SUPPORTING FAMILIES WITH COMPLEX NEEDS

1. SUPPORTING FAMILIES WITH COMPLEX NEEDS Presentation to the Shadow Health & Wellbeing Board by: • Paul Greenhalgh (Executive Director of Children, Families and Learning) • Paula Hassall (Payment by Results Project Manager) • Paula Doherty (FRS Manager) 9 February 2012

2. Supporting families with complex needs: presentation to Health & Wellbeing Board • Support to families with complex and multiple problems when their children are very young through Family Engagement Partnerships and Payment by Results for Children’s Centres • Support to ‘troubled families’ and families with complex problems through the multi-agency Family Resilience Service • Longer term savings strategy that these initiatives could help make in terms of reducing the take up of later interventions and acute health services

3. Vulnerable Complex Acute Number of children Cost Early Identification and Early Help Family Engagement Partnership Family Resilience Service Universal Services & early identification Social Care System

4. Early Intervention ‘Intervening early and as soon as possible to tackle problems emerging for children, young people and their families or with a population most at risk of developing programmes. Early intervention may occur at any point in a child’s life.’ (C4EO definition and research) Early in a child’s life Early in the development of a problem

5. The escalating costs of intervention Severity of assessed need Child looked after in secure accommodation – £134,000 per year placement costs Cost per child / family Child looked after in children’s home – £125,000 per year placement costs The disparity in cost between the cheaper provision and more intensive support shows how important it is that children and young people receive the right services at the right time. Cost Multi-dimensional Treatment Foster Care – £68,000 per year for total package of support Costs increase as children get older. Increasing related costs such healthcare and the criminal justice system make it clear joined up working is a core part of cost effectiveness Child looked after in foster care – £25,000 per year placement costs Family Intervention Projects – £8-20,000 per family per year Multi-Systemic Therapy – £7-10,000 per year Parenting programme (e.g. Triple P) – £900-1,000 per family Family Nurse Partnerships – £3000 per family a year Information services – Around £34 via telephone helpline Around £2 via digital services PEIP – £1,200 - 3,000 per parent Children’s Centres - around £600 per user Schools - £5,400 per pupil These figures are intended to be illustrative only. Costs have been estimated from a range of sources and will not always be directly comparable. For example, the MTFC figure includes the package of support, social workers etc. that is needed whereas the foster care figure only includes placement costs.

6. Early Intervention: Complex & Troubled Families Support at Level 1 Information, training advice and guidance to universal settings and practitioners Support at Level 2 Family Engagement Partnerships with single pathway (vulnerable <3’s) Early Intervention Consultant (health) Children’s centre family support teams (0-5) & commissioned services Support at Level 3 Family Resilience Service Health & CAHMS input assessment and key UNIVERSAL Children & Young People requiring personalised universal services LOW/VULNERABLE Children & Young People with low level additional needs requiring single agency support or an integrated response using a common assessment. COMPLEX Children, Young People & Families with high level needs. These children/young people include ‘Children in Need’ (Section 17) who require integrated, targeted support ACUTE Children, Young People & Families with complex additional needs requiring specialist/statutory integrated response; includes child protection (Section 47) and children whose needs / safety cannot be managed in the community

7. Family Engagement Partnership Model

8. Payment by Results (PbR): added value of health and children’s centres; joint outcomes between centres and healthy child programme Strategic Collaboration Board – statutory/local partners & parents PbR funds success of the Collaboration Board as measured by key indicators that best represent Croydon’s ambitions Voluntary sector centre Funding formula for each children’s centre: weighted - nos /disadvantage Small school based centre

9. Family Engagement Partnership • Single Pathway for vulnerable families (-9mths – 3 years) • Referrals from GPs, midwives, health visitors, settings, voluntary sector through Children’s Centre collaboration • Early Intervention Consultant (health) - leadership, breakdown barriers, expertise and safeguarding • FEP focus on progressive-higher risk families • Engage families, link with commissioned services • OUTCOMES: healthy child indicators – linked to the Payment by Results for children’s centres

10. Issues likely to emerge • Numbers of families to be supported • Unmet demand – 630 higher progressive risk • Sufficiency of services and support • Breaking down the barriers – integrated locality based approach – build on what works … • Realistic expectations – all start by Sept 2012 • Cost avoidance/savings … estimates/futurisation

11. Community Budgets & ‘troubled families’ • Driver: Pooled Budgets – currently pooled resources • At the cusp of the cost curve – ‘cost avoidance service’ … link to capacity to change • Key worker & high quality engagement (Dfe research) • Up to 10 hours per week; av 15months – research shows longevity has impact • Research shows health as one of intransigent factors • Target population 772 (now est 785) • Making and reinvesting savings

