Michele Farmer - Service Director, Early Help and Intervention Children and Young People’s Network Meeting - 3rd December 2015

Early Help and Intervention: The Bristol Children and Families Partnership

What do we mean by Early Intervention?

Overview

What do we know about the needs of families in Bristol?

How are we meeting the needs of families in Bristol? What is the evidence of Impact?

How can we work together to improve outcomes?

• Dom Wood, CEO, 16-25 Independent People has worked in various roles in the VCS in Bristol since 1990 and led both Priority Youth Housing and Independent People over the last 7 years and has fulfilled many representative roles for the VCS and for Housing Providers

• Fiona Castle, Programme Manager - Imayla CIC has worked for over 20 years as a social work practitioner and manager in social care, community and regeneration programmes for children, young people and their families across the statutory, voluntary and community sectors

• Toria Moore, Project Manager - Easton Families Project is an Early Years teacher and Incredible Years parenting leader and has knowledge and experience of delivering an early years and family support service to children and families experiencing multiple deprivations in Easton for the past 7 years

VCS Advocates

• The Advocate role is part of the 'Voice and Influence' element of Voscur's support to the sector

• VCS Advocates are chosen by VCS organisations in Bristol and, supported by Voscur provide a voice for the sector and influence and inform relevant decision making partnerships and processes across Bristol

VCS Advocates

• The Best Start in Life

• Strategic groups:• Early Years strategic

partnership• Family Nurse Partnership• Families of offenders

The Best Start in Life

Strategic groups:

-Early Years strategic partnership-Family Nurse Partnership-Families of offenders

Example Indicators:-Attendance at children’s centres-Numbers of young parents

Children in Care and leaving care

Strategic groups:-Corporate parenting panel-Children in Care Health Wellbeing Strategic delivery group-Care Leavers?

Indicators:-Numbers of children in care-Outcomes for care leavers

Child and Family Health and Wellbeing

Strategic groups:-0-25 SEN and Disabled children--Complex Needs Stakeholder Group -Transition Forum- Joint Agency Panel / One Service One Process -Short breaks Group- Emotional H+ W Commissioners Group -CarersIndicators:-Child health eg obesity-Numbers of EHCPs

Youth and Play

Strategic groups:-Child Friendly City-Youth Council-BYL Partnership-Section 136 support for vulnerable young people

Indicators:-NEETS-Young people engaged in democracy

Think Family and Early Help

Strategic Groups:-Think Family Steering group-Early Help/area partnerships-Child Poverty? -Better Care?-Resilience groups?

Indicators:-Early Help assessments completed-Troubled Families outcomes

Task and Finish

Time limited pieces of work where we need to focus our attention in the short term:

-Assessment, pathways and information sharing-Information Advice and Guidance-Strengthening our evidence-Developing a skilled and integrated workforce-EI Vision and Innovation group?

Early Intervention Foundation Research in Bristol

• Help to think through what EI means and get a consistent definition

• Get stakeholders on board, and develop a draft charter• Develop strategic thinking about a Bristol approach to

EI -• understanding 'as is'• identifying areas for change and improvement

• Assist with developing an outline business case

Key messages• So much going on• Will, dedication, energy - and resource• Lack of clarity and coherence – need

for strategic direction• Lack of robust evidence on what’s

effective or value for money• Innovations and opportunities

• In particular: Troubled Families and Early Help, Bristol Ageing Better, Healthy Home Zones, advice services, Asset-Based Community Development, re-commissioning, Resilience, Cities of Service, first contact training and development, predictive analytics

“Early Intervention in Bristol means acting to build resilience, prevent and tackle issues that may arise for children, adults, families, and communities, before these issues require acute services and lead to negative outcomes.

It includes primary, secondary, and tertiary prevention – that is, universal action to prevent issues arising; targeted action to address the risk of problems for groups at risk, and early action to address problems that have already arisen,”

“Delivering EI involves working together across agencies and with communities in Bristol to provide the right support at the right time, creating the conditions for strong social capital, reduced inequality, and an environment in which families and individuals can reach their potential and live happy, safe, and healthy lives, whatever their level of need.”

Definition

Note - Is

there a case

for an

alternative

name to ‘early

intervention’?

