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Special Report: Early Intervention and social work

The chief social worker for children has called for social workers to be increasingly involved in early intervention services saying they have a "a big part to play".

Giving evidence to the All Party Parliamentary Group for Children, Isabelle Trowler said she would like to see more social workers in early years settings and said that Ofsted inspections had shown that getting social workers involved earlier could help reduce the numbers of children in care.

“Social work has a big part to play in this public service landscape and we can offer professional support at any point actually within the need of risk,” she told the APPG’s inquiry into social care.

Trowler’s comments, while welcome, are not ground-breaking given there has been repeated calls for increased funding for and support of early intervention services over the last decade. Very few Serious Case reviews fail to mention the importance of preventive work.

Preventive work can do more than reactive services

Indeed, Lord Laming’s review of child protection, published in March, 2009 and ordered by government in the wake of the Baby P case, called for an overhaul of children’s social work. A key recommendation was that the government should ensure councils have sufficient funds to invest in early intervention and preventive services for children.

Furthermore in June 2010, the prime minister commissioned a Review of Early Intervention to be led by MP Graham Allen who delivered the report in January 2011. Allen recommended a “rebalancing of the current culture of ‘late reaction’ to social problems towards an Early Intervention culture, based on the premise of giving all children the social and emotional bedrock they need to achieve and to pre-empt those problems”.

Within that context, he called for an essential shift to a primary prevention strategy which offers substantial social and financial benefits. “I recommend proper co-ordination of the machinery of government to put Early Intervention at the heart of departmental strategies, including those seeking to raise educational achievement and employability, improve social mobility, reduce crime, support parents and improve mental and physical health,” said the report.

And in May 2011, Professor Eileen Munro published her review of child protection which stated that, as the reviews led by Graham Allen MP, Dame Clare Tickell, and Rt Hon Frank Field MP had already highlighted, her review “has noted the growing body of evidence of the effectiveness of early intervention with children and families and shares their view on the importance of providing such help”.

Professor Munro said: “Preventative services can do more to reduce abuse and neglect than reactive services. Many services and professions help children and families so co-ordinating their work is important to reduce inefficiencies and omissions.

“The review is recommending the Government place a duty on local authorities and their statutory partners to secure the sufficient provision of local early help services for children, young and people and families. This should lead to the identification of the early help that is needed by a particular child and their family and to the provision of an offer of help where their needs do not match the criteria for receiving children’s social care services,” Munro added.

High thresholds

While practitioners, academics, the government were all, for once, singing from the same hymn sheet, the coalition government elected in 2010 had a primary concern of tackling the budget deficit and national debt and set about plans to make £6 billion cuts in the financial year 2010–11.

Local authorities’ budgets were slashed and they were forced to set high thresholds for eligibility for services meaning early intervention services – while financially beneficial in the long-run – were a victim of the cuts as social workers were forced to concentrate on the most needy of cases.

In fact, just last year, a survey of more than 1,000 social workers found that 71% of practitioners believed the threshold for child protection had risen in the past 12 months. The survey found that 74 per cent of those felt the threshold for abuse had risen for neglect, while 39% felt it had risen for cases involving sexual abuse and exploitation.

One social worker said plainly: “With neglect the thresholds aren’t really that clear. It has to be really extreme before it is seen as a child protection issue, because of issues around money basically.”

Weaknesses in management

However, while Trowler’s message is nothing new, it is, perhaps, signalling that more focus should be placed on early intervention and effective multi-agency working to reduce the numbers of children in care and protect them effectively regardless of cuts.

The chief social worker said that Ofsted’s thematic inspection of early help published in March last year had contained some “harsh messages”. The report identified that many local authorities were establishing a more coordinated and structured approach to early help and preventive services.  However, the inspection into how effectively local partnerships’ early help services are improving children’s circumstances, reducing risk and taking further action when needed found:

  • In over a third of cases, partner agencies had missed earlier opportunities to provide help, leaving these children with no support when they needed it.
  • Over half of the cases were of poor quality and in some instances professionals gave limited or no consideration to family history.
  • Inspectors found evidence of effective planning in only a third of cases. Yet in two thirds of the cases plans were ineffective.
  • Inspectors identified serious weaknesses in the management oversight of early help cases.
  • Inspectors found that Local Safeguarding Children Boards (LSCBs) were not monitoring the management oversight of early help practice.
  • Local authorities and their partners were not fully evaluating the impact of their early help work.

The inspection recommended that the government “strengthens and specifies the roles and responsibilities of local authorities and statutory partners, setting out that they must secure sufficient provision of local early help services for children, young people and families and require that an annual plan is published by the partnership and aligned with the local joint strategic needs assessment”.

The Early Help report does however highlight good practice, for example, professionals in Milton Keynes using the ‘Signs of Safety’ model for early help assessments which ‘assisted professionals to identify strengths, needs and risks within the family’. Involving children and male partners living in the household in assessments was considered good practice and was often overlooked.

Working in clusters

Trowler also used her evidence to the APPG for Children to highlight areas of good practice in the country. “There are authorities like Leeds, Essex and North Yorkshire, again using particular practice methodologies that are having significant impact on their care populations,” she said.

Indeed, Leeds Council, which was rated as ‘good’ in its last inspection report published in March 2015 had reduced the number of looked after children from 1,340 at the end of March 2014 to 1,294 children in January 2015. At the end of December 2014, 5,610 children were identified as being in need of a specialist children’s service, down from 6,974 at the end of March 2014 and in December 2014, 642 children were the subject of a child protection plan, down from 983 in March 2013.

