise the risk to victims. It was noted that, as well as support programmes for victims, there are also programmes available which seek to change the behaviour of perpetrators of domestic violence. 

·         In response to a query, it was commented that there was no backlog at the central referral point and Families First did not have a waiting list. Families First arrange a visit within three days of a referral, and the visit then takes place within a week.

·         A member provided anecdotal evidence about particular cases of domestic violence. It was commented that although some services had experienced a decrease in funding, in recent years domestic violence services have sought a more systematic approach and the safety of victims was still the highest priority.

·         It was explained that the self-referral process is not bureaucratic. There are no forms to complete by the client and contact may be made by email or telephone.

·         It was explained that some families choose not to engage with Families First. The service has been persistent and followed up referrals multiple times; however families cannot be made to engage. It is possible to carry out unannounced home visits if there is a concern for the family’s welfare.

The Committee received evidence from Mairead McDonnell, Deputy Head of Newington Green School, during which the following main points were made –

·         Ms McDonnell is the school’s designated teacher for safeguarding and is responsible for liaising with statutory and non-statutory agencies about safeguarding issues.

·         Ms McDonnell praised the work of Families First, noting that their work was well coordinated and tailored to the needs of individuals and specific schools. It was noted that the service had established outreach coffee mornings and parenting groups, and Families First had attended school safeguarding meetings with other agencies. 

·         Each school was allocated a Families First link worker. It was suggested that this was well received by parents as it provides a “face” to the service.

·         It was commented that the electronic form used for a school to refer a family to Families First was more detailed than form under the previous early intervention offering; however it was considered worthwhile as the service provided better outcomes for families. Examples were provided of particular families that had benefitted from the service.

·         The school’s opinion was that parents are happier to engage with Families First than Social Services as there was less stigma attached to the service.

·         Families First had worked to stop families with housing issues being evicted, and had helped families with medical needs source funding.

·         A member queried the accessibility of council services to schools. Ms McDonnell advised that the school had good relationships with council officers and knew who to contact about particular issues.

·         It was queried if early intervention by Families First had led to successful resolution for families referred to the service by the school. It was commented that the majority of families referred to the service were turned around within the timeframe.

·         The opinion of the school was that the Families First budget should be protected.

·         A member of the public queried the staff turnover of Families First. It was noted that there had been some turnover of staff, however in general these had left for career progression. Turnover was not related to workload or stress.

·         The Chair asked for Ms McDonnell to identify two weaknesses of the Families First service. The suggested weaknesses were that schools cannot receive information on families who have self-referred to the service, however the importance of confidentiality was accepted, and that the service was only open to Islington residents, as some families attending Islington schools were in need of support but were residents of neighbouring boroughs.

The Committee received evidence from Win Bolton and Michelle Tolfrey of the Camden and Islington Mental Health Foundation Trust, during which the following main points were made –

·         It was commented that there was a high prevalence of mental health disorders in the Borough and some clients of Families First require related support.

·         Families First did not offer direct access to trained mental health practitioners and it was considered that this would replicate existing services. Instead, Families First had access to clinical psychologists, employed by the NHS, who were able to be consulted on the needs of service users and possible solutions. This was considered to enhance the service provided by Families First by developing the knowledge of mental health among its staff.

·         Psychologists had been working with Families First since November 2013 and offered support on 400 cases in their first year. The services were co-located and had a successful working relationship. 70% of the work the psychologists carried out with Families First was indirect; however some visits to service user homes were carried out.

·         It was thought that 46% of families engaging with the service had a mental health need. These were often complex needs and related to trauma. Some families had a history of not engaging with mental health services and therefore psychologists and Families First would consider how to improve the wellbeing of those in need without necessarily referring to specialist services. Sometimes this involved preparing the service user to engage with other services at a later date.

·         There was no waiting list for support from the clinical psychologists.

·         A member commented that although there was often good provision of mental health services for children and adults, there can be a gap in provision for young people making the transition into adulthood. This issue was recognised as a national problem by the Foundation Trust, and the Trust had recently introduced transition plans for service users moving from child to adult support services to address this problem.

·         It was explained that Families First may refer to a number of services which can improve mental health, such as voluntary sector counselling services, Solace Women’s Aid, and general practitioners. Support workers looked broadly at the services which may improve a client’s wellbeing, and may suggest social groups for those with problems relating to social isolation, for example.

·         Difficulties could arise when a client is referred to a service with a lengthy waiting list. In general, primary care services were easy to access, whereas more specialist services often had a waiting list. It was noted that Islington Clinical Commissioning Group was piloting primary care mental health services.

·         A member queried how the effectiveness of the psychologist support to Families First was measured. It was recognised that this is difficult to evaluate as the psychologists did not frequently work with service users directly, however it was possible to undertake staff surveys, measure family wellbeing, and review how the recommendations of the clinical psychologists were being implemented.

The Chair thanked all witnesses for their contribution to the scrutiny review.