Vision and ultimate outcomes

Why Early Intervention matters: Strategic Business Case• Inequalities and negative outcomes exist which are not being solved by

existing interventions and approaches• Significant spend on ‘failure demand’ and acute services (£124m just on ‘late’

interventions for children and young people)• Ongoing budget reductions and savings needed• Evidence that there are earlier interventions and systems reforms that can

reduce this, for CYP, adults, and communities, e.g.• Greater Manchester reform of Early Years system Benefit-Cost ratio 4:1• £3.1m investment in intervention to prevent Looked After Children in Essex predicted to

save £17m+• Worcestershire SIB on social isolation predicted to save £3.1m from £2m investment• Newcastle social prescribing SIB aiming at £8.7m healthcare savings for £1.65m investment• Community development SROI suggests direct social & economic return of 2x what invested

• Need to better show aims, costs and benefits of Bristol approaches to demonstrate potential – and calculate real impact

Recommendations• The ‘Charter’ and Theory of Change

• agreed definitions, goals, and ways of working• agreed ways to get to those goals• clarity about contribution from different projects/teams/agencies• ownership of these through H & W Board, Safer Bristol Partnership, Children & Families

Partnership, annual review

• EI as a core theme of Resilience programme• Community development capacity• Advice and guidance

• Predictive analytics, improved JSNA, coherent IT systems• Targeting outreach work, HHZ activity, social isolation

• Joint commissioning and re-commissioning• More detailed understanding of services, projects and their impact – what resource is going

where• Children’s PH services, VCS prospectus, PCC commissioning – EI as a consistent theme• Joint/pooled funding opportunities• A single ‘pathway’ to understand and promote – staff, service users and communities

Recommendations• Joint training – Making Every Contact Count / First Contact Checklist

• Involve wider partners• Promote ‘pathway’ of EI through life

• Troubled Families• Better joint work with housing• Advice and guidance• Other services benefit from outcomes monitoring approach

• Cities of Service, Asset Based Community Development, neighbourhood management• Clarity about what’s happening where and how supports EI – measure success

• Opportunities to evaluate HHZ, social prescribing, and expand• Join up with predictive analytics, training• Social investment opportunities

• Mayor’s Allocation

• Measuring success and using evidence• Consistency, quality and understanding• Full costed business case – will require focus and specificity of outcomes

Resilience programme

Strategic Housing

Partnership

Troubled Families Outcomes Plan

Strong and connected communities,

Happy and fulfilled lives.

Seen through Improvement in outcomes on:

Healthy pregnancy (eg. Smoking)

Good parental MHBirthweight

BreastfeedingImmunisation

EYFS scoreAccidentsBullying

Child povertyKS2,3

AttendanceTeenage pregnancy

CIN / CPP / LACDV&A

YO/ASBNEETCSE

EmploymentHealth

Mental HealthSubstance misuse

HomelessnessCrime/ASB

Poverty/financial securityAccidents

Social isolationLife expectancy

Community cohesionParticipation, volunteering,

activity

Cities of Service – impact volunteering

Troubled Families Programme

Early Help services, First Response, Single Assessment

Early years services – midwifery, health visiting, children’s centres

Assessments completed, actioned, high quality

Workforce dvpt, e.g. Making Every Contact Count

Neighbourhood management and asset-based community development

Core Cities

Evidence that services work together to plan and deliver

Learning City, skills for employment

Schools-based support, e.g. counselling, Bristol Ideal, healthy Schools

Public health Outcomes Framework

What else currently measures immediate or

short-term impact? What frameworks and

tools are there for monitoring?

e.g. Other measures might be: Reductions in

re-referral rates to services,

communities/individuals report improved QoL or

wellbeing

Change programme

Applied Programme - demand mgmt. & EI

Predictive analysis

Needs assessments, JSNA

Improved ability to predict & target need on the ground

Better forecasting informs strategic planning

Extra care housing

Risk based tenancy management

PH – e.g. Health checks, workplace wellbeing, exercise referrals

Learning City partnership

Safer Bristol partnership

Health and Wellbeing Board

Bristol Safeguarding

Children’s Board

Neighbourhood Policing, PCSOs

HITs

SPHERE – falls monitoring

Telehealth

Neighbourhood Partnerships,

Neighbourhood planning forums

Supporting partnerships,

e.g. Older People’s,

Homelessness prevention, Better Care

Boards

Golden Key (MH)

Corporate Plan

Other supporting strategies, e.g.