The authority claims three ‘obsessions’: to safely reduce the number of children and young people becoming looked after, to improve young people’s life chances through better attendance at school, and to improve the provision of education, employment and training opportunities for all young people.

Leeds has successfully integrated local authority, health and third sector services which have evolved into a new early help service, underpinned by the ‘Best Start’ strategy. Social workers, teachers, police, health workers and staff in children’s centres now work together in groups across the city called ‘Clusters’, meaning that families get help very quickly and that small problems can usually be sorted out before they become big problems, the Ofsted report highlighted.

Each district also has a Family Intervention Service providing intensive, time - limited support for families with a number of additional needs such as where there is violence in the family, parental mental health issues, parental substance misuse, and/or children’s poor school attendance. Practitioners are offering a range of practical support to parents and families, including access to parenting classes, individual work to address specific needs and vulnerabilities and help with establishing effective routines in the home. Parents who spoke to inspectors feel that this help is effective and has made a difference to their lives.

Children and families are supported well

North Yorkshire Council, also rated good by Ofsted in its latest inspection has also reduced numbers of children in care from 489 in March 2013 to 465 in March 2014. Young people on a child protection plan decreased from 427 in 2013 to 377 in 2014.

Inspectors praised early help services at the council and said children who are the subject of concern about their welfare or who are at risk of harm are identified, supported and protected well. The Signs Of Safety (SOS) methodology is used across the county effectively to assess and manage risk. Children only become looked after if they need to be and families receive good support to address the issues which may put children at risk of becoming looked after.

“Children of all ages and families are supported well by a wide range of early help services. These are effectively coordinated through multi-agency screening service meetings chaired by Early Intervention Managers. Multi-agency support using the common assessment and team around the child activity is effective and as a result the number of these family based meetings has increased to over 1,400 meetings undertaken during 2013. This is providing good quality assistance to those needing additional help,” said the report.

Activities based in schools and children’s centres and targeted youth work are highly effective for children of all ages. The widespread use of the ‘Vulnerability Check List’ means all agencies have a thorough understanding of thresholds when accessing early help or more specialist services. Social workers make good use of the range of preventive and supportive services and programmes, such as Making Safe and Project 6, which assist families affected by substance misuse, domestic violence and poor mental health. Inspectors praised edge of care services as being extensive and of high quality, for instance, the Family Intervention Service (FIT) provides excellent support to families by applying a holistic Think Family approach, utilising evidence-based models.

Essex Council, also rated as good by Ofsted, has made strides in reducing children in care from 1,260 in March 2013 to 1,139 in January 2014. Children on a child protection plan fell from 547 to 438 in the same time frame.

The Ofsted report of Essex Council highlights that as part of ‘Effective Support for Children and Families in Essex’ the Early Help Hub provides enhanced signposting to early help services. This is helping professionals to identify the right mix of community-based support to children and families. Trained advisors use a comprehensive directory of local services to provide good quality information, advice and guidance to professionals which ensures that children, young people and families get the right level of help and support in a timely way.

Inspectors found good quality and effective services to children and young people on the edge of care are offered by time-limited, solution-focused intervention and multi–systemic therapy teams. Parents and young people spoken to value these services and the resulting improvements in their lives.

School nurses are undertaking child protection work

Trowler told the APPG the examples indicate “that there are some effective things that are taking place in the system”. Where early help is working well, multi-agency working and strong links between social workers and teaching and health professionals is key. To this end, the government has also mooted the idea of supporting early intervention mental health services for children and young people in schools in mental health hubs.

The system has long been in existence in America where school social workers provide counselling services to children and adolescents in schools. School social workers address student community issues by working with parents and the community, crisis intervention, group treatment, child neglect and abuse identification and reporting. Access to support in schools in the UK is crucial given that three children in every classroom have a diagnosable mental health problem.

Yet services are not as well established in the UK and while teachers increasingly find themselves taking on a child protection role alongside classroom teaching, a report from the children’s commissioner found that school nurses are having to undertake child protection work. Again, local authority thresholds are so high that school nurses cannot refer on to children’s services. School nurses are picking up early child protection work and developing support activities for rejected cases – work previously done by social workers.

A fifth of school nurses felt that their child protection caseload was limiting their capacity to perform other activities. On average, school nurses attended one case conference a week, which including travel and paperwork took up around 4.5 hours of their time. However, 8% were attending four or more case conferences, indicating they were spending at least half their working week attending these meetings and completing tasks associated with them. As a result, this means that school nurses have less time for the preventive work to spot the signs of abuse and help prevent problems developing.

Involving social workers doesn’t make it statutory

The DfE said: “The Government is committed to improving children and young people’s mental health and wellbeing. While mental health issues are relatively common, with around 10% of 5 to 16 year old pupils experiencing them1, children and young people do not always get the help that they need as quickly as they should. Issues such as anxiety, low mood, depression, conduct and eating disorders can impact significantly on their happiness and future life chances.

“One of the benefits of school based counselling is that children and young people do not need a clinical diagnosis to access it. Presenting emotional or behavioural concerns, identified at an early stage, can be reasons to access counselling. This prevents problems escalating over time.

“Our strong expectation is that, over time, all schools should make counselling services available to their pupils,” the DfE added.

In conclusion to the APPG, Trowler said: “I'd like to see more social workers in early help settings,” she said.

“Just because there are social workers around doesn't mean that it suddenly becomes statutory activity, it just means we have people who are confident in undertaking assessment and helping think through what should happen with families.

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