A multi-agency group in Wolverhampton has pooled resources and solved the tricky problem of finding local placements for children with complex needs. Camilla Pemberton reports
Finding the right placement for children with complex needs is fraught with risk. Often the child is placed far from his home town and friends, leaving councils with hefty bills for placements that are more difficult to monitor.
In Wolverhampton things are different. Now, nearly 90% of children with complex social care, educational or health needs can be provided with suitable in-city placements. Children placed as far as Cornwall have returned to their local communities.
These achievements are a result of a multi-agency approach adopted two years ago by Wolverhampton Council and the city’s primary care trust (PCT).
Better co-ordination of multi-agency resources has improved the quality of internal services, so the occupancy rate of local authority children’s homes has increased from 60% to 90%. Spending on external placements has fallen by 35% and only 12 children are in jointly-funded external placements.
“Some children require out-of-area placements to sever destructive peer links or if they have an unusual problem where there is low demand for in-city specialist units,” says Enno Kuttner, director of Wolverhampton’s child and adolescent mental health services. But children in Wolverhampton were being referred out of the area “too easily”, he says, resulting in stretched and unequal budgets across social care, education and health.
This led to disagreement about needs assessments. “For example, was challenging behaviour the result of an unmet social care or mental health need?” says Arif Dar, head of looked-after children at Wolverhampton Council. The decision would govern whether the council or PCT funded the bulk of the child’s placement. Because each was protecting its own budget and was limited by its own procedures discussions could become “quite protracted” and the voting process “complicated”.
Case workers were becoming embroiled in complex managerial decisions, which resulted in a lack of clarity about needs assessment criteria and delays to placement reviews. “Cases were drifting because there was no combined management saying ‘let’s have a placement review’,” says Dar.
All reviews are completed within six months – just one of the improvements driven by the Multi-Agency Strategy Management Group, which comprises senior council and PCT managers who came together in 2007 to propose the new partnership.
Bringing together managers from both organisations and pooling their three budgets, the group created a £3.1m pot (£1.2m from the PCT, £1.1m from social care, and £800,000 from education) for children who need a jointly funded, external placement. Wolverhampton Council has a single administrative pool with a central database so managers know where, and how many, children are being funded by the joint budget. Funding is approved for just six months. “This builds in a mechanism to ensure placements are monitored and routinely reviewed,” says Dar.
A holistic, rather than tripartite, approach now governs the care of children with overlapping social care, health and educational needs. “Rather than debating where needs fall and who pays, people can forget they work for different organisations and make joint, child-centred decisions,” says Dar.
The External Placements Panel, chaired by Dar since April 2008, scrutinises placements and ensures services are delivered within the joint budget. Dar clarified membership and manages the working relationship, which includes three voting members: Dar, Kuttner, and head of social inclusion Gren Knight, who is an educational psychologist. A representative from adults’ services also sits on the panel to ensure a smooth transition in the cases of children with long-term needs.
Because each case is assessed individually, part of the panel’s gatekeeping process is a multi-agency case conference, where workers put forward their assessments and reach a consensus about placement needs. The panel assesses the evidence and considers whether the child meets the criteria for a jointly funded external placement. Voting members decide whether local resources can meet their needs or whether they need to be enhanced, for example by allocating more Camhs staff to the case. Dar ensures the panel considers in-city options before approving external placements.
Knight says the case conference is key to Wolverhampton’s success. “It is chaired by a senior manager who understands the working of the panel and the criteria we have for approving funding,” he says, adding that the new partnership approach has helped all children requiring multi-agency support, not just those in care. “The parents of a seven-year-old autistic child, with a troubled home environment, wanted her taken into care,” he says. “But we were able to place her in a specialist residential school full-time which is meeting her needs.”
Wolverhampton social worker Samantha Cook says monthly panel meetings and six-monthly placement reviews provide case workers with a clear structure. “We now have a clearer idea of how to evidence a child’s placement needs,” she says.
Kuttner says the panel’s triadic interests now complement each other while each shares a “passion to keep children in our local community systems where possible, and reduce their need for long-term specialist placements by enhancing our services”.
● Wolverhampton’s Multi-Agency Strategy Management Group received a 2009 Excellence Network Award for partnership working.
CAITLIN Formerly in a residential home
Multi-agency working brought swift decision
Caitlin* was living in a residential home when her additional therapeutic needs were identified. Her case workers decided she needed an enhanced placement so a multi-agency case conference was called.
This resulted in a request to the External Placements Panel for a therapeutic placement, with education provision on-site.
Because of revised multi-agency working professionals were better set up to identify the right placement, and the shared budget and objectives meant she was placed quickly.
She now has stability in her life and is engaging with therapy.
* Not her real name