Violence & Abuse, Dementia,

Prevention+Self-care

Supporting strategies, e.g.

Parenting

City Council performance indicators

Children’s Public Health Services

What else sets direction for EI?

Others? Who owns EI?

Her

e it

will

be

wor

th c

onsid

erin

g –

who

put

s res

ourc

es in

to d

iffer

ent a

spec

ts?

e.g.

Cou

ncil,

PCC

, CCG

…

Increased staff awareness and knowledge about EI

More robust measurement of success

Ultimate impact

What about longer term outcomes?

How is short term success measured?

Target population

What activities and projects are contributing?What strategy/plan sets

the direction??

What Board leads?

Children, young people, and

families in need of extra help

Adults in need of extra help

Communities and

neighbourhoods

Local agencies – internal system

change and development

Reduced demand on statutory services

Opportunity to shift

investment

Reduced disadvantage

and inequality

Local economic

growth

Health and Wellbeing strategy

Child Poverty strategy

BSCB Priorities and business plan

Police and Crime Plan

Children and Families Board

BLF partnership arrangements

Preventing Homelessness

Strategy

Bristol Ageing Better, including social prescribing and reducing social isolation; LinkAge

Better Care Bristol

Theory of Change for EIHow do activities in Bristol provide early intervention and prevention to improve outcomes for people in the City?

CHILD FRIENDLY CITY

Michele Farmer

Discussion

• Do you agree with the definition?

CHILD FRIENDLY CITY

Michele Farmer

What do we know about the needs of families in Bristol?

• Joint Strategic Needs Assessment• Additional datasets from Bristol City Council• Early Help Stock take findings• Your experience and expertise

JSNA

Nick Smith; BCC Consultation & Strategic Intelligence Coordinator

Health and Social Care Needs of Children & Young People

JSNA 2015 update (Nov 2015)

JSNA

JSNA children’s update 2015 1) Informing strategic direction for improving health and wellbeing for children and YP •JSNA update - to inform the Health and Wellbeing Strategy (via Health and Wellbeing Board in 2015) •Children and Families Partnership Board plans and vision for Early Intervention 2) Focus on current priorities: •Shaping strategic direction for specific issues, e.g. maternity strategy; oral health strategy, child obesity strategy •Current re-commissioning programmes, e.g. Children’s Community Health Services; sexual health services

JSNA

Child Population changes• Rising Child Population

82,800 children under 16 (18.7%) 68,400 young people 16-24 (15.4%)

• Highest since ‘80’s, esp under 5’s but now 5-9s rising fastest

• Rise has been focussed in Inner City & East (esp Young People), but younger ages rose in all areas

• Births dropping off – pressures remaining in South Bristol

• Increasingly diverse - children 28% BME and 50% in Inner City & East

• 19% children have English as Additional Language (2015)

JSNA

Child Poverty• Almost 1 in 4 (22.6% or 18,200 children

under 16) in low income families (above national 18.6%, 2013)

• Falling (from 27.1% in 2009) and now 2nd lowest % of English Core Cities

• Inequalities: 2% Henleaze to 45% Lawrence Hill. Issue in South Bristol.

Free school meals as local proxy• 2015: 22.2% of Bristol school children

entitled to FSM

JSNA

Other wider determinantsYouth Offending •First time entrants to criminal justice system – above national & rising in 2014

Domestic Violence•Being exposed to domestic and sexual violence and abuse as a child or young person can be extremely detrimental

•NSPCC Study: 23.7% of 18–24s had been exposed to domestic violence

NEETs•6.3% of 16-18 year olds are not in education, employment or training (2014).•NEET rate is falling year-on-year and similar to Core Cities, but above national average •Range <2% to 13.5% in Filwood

JSNA

Maternal & baby health• % women smoking in

pregnancy (11.1%, 2014/15) had risen but now falling in line with the England average

• Inequalities: ward 1% to 28% (2008-2012)

• Breastfeeding – rates significantly higher (82%) than national (74%) for initiation

• Inequalities - low in South Bristol; very high in Inner City & inner North & West

JSNA

Oral Health • 15.3% of 3 year olds with

decay, higher than England average (11.7%), 2013-14

• Rate of fillings (under 5’s, per 1000 children, 2011) ranges from 9 to 128 fillings per ward. Link to areas of deprivation

• More 0-17s yr olds in Bristol (33.4%) have not attended a dentist in past 2 years than nationally (32.5%).

