Improving outcomes for children

Although there is limited evidence on how integration of children’s services is working at this stage, LARC has collated useful data in the first round. Susannah Bowyer reports

THE RESEARCH

Title: Evaluating the Early Impact of Integrated Children’s Services

Authors: Pippa Lord, Kay Kinder, Mary Atkinson and Jennie Harland

ABSTRACT

A report on the Local Authorities Research Consortium (LARC) collaborative research venture. The consortium included 14 local authorities, The National Foundation for Educational Research, EMIE, Research in Practice, the Improvement and Development Agency (IDeA) and the Local Government Assocation. The research team at NFER collated and analysed the data.

OBJECTIVES

LARC’s aim was to identify early impact of integrated children’s services and features that promote or hinder success in improving outcomes for children and young people.

Research was carried out within the 14 participating councils, and was mainly interview-based, capturing the views of the directors of children’s services, service managers, practitioners, children and young people and their parents/carers.

THE PROCESS

The project focused on three key groups: looked after children children and young people with autistic spectrum disorder and young people with over 20% absence from school at key stage 3.

Local authorities were asked to select cases for each key group whose support exemplified some element of integration. Clearly many of the desired outcomes of integrated working are long term. In order to analyse early impact, the project adapted a model developed by NFER in the course of other evaluations of major, multifaceted initiatives (see graphic below). Findings were analysed using this four-stage model, and reported impacts of integration were triangulated through the different perspectives of each group of interviewees.

The researchers placed the participating authorities on a continuum – from those in the early stages of integration to those with more confidently integrated services – using two key variables: their self-reported level of impact and the amount of consensus among directors and practitioners on types of impact and key contributing features.

The most confidently integrated authorities were those that had been developing integrated children’s services for some time. Beyond that factor, three areas of clear variation in features were identified in these confidently integrated authorities:

● Working together, relationships and (to some extent) communication between agencies were cited as positive features and rarely nominated for further development in confidently integrated authorities, while in other authorities these were frequently cited as requiring further development. Key issues for less confidently integrated authorities (noted by both service managers and practitioners) included shared ownership across agencies and ensuring schools’ engagement with integrated children’s services.

● Having a clear and shared high profile vision was a key feature exclusively perceived as positive in the confidently integrated authorities, with leadership and management contribution positively perceived by service managers and practitioners.

● There were no negative comments about models of funding (eg, the pooling of budgets) in the confidently integrated authorities. In contrast, in authorities in earlier stages of integration interviewees were concerned that funding and accountability arrangements were not well developed.

FINDINGS

Level 1 impacts: changes to inputs, processes and structures

In more confidently integrated authorities, interviewees spoke with greater specificity about changes to service, management and front-line structures and how they were working, while managers in earlier stages of integration described structural change more broadly, with no change yet perceived by practitioners in management or delivery structures.

Confidently integrated local authorities were characterised by the introduction of distinctive tools and frameworks (such as Team Around the Child, locality working, lead professional or CAF), and there was consensus from service managers and practitioners over these impacts.

Level 2 impacts: changes to professionals’ experiences and attitudes

In more confidently integrated authorities there was evidence of significant role changes (such as new roles for all staff in the locality, role change into small locality teams) while in authorities in earlier stages of integration role changes were described for individuals but not reported significantly across the workforce.

Where significant role changes were reported, staff were more vociferous about both the positive and negative impacts of these changes (such as the challenge for service managers now responsible for a range of different professional groups or the concern for practitioners of taking on different levels of need in their caseloads).

Staff in confidently integrated authorities spoke about how improved relationships had led to further impacts (such as trust and confidence in referrals or reduced confrontation between professional groups).

Level 3 impacts: outcomes for children, young people and their families

Clear variation between more or less confidently integrated authorities occurred in only one area at this level: that of better access to services for children and their families. Quicker and more coordinated response and support, and early identification were all more numerously cited (by both managers and practitioners) in more confidently integrated authorities. Managers and practitioners placed outcomes for children, young people and their families in the following categories:

● Changes to outcomes, eg, school attendance, number of referrals, school attainment, etc. Examples of improved attendance were spread across almost all the authorities, the vast majority in relation to the key stage 3 non-attenders group.

● Improvements to “softer outcomes” such as children and young people’s social and emotional wellbeing.

● Improvements to parents’ views/understanding of services and to their wellbeing.

● Better access to services and improvements to children’s experiences of services.

● Improvements to children’s views of services (noted only by practitioners).

The findings are then reported in relation to each of the key groups of children and young people in the study.

Impacts for looked after children

Managers and practitioners focused on:

● Reductions in referrals to acute services in some cases improved attainment.

● Improved access to and coordination of services.

● Improved stability, placement in care avoided in other cases.

● Improved parental attitudes towards services, with less opportunity for parents to play services off each other.

● Practitioners also mentioned soft outcomes of improved confidences, self esteem, health and well-being.

Children and young people and parents/carers focused on:

● Improved social relationships with peers and with family or carers.

● Improved confidence and/or self-esteem

● Getting on better with school work.

● Parents/carers also mentioned improved behaviour.

Impacts for autistic spectrum disorder group

Managers and practitioners focused on:

● A rise in initial assessments and in ASD diagnoses and a reduction in the number of statements during primary/secondary school transition.

● An improved range of services to support these children and their families.

● Improved social skills for the children.

Children and parents/carers focused on:

● Getting on well/better with school work.

● Improved behaviour and concentration.

● The children and their parents both felt that the children were feeling safer and happier, calmer and more relaxed.

Impacts for key stage 3

Managers and practitioners focused on:

● Improved attendance and prevention of exclusions.

● Improved access to better co-ordinated services.

Young people and their parents/carers focused on:

● Improved attendance.

● Enhanced confidence and self-esteem.

● Feeling happier and safer.

● Improved relationships with peers and with teachers.

● Improved behaviour.

Level 4 impacts: towards systemic embedding

The majority of DCSs and service managers did not identify systematic embedding, but spoke about challenges and future aspirations at this level.

ANALYSIS

Many key findings of the LARC study echo those of other research on integrated working. The importance of clarity of purpose strong leadership and management developing common language and trust between partners and understanding responsibilities are all identified as enablers of integration by other studies (see www.rip.org/prompts).

The LARC report does not provide headline-grabbing, quantitative data on early impacts of integrated children’s services on outcomes for service users. The consortium was realistic about the limited evidence that might confidently be ascribed to integration at this early stage, and this pragmatism was reiterated in the research findings.

The consultation process for agreeing the focus of Round 2 is currently in progress research will continue with at least one of the key groups of service users from Round 1 in order to build on these findings. The 16 authorities are currently signed up to participate in Round 2 and research is due to begin in autumn 2008. Any authority interested in joining LARC 2 should contact Celia Atherton celia@rip.org.uk.

Susannah Bowyer is research officer at Research in Practice, part of the Dartington Hall Trust

LINKS AND RESOURCES

● Lord, P. Kinder, K., Wilkin, A., Atkinson, M. and Harland, J. (2008). Evaluating the Early Impact of Integrated Children’s Services. Slough: NFER

● Robinson, M., Atkinson, M. and Downing, D. (2008). Supporting Theory Building in Integrated Services Research. Slough: NFER

● These reports and the LARC literature review

● Research in Practice Prompt topic briefing on Managing distinct professional identities in multi-professional teams 

● Disengagement and Re-engagement of Young People in Learning at Key Stage 3 (Morris and Pullen 2007)