12. Disproportionate costs on services 46,000 families Can be as much as £250,000-330,000per family per year…… All of these families access universal services… Universal Services1 Education - £580m Child benefits - £110m GP/NHS costs - £30m £0.7bn universal spend/yr …and specialist services, (often repeatedly for many years)  Targeted Services2 Welfare benefits - £750m Mental health treatment - £20m Parenting support - £50m Drug misuse treatment - £10m £0.8bn targeted spend/yr but family breakdown and crises still leads to very poor and costly outcomes Reactive spend3 Children going into care, hoax fire calls, nuisance behaviour costs, juvenile criminality costs, truancy costs, alternative education costs, vandalism, evictions due to ASB £2.5bn reactive spend/yr NOTE: INDICATIVE COSTS ONLY - do not include costs of criminal justice services pending further analysis by MoJ.

13. Multiple funding and accountability structures make coordinating support for the families with the greatest needs very difficult DfE HO MoJ DH CLG DWP YJB Police PCT LA Housing authorities JCP Prisons VCS YOS worker CAMHS/ Mental Health Worker Young carer support worker Police officer Drug and alcohol team Housing link worker Employment Personal advisers Family support workers Parent support advisers/Schools Surestart Intensive family intervention worker/ parenting practitioner

14. Health issues: complex/troubled families

15. Structure for Family Resilience Service (FRS) Paula Doherty (consultant) FRS Manager Tracy Weight Operational Manager Darron Ward Senior FRS Support Officer Terri Dorman Operational Manager Beth Mitchell Family Therapist Pam Jeffers Family Therapist Sharon Liatbeaudide Family Therapist Bola Peters, Tricia Le Gassick, Danny Smith, Maria Auguste, Alexia Demetriou (1 vacant) Key Workers Donna Darby, Alisha Musambik, Esther Brewster, Michelle Phillips, Verna Francis and Anne Marie Marshall Key Workers James Hillam FRS Support Stephanie Standen FRS Support YOS Parenting Phil Rainsford Police Officer Clara Goodwin Housing Officer JCP DASH ASB Amaal Ally CAHMS 15 Updated Janurary 2012

16. Community Budgets: The story so far • Transformation: of interventions for Families with multiple problems and multiple disadvantage • Transactional: Working interdepartmentally and inter agency, to improve our currency and evidence shared returns on outcomes • Transition: Community Budgets and the relationship to ‘Troubled Families’

17. Troubled Families Team set up in DCLG: November 2011 with an expectation of ‘turning troubled families around’ • Government research estimates 120,000 families fitting the description ‘Troubled families’ in England ( 785 estimated in Croydon, figures based on Family and Children Service Data (2005) Child Well Being Index (2009) and the Index of Multiple Deprivation • Announcement of £448m of investment over next 3 years • Next Phase: understanding what the troubled families announcement means at a local level; mapping out who they are, where they are and how we can reach them in a more effective way – use the learning of partners from FRS to ‘turn troubled families around’

18. FRS Overview February 2012 • recruited 60 cases (2011-12), 333% increase in case-load in 2011/2012 ( 250% increase planned for 20012/2013) • FRS referrals March 2011 – to date = 87, average of 8/9 per month ( 14 declined by service, 3 declined by families, 10 closed) • Average duration of contact, 12 -14 months; average contact of 3 times per week

20. ASB Housing Referral Mum did not complete her education Child’s father has no contact Domestic Violence Homelessness Alcohol Abuse Mum has depression Mum has never worked Intergenerational worklessness History of sexual abuse Significant debts Mum has no qualifications Anti Social Behaviour Child has not been in school for several months

21. Cost • Cost of a YOI = £54,750 • Cost of Foster Care = £20,000- £40,000 • Residential Care = £ 130,000 • Child on a CP Plan = £ 40,000 • Problematic drug use = £ 50,000

23. Cost avoidance and savings: Reinvestment Strategy • develop an efficient and effective system for dealing with referrals and assessing families’ needs. • have a clear system for responding to these needs appropriately and tracking families as they progress through the FRS • have an effective means of reviewing families‟ progress, and monitoring their capacity to change • have good arrangements in place for data collection and sharing

24. 6. Next Steps • Clear metrics to monitor savings/cost avoidance of children’s centres & Family Resilience Service • Payment by Results – making sure we are ‘counting what counts’ and that we can evidence this for LA funding • ‘troubled families’ - CLG expectations – identifying and mapping out families etc • Social Impact Bonds – opportunities and risks