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Looking for Learning HSCWRU Presentation March 26 th 2019

Looking for Learning HSCWRU Presentation March 26 th 2019. By Stephanie Cash ( luton Council) & ruth gardner (independent evaluator) An independent Evaluation of Luton’s implementation of Graded care profile 2 assessments (Bunn and gardner 2018). This Presentation is about.

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Looking for Learning HSCWRU Presentation March 26 th 2019

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  1. Looking for LearningHSCWRU Presentation March 26th 2019 By Stephanie Cash (luton Council) & ruthgardner (independent evaluator) An independent Evaluation of Luton’s implementation of Graded care profile 2 assessments (Bunn and gardner 2018)

  2. This Presentation is about • Luton - why implement GCP2 and why evaluate this? • Neglect and best Practice- what do we know? • How did we evaluate? Process, methods & challenges • what were the key findings? • What has happened since the evaluation? • True for you? - reflections And Discussion RG AB SC 2019 NOT FOR MODIFICATION

  3. The evaluation was assisted by • Vijay Patel (Strategic Business Manager for the LSCB & LSAB Luton Borough Council) and Stephanie Cash (Flying Start and Healthy Child PrograMME Service manager); • Lucia May (LSCB Administrator) and MossumMaKhatun (LSCB Apprentice); • GCP2 trainers, facilitators and champions including Salma Fazil, Debbie Brown and Alison Braniff; • Sarah Goldsmith (Flying Start and Children’s Centres: Senior Performance Analyst, Luton Borough Council) and Jessica Wilson (Flying Start Parenting and Workforce Training Support Officer in Luton) ; • Robyn Johnson (Senior Evaluation Officer NSPCC); Dez holmes(director) and susannah bowyer (asst director) research in Practice; who read and commented on the draft report. • The authors are Responsible for the final report RG AB SC 2019 NOT FOR MODIFICATION

  4. The Aims of the Study Evaluation questions 1) How far have the aims of introducing GCP2 in Luton been met? “TO IDENTIFY NEGLECT EARLIER AND MORE ACCURATELY, IN ORDER TO ADDRESS AND PREVENT IT” 2) What remains to be done ? Other questions Is there evidence of GCP2 impacting on practice? Or/and on families? What has assisted or been a barrier? Are there local strengths or challenges that could affect the sustainability of GCP 2 in Luton? RG AB SC 2019 NOT FOR MODIFICATION

  5. Higher than average number of young people aged 0-18yrs 28% • (22% England) • Around a third of children live in poverty LUTON CONTEXT • ) • Low number of under 5’s free from • dental caries • 47th most deprived LA out of 152 in England (IDACI) • Estimated up to 50% of current population either not born or not living in Luton at time of 2011 census • Over 120 languages spoken in Luton Higher unemployment 6.1% compared to 4.4% nationally

  6. Neglect in Luton during 2017/2018: • 2,147 Early Help assessments undertaken, 169 related to neglect (7.9%) • 9,395 MASH contacts, of which 886 (9%) related to cases of neglect.   • New cases and referrals where neglect was a presenting factor • Child Protection - 140 children who became subject of child protection plan with an initial category of abuse: Neglect • Child in Need – 332 children with a referral reason of Neglect • Looked after children - 141 children who became looked after with category of need: Abuse or Neglect

  7. PRACTICE with neglect - OFSTED criteria Prevent and reduce neglect at an early stage, working closely with families and colleagues; Use of evidence-based approaches, tools and services; A child-centred approach from all professionals so that children living with neglect receive the right help and protection at the right time; Agencies work together to identify and address neglect with a sufficient range of local services; Staff are well trained, confident and knowledgeable in engaging and challenging families; Assessments consider family history and the cumulative impact of neglect if unchecked; Professionals understand how the behaviour of parents/carers affects children; Community based services ( EG schools , GPs) have effective systems to identify and refer children at risk or subject to neglect; and Police work in partnership with other agencies to identify and address the needs of children who are neglected. RG AB SC 2019 NOT FOR MODIFICATION

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  9. the challenge of assessing child neglect Ofsted ( 2014) In the child’s time: professional responses to neglect ‘the quality of assessments was too variable’; neglect can present a confusing picture of parental difficulties and inconsistent care; ‘some assessments focused almost exclusively on the parent’s issues rather than on the impact of neglect’; practitioners can find it difficult to know whether the child’s needs are being met. RG AB SC 2019 NOT FOR MODIFICATION

