Research Realities: benefits of intensive family support

James Blewett discusses the implications for practice of a recent study of targeted family support, which he co-authored

Title: Evaluating the delivery by Action for Children of targeted family support

Authors: Professor Jane Tunstill, James Blewett and Pamela Meadows

Institutions: This research was commissioned by Action for Children and carried out by Synergy Research and Consulting.

Objectives: Early intervention is now seen as a key building block in systems for delivering better outcomes for vulnerable children and their families. Action for Children delivers a range of family support services through 300 projects across the UK, including children’s centres.

It seeks to provide a continuum of services to meet the needs of children most at risk of poor outcomes, ranging from short-term, time-limited, intensive interventions, to long-term support that can meet multiple and complex needs.

This evaluation of provision was commissioned in order to explore the extent to which the projects contribute, through their delivery of targeted family support, to improved child and family level outcomes; and sought to identify some key implications for strategic and operational service development.

Method: The study involved four projects, with two in England and one each in Wales and Scotland and was carried out using a mix of methods. An analysis of national, local, and Action for Children policy documentation and monitoring data for each of the projects was undertaken.

Given the different project structures, in three centres the sample was selected from the total population of centre users. In the fourth, the research team was given access to data on a group of families (about 10% of the overall population of 600 or so families using the centre), who were in receipt of targeted family support services.

In the data collection process the researchers recorded the needs that were apparent at the point of referral, rather than prioritising only one. Interviews with key stakeholders were also undertaken and these included parents and project staff, exploring overall issues about the projects’ aims; organisational structure; and service delivery.

In order to explore outcomes for the families who used the family support services, the researchers created a conceptual framework derived from the existing knowledge base around family support provision. To capture the service inputs of the respective projects, and take account of the limited timetable for the evaluation, a specific set of research tools was used.

Based on the aspirations of the Every Child Matters framework, a template was designed for exploring the level of need which a child or family had brought initially to the respective projects and for identifying stages in progress towards positive outcomes at the time of the file study.

Findings: The study found that intensive support can make a positive difference to the lives of children and their families in even the most challenging circumstances. In terms of this impact researchers concluded that the measurement of an individual child level outcome needs to allow for the concept of added value, given the complex needs of many families in receipt of targeted services. In other words a genuinely preventive approach seeks to prevent “something worse” happening, whatever that may be.

The team found that robust outreach is essential to enable access for those families who are seen as being the most hard-to-reach. There is a clear association between proactively visiting families in the community at the time of referral and their engagement with the centre-based services.

One of the perennial challenges faced by those delivering family support services is the stigma that can be associated with such services. However, this study found that targeted support is not seen as stigmatising by parents and young people. Many welcomed a personalised approach to their problems in order to produce personalised outcomes.

Each of the projects were attempting to provide a continuum of family support services. A key way of promoting access and also address stigma is to ensure that bridges to service access are constructed between different levels of need.

In terms of the family support workforce, workers with a wide range of skills and professional backgrounds were employed in the projects and demonstrated that they can work together to deliver a high quality service. However, a common feature of the four projects was that intensive family support based on sustained professional relationships was particularly effective in cases of neglect.

Across the cases that were examined effective family support was found to encompass services which deliver both practical help and emotional support.

Finally re-referral rates to services are often perceived as a negative indicator. In relation to closed cases if a family needs to access services again in the future, this was perceived as a failure by the service to have addressed the family’s original difficulties. However, this study found that it is a mistake to view the “revolving door” as an indicator of a service deficit. On the contrary the “open door” approach sustained across the projects was likely to maximise positive outcomes, given that it facilitated early access at whatever stage of the problem.

PRACTICE IMPLICATIONS

Service continuum

● There are clear advantages at both the level of child outcomes and value for money in being able to offer families in the locality, variety of services. These may take the form of targeted services embedded within universal services. However even when the need profile of families using a service is exclusively at the higher threshold, there is still a powerful case for providing a range of interventions and services. Multifaceted interventions are necessary to address multifaceted problems.

What is a ‘service base’?

● What is a “service base”? The bases from which services are delivered can be single or multiple. Children’s centres are very attractive and accessible places from which to deliver the full range of services. But an absence of purpose-built premises need not preclude the maximising of service access by families, as long as robust effort is put into outreach activity to support the centre based service delivery.

The role of outreach work

● Outreach activity is most likely to be successful if outreach workers can offer a genuine “menu” of services to families, ranging from drop-in activities and fun days to individual sessions with a caseworker. Even families who are reluctant to use services can be successfully engaged through such a personalised approach. Once engaged, the possibility arises of “bridging” the families into the full range of services that can support their needs, develop parenting capacity and enhancing childhood resilience.

The art of integration

● Assumptions are sometimes made that families with “straightforward needs” will be deterred from using services. But there is positive value to be derived from integrating families with different levels of need. Skilled facilitation, including the clarification of ground rules in groups is the key to successful integration. This can work to the benefit of everyone.

The value of a skills mix

● Professionals from a range of disciplines are not only capable but are essential for providing a range of attractive and responsive services. The key to such an approach is strong and sensitive professional leadership delivered within a culture of mutual respect.

The value of early referral

● Commissioners are faced with a perennial tension between “net- widening” and “gate-keeping”, ie, restricting resources to those with the most acute needs. This can take the form of a late referral in the chronology of a family problem. However, this delay means not only that the problem becomes entrenched but that the benefits of integration into the wider group of families are difficult, if not impossible to deliver. Such a strategy of postponement is a false economy.

Links and resources

Jane Tunstill and Debra Allnock (2008), Understanding the Contribution of Sure Start Local Progammes to the Task of Safeguarding Children’s Welfare (part of the national evaluation of Sure Start).

Wendy Rose and Jane Aldgate (2007), Changing directions for children with challenging behaviour and their families: evaluation of Children 1st directions projects.

June Statham provides an excellent summary of the Every Child Matters briefing, Supporting Families.

James Blewett, Social Care Workforce Research Unit, Kings College, London

Published in the 21 May 2009 edition of Community Care under ‘Evaluating the delivery of targeted family support’