West Midlands, NESS Workshop - Sharing Findings

Start Mainstreaming Pilots

by Geoff White, SQW

19th July 2005

NATIONAL EVALUATION OF SURE START

 

Contents

1) Mainstreaming – general2) Mainstreaming – multiple providers

a) Integrated or unified modelb) Co-ordinated modelc) Federated network model

3) Transition from pilot to mainstream change4) The role of monitoring and evaluation5) Constraints on service providers6) Overcoming the constraints7) Focus for evaluation

1) Mainstreaming - general

Service improvements targeted by the pilots Policies

Redirecting resources Reshaping services

Extending & improving access

Pilots

Clientsmainstreaming

mainstreaming

Integration, extension, infrastructure, preparation

Test-bed for more widespread change

Innovative, risky & counter-cultural

Joining up resources, cultures, practices & activities integrated coordinated networked

2) Mainstreaming – multiple providers

Mainstreaming pilots – service providers

Health EducationSocial

services

Pilots

Clientsmainstreaming

mainstreaming

Multiple service providers

Achieving steady state in the joining up of resources & activities

Target clients

Model 1: Unified, horizontal linkage, co-location and/or integration

2a) Integrated or unified model

Multiple service providers

Achieving steady state in joining up

Target clients

Model 2: Formal co-ordination – synchronised training, standardised referral & information sharing protocols -

some co-location

2b) Co-ordinated model

Multiple service providers

Achieving steady state in joining up

Model 3: Network within a coalition - federated structure – with single provider in the lead

2c) Federated-network model

Target clients

3) Transition from pilot to mainstream

Risk

Rew

ard

High

High

Low

ABI

1. Continuity funding

2. Applied in targeted way 3. Absorption of good

practice

4. Scaling up

5. Steady state mainstreaming

4) The role of monitoring & evaluation

Making an evidence-based case for change to service providers

Acknowledging the broader implications – this is not just a “project”

Considering process as well as impact outputs and outcomes

Engaging the providers and generating learning materials – a legacy

Recognising the constraints on providers and addressing them in an appropriate vocabulary

Provider capacity constraints – partnership overload Provider risk aversion – preserving scale economies Short-termism – competing pressures Incompatibility of targets/priorities – equity issues Local authority constraints – political & governance Information deficiencies – need and supply Vertical disconnection within single provider Horizontal communication failure between providers

5) Constraints on service providers – the evidence from the mainstreaming pilots

6) Overcoming the barriers – what worked

Achieving consensus on the mainstreaming aim“we aim to improve existing services not create new ones”

Adopting strategic, focused & continuous approach“establishing fit with national and local agendas and priorities”

Securing a mainstream champion with clout“getting providers to take responsibility to identify problems & solutions”

Setting up structures & processes for innovation“engaging partners & clients transparently through existing networks”

6) Overcoming the barriers (contd)

Providing resource & support to front line staff“clear definition of roles, training & operational guidance, peer support – team working – networking, systems – tools - protocols”

Making the case for change in provider ‘language’“focus on how change enables targets to be achieved more efficiently”

Learning & disseminating lessons & good practice“leave something behind – a legacy – protocols, guidance manuals”

“pro-active and evidence based promotion of mainstreaming lessons”

7) Focus for evaluation

Costs and activities, outputs and outcomes at different volumes and for different client groups

Nature and extent of achieved integration & issues of scaling up

Development of capacity – strategic partnership leadership, multi-professional & multi-agency management of delivery chain and at front-line

Reliable risk management – taking account of multiple & diverse needs, addressing weak links in & between delivery chains, harmonising & sharing of cost and other information

Outward and engaging perspective – providers, users & potential users and their communities