  10. Graded Care Profile 2, 2017 GCp1 was evaluated and modified by NSPCC (2015) ; GCP2 is a Practice Tool, scaling parental care ( 1 to 5 ) in four domains 1. Physical Care; 2. Safety; 3. Emotional care 4. Developmental Care It CAN offer • a common language for discussing concerns about care with parents and professionals • a framework for making an assessment of the care of an individual child and bringing observations together ; • A way of recordingstrengths and areas for change; • A baseline measurement and measure of distance travelled over time;and potentially • aids understanding and judgement about parental care and capacity; to help identify timely support RG AB SC 2019 NOT FOR MODIFICATION

  11. The Graded CARE Profile 2 assessment tooL

  12. Cross Discipline Assessment Tool USE OF GCP 2 Section 47 USE OF GCP2 Early Help Assessment GCP ( child’s needs) Initial Assessment Enquiries(GCP – neglect) Core Assessment (GCP parenting capacity) Protection / Support Plan USE OF GCP2 GCP – monitoring tool RG AB SC 2019 NOT FOR MODIFICATION

  13. the challenge of implementation Ofsted BLOG ( 2018) “models that set clear expectations and have a consistent approach build staff confidence. They can improve the quality of assessment, intervention, and direct work with children and their families”.There is “significant variation in the quality of implementation”. Success needs not only a clear implementation strategy but a “whole system” approach that means “the model is understood and embedded across the whole local authority” and “staff are given significant support to use it from leaders at every level”. The basics of best practice also need to be in place IE a stable workforce; manageable caseloads; effective management oversight and supervision; highly visible leaders and managers; a strong culture of learning; good quality assurance, performance monitoring and performance management arrangements; and mature partnerships with other agencies. RG AB SC 2019 NOT FOR MODIFICATION

  14. WHY Implementation MATTERS • quality of implementation can have an effect on outcomes for service recipients: “effective implementation is key to better outcomes …where there was careful implementation without major problems, effect sizes were at least twice as great as where these conditions did not exist”. Wiggins et al (DfE 2012) • Implementation is not a linear process, but a circular one with stages often being revisited • Exploration and adoption - check evidence, select programme or model, set up implementation team, determine required outcomes, gain leadership support. • Installation - develop systems for practitioner selection, training and coaching, secure funding, develop support systems. • Initial implementation - initiate staff coaching and programme monitoring; make adjustments. • Full operation- evaluate for fidelity and outcomes, assess cost-benefits, consider any adaptations. • Sustainability -assess prospects for sustainability, secure long-term funding. • Scale -Up -assess prospects for scale -up, set up team etc. Fixsenet al (2005, 2009) RG AB SC 2019 NOT FOR MODIFICATION

  15. why implement GCP2 in luton? The goal of the roll- out of GCP 2 was to strengthen inter agency practice with neglect in the light of inspection and SCR findings. The tool was to be widely used “as part of the early identification of neglect and ( to) provide a robust mechanism to assess and make a judgement on the extent of neglect and the specific areas for support”. This included supporting the “development of effective plans to reduce and prevent children being neglected” ( report to LSCB and evaluation brief) . timeline for implementing GCP2:pilot stage in March 2016;initial training of staff through 2016;using the tool in 2017;evaluation 2017 /18. RG AB SC 2019 NOT FOR MODIFICATION

  16. How? The evaluation ApproachA mixed methods evaluation over 24 days between Sept 2017 and march 2018BUNN a & Gardner R ( 2018) We divided the process of ImpLEmenting GCP2 into three consecutive stages and grouped the evidence accordingly: • Preparation for implementing use of GCP2: training and awareness raising • Achieving the aims - Implementation of GCP2 influencing practice • Achieving the aims – Implementation of GCP2 influencing families RG AB SC 2019 NOT FOR MODIFICATION

  17. How? The evaluation methods Qualitative data about • Response to training and awareness raising events • Changes in practice – analysis of 43 practitioner questionnaires • Quality of assessment using gcp2 -Pan beds audit 2018 • Using gcp2 in practice – evaluators attended 2 practitioner workshops • Progress and challenges in implementation - focus group for 13 managers Quantitative data about • 343 Children assessed using GCP2 – luton’s quarterly data april 2017- April 2018 • Nspcc survey on use of gcp2 after training ( 46 respondents/346 trained ) Background data and reports – ONS, luton LSCB, Ofsted etc RG AB SC 2019 NOT FOR MODIFICATION

  18. Limitations of the evaluation • time & resource limits; a brief exercise based on early data and elective views • the majority of trainees had not answered the survey about early use of GCP2 - AREAS FOR FUTURE EVALUATION • can we obtain a broader perspective on use / non use of the tool ? • What do parents or older children think about GCP2 assessments ? • what would a Comparison with (views on) implementing other assessments of parental care tell us about the relative benefits and challenges of implementing GCp2? • What impact on children have plans arising from assessments had over 6 – 12 months ? RG AB SC 2019 NOT FOR MODIFICATION

  19. POTENTIAL For the IMPACT OF GCP2 TRAINING RG AB SC 2019 NOT FOR MODIFICATION

  20. Potential for Impact OF PRACTICE with GCP2 RG AB SC 2019 NOT FOR MODIFICATION

  21. FINDINGS: Training and early use of GCP2 2017 quantitative findings ( NSPCC survey) • Initial GCP 2 training was delivered to 300 LUTON practitioners and 46 managers in 2017 • Trainees came from a wide range of agencies – statutory , voluntary and community • Nearly 2/3 of trainees who responded ( n=46) started to use GCp2 quickly • Over 2/3 of those using gcp2 did so with most of the relevant cases they held • The majority felt they had adequate to good skills to use gcp2 • 8/10 said they would use gcp2 in the next 6 months ( from may 2017) • Reasons for non use: mainly no relevant cases; some lack of confidence or support RG AB SC 2019 NOT FOR MODIFICATION

  22. FINDINGS: Training and preparation 2017/18 Seven Multi - agency and single - agency briefings by gcp2 champions across luton • 150 + attendees from a wide variety of occupations ( police , childminders etc) • Positive feedback E.G. • I shall use this within my role in adult safeguarding; • I shall share my knowledge in a team meeting; • I have a better understanding of what the GCP2 is and how it fits. Practitioner workshops (4) delivered across luton by GCP2 trainers, to share best practice, Trouble –shoot and offer support Positive feedback: without the workshop I would have found my first assessments much harder RG AB SC 2019 NOT FOR MODIFICATION

  23. QUESTIONS FOR THE NEXT STAGEthe majority of questions come from workshops in luton RG AB SC 2019 NOT FOR MODIFICATION

  24. FINDINGS: USAGE AND REACH OF GCP2 2017/18 Use of Gcp2 -quantitative findings ( Luton quarterly data ) • 343 GCp2 assessments were undertaken: Q1 =109; Q2= 66; Q3=50; Q4=118 • GOOD RANGE OF USE: 118 ( early help); 87 ( HV); 67 (school nurses); 53 ( CSC) • wide age range of children: unborn to age 4= 142; 5 to 11 = 116; 12 to 17=65 • The range of ethnicities was broadly in line with that of the population *Numbers in ages 5-17 reduced in Q3 RISING again in Q4 *BY Q4 GCP2 was in use with previously unknown families *It would be helpful to identify contributions to gcp2 Other than the LEAD AGENCIES RG AB SC 2019 NOT FOR MODIFICATION

  25. QUESTIONS FOR THE NEXT STAGE RG AB SC 2019 NOT FOR MODIFICATION

  26. FINDINGS pan-Bedfordshire audit 2018 qualitative findings 2018 – In DEPTH AUDIT OF 8 CASES • Gcp2 appeared to assist in communication with families; measurement of baseline /progress; and action on neglect. • there was Variance within and between agencies on: sharing assessments and information ; USE OF UNTRAINED STAFF; application of thresholds; and recording - with Potential for confusion across boundaries. MORE JOINT WORK NEEDED ON • GREATER CONSISTENCY OF USE AND Data collection • ways of sustaining numbers of trained staff • THE FEASIBILITY OF UsING GCP2 retrospectively • How different assessments CAN best be combined RG AB SC 2019 NOT FOR MODIFICATION

  27. Looking for learning practice questionnaires The questions – do you think that use of GCP2 has made any difference  to the following aspects of practice? ( Y/N and if so, how) • focussing on and understanding A child’s needs ; • AND the parent’s capacity to meet those needs ; • communicating strengths and concerns clearly to family and colleagues ; • recording  evidence for  strengths and concerns clearly and drawing up an evidence based  plan of what needs to happen ; • executing  and  reviewing  the plan and acting on unresolved issues when  necessary  ( eg More Help, challenge , pursue,   escalate) • Plus Any other changes relating to work with child neglect or to other areas other comments GARDNER & BUNN 2018 RG AB SC 2019 NOT FOR MODIFICATION

  28. FINDINGS from practice questionnaires: 2018( N= 43 ; 30 practitioners and 13 managers) evidence of gcp2 enabling greater confidence in practice with neglect • Better able to understand the child’s and the parents’ needs and capacity; • Helps to explain openly what change is needed to family and colleagues; • Offers A more succinct way of creating a plan; • Could involve the family in the plan building on strengths identified jointly. *Some practitioners see family changes that they attribute to use of GCP2 use of The tool helped a parent to express their views more fully than previously, to get the right help Using gcp2 I was able to express concerns and keep OUR relationship ; this was difficult before The parent saw and made the changes as per the gcp2; and the case went from CP to CIN RG AB SC 2019 NOT FOR MODIFICATION

  29. FINDINGS from three detailed case studies 2018 Why ?: To obtain a current front line view of using gcp2 How?: a case study template was provided and 2 children’s centre and one FNP practitioner completed them What Did they say?: Joint work can save time: Working with the HV really helped, especially when it came to discussing diet and nutrition of the youngest child Joint Planning improved:All tools within the GCP2 were used and a prioritised action plan was formulated with the parents’ input to tackle the key areas They thought that using GCp2 had an observable impact: Father was aware there were many safety issues once we completed the GCP and he was happy to address them The assessment really helped the mother understand how her daughter was feeling and the impact of her home environment on her daughter’s development The initial GCP visit resulted in a lot of immediate changes to the cleanliness of the family home. RG AB SC 2019 NOT FOR MODIFICATION

  30. QUESTIONS FOR THE NEXT STAGE RG AB SC 2019 NOT FOR MODIFICATION

  31. findings from a focus group with operational managers 2018WE ALSO SHARED THE EVALUATION WITH STRATEGIC LEADERS Why? to obtain views on implementation from managers of those using it In practice How? Managers from health , social care , children’s centres and early help met with evaluators and discussed implementation and facilitators and barriers. What did they say?( n=13) • StrenGtHs : the group thought that the tool itself was sound and that training , links to neglect strategy and potential use with other developments were strengths. • over half had confidence in the progress of implementation , especially in children’s centres, health visiting and school nursing. • Concerns : technology not keeping up with implementation; implementation at higher levels of need faltering due to lack of staff capacity and continuity ; and lack or loss of senior support . • Half the managers could not answer the practice questions because they did not monitor GCP2 :- “we just tick a box if one has been done “ RG AB SC 2019 NOT FOR MODIFICATION

  32. Looking for Learning: Summary of KEY FINDINGS • the majority of interviewees and survey respondents were positive about the GCp2 tool, the training and the implementation. • Active Follow up after 3 and 6 months might pick up more of those who are struggling to use the tool . Response rates need to be better to achieve learning . • Some Groups of practitioners are using the tool REGULARLY AND systematically • Some practitioners think it is making a difference to children and families concerns re sustainability • Capacityat all levels of implementation ; staff turnover and loss of trained staff • Line Oversight of GCP2 ( consistency of) use , Data accuracy and data accessibility • CONINUING Support for implementation of GCP2 at all levels RG AB SC 2019 NOT FOR MODIFICATION

  33. QUESTIONS FOR THE NEXT STAGE RG AB SC 2019 NOT FOR MODIFICATION

  34. Actions since the Implementation • Dedicated officer providing support for Implementation • More training for managers and Deputy Managers • ReFreshed Practice Guidance • Time frame for completing First Assessment • Time Frame for review • Practitioners expected to complete a GCP2 Assessment with experienced practitioner within three months of completing training to be awarded Licence • Introduced and Implementing aN online Gcp2 assessment tool for practitioner . Should assist in • tracking completion of GCP2 for All neglect case • Comparing families outcomes from point a to Point b – tracking Tool • Performance reporting. • Introducing a Screening Tool to help all workforce to be responsible for helping to identify Neglect earlier RG AB SC 2019 NOT FOR MODIFICATION

  35. THANK YOU! Stephanie Cash is Service Manager Flying Start and Healthy Families Programme, Luton Council Stephanie.cash@luton.gov.uk Ruth Gardner is an author & independent researcher (Tackling Child Neglect pub. JKP 2016) ruthgardner@talktalk.net Amanda Bunn is a researcher with over 20 years experience in academic and applied research mail@amandabunn.com RG AB SC 2019 NOT FOR MODIFICATION

  36. The Evaluation Reports BuNn A. & GARDNER R. (2018) LooKING FOR LEARNING: A SHOrt EVALUATION OF THE IMPLEMENTATION OF GRADED CARE PROFILE 2 IN LUTON. LUTON SCB • https://www.flyingstartluton.com/wp-content/uploads/2019/03/LUTON-GCP2-REPORT-JULY-2018-dec-18.pdf • https://www.flyingstartluton.com/wp-content/uploads/2019/03/LUTON-GCP2-Executive-Summary-JULY-2018.pdf RG AB SC 2019 NOT FOR MODIFICATION

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