JSNA

Children % overweight or obese• Reception (4/5yrs): 23% (2013/14) • Year 6 (10/11yrs): 34.8% (2013/14)

• Both similar to national • Consistent Inequalities across Bristol linked to deprivation

JSNA

Sexual HealthSexual health Needs Assessment •Young people are at increased risk of poor sexual health•Looked After Children, Care leavers and youth offenders are esp vulnerable to poor sexual health •Experiences of sexual harassment, sexual bullying and sexism have been found to be normalised amongst this generation.

Teenage pregnancy rates- falling and now similar to national average (2013: 25.7 per 1,000 in Bristol; England 24.3)

JSNA

Emotional and Mental Health• More than “mental health” - impact of poor emotional health & wellbeing on

physical health, behaviour and academic performance. • 10% of children & young people affected by poor emotional health• Locally, 2014 estimate is 5,400 of 5-16 year olds have emotional ill health likely to

require support (3300 boys & 2100 girls)

• Deliberate Self-Harm (DSH) is of increasing concern - 500 young people admitted to hospital for self-harm - rate significantly above national and no sign of reducing (below), but may be due to adhering to NICE guidelines around admissions:

JSNA

Social Care• “Children in need” (allocated to Social worker) differs by ward:

under 10 in some wards to over 200• Child Protection Plans - gradual rise in rate of CPP since 2013• Looked after children – total is stable around 700 (at any given

time)

Health assessment figures for Bristol children in long term care are improving:• 91% have completed Health Assessments (2014); compared to national

87%• 92% have completed Dental Checks (2014); compared to national rates of

82% • 78.9% have all immunisations recorded as up-to-date (2014), which is an

improvement locally but remains lower than the national rate of 83% in 2013.

JSNA

What more do we need to know?More data access – inc ward level data

JSNA reports / webpage: www.bristol.gov.uk/jsna

Data site: http://profiles.bristol.gov.uk

More interpretation

So what do we need to do about it?

How can we prevent these things?

What are the inequalities?

How can we work more effectively together?

Recommendations for Service change - What is the evidence?

JSNA

Enhanced Bristol JSNA plans• Develop JSNA ‘Chapters’ for more in-depth intelligence (from 2016): Quantitative and qualitative data Evidence, user views and current services/assets Led by Public Health with BCC/CCG commissioners Determine gaps & recommendations for action

• Better access to information to improve usability & transparency and drive commissioning process

Add links to wider range of information ‘products’

• Better integration of intelligence functions between council, NHS and other partners

JSNA

FURTHER QUESTIONS?

CHILD FRIENDLY CITY

Michele Farmer

Deprivation in Bristol 2015This report presents the findings of the newly published English Indices of Deprivation 2015 It provides a set of relative measures of deprivation across England, based on seven different domains of deprivation: Income DeprivationEmployment DeprivationEducation, Skills and Training DeprivationHealth Deprivation and DisabilityCrimeBarriers to Housing and ServicesLiving Environment Deprivation

It is available to download from www.bristol.gov.uk/deprivationIncluded in the report is a one page summary of the key findings.

CHILD FRIENDLY CITY

Michele Farmer

Early Help Stock Take1 Assessment of current provision of Early Help (EH) services for families

to see whether support is available for the families that need it, at the right time, in the right way

2 Investigate the views and experiences of Professionals across sectors on the current EH service offer in terms of strengths, gaps and challenges, in order to identify ways to improve

3 Development of case studies where a child or young person has entered Care since 2010; identifying the services involved in their journey, reviewing strengths and challenges in delivery of support and seeking to understand whether entering care could have been prevented

Presenting issues upon becoming LAC

Parental issues for cohort families

CHILD FRIENDLY CITY

Michele Farmer

Populations known to the Council

Early Help Data

CHILD FRIENDLY CITY

Michele Farmer

Discussion

1. Does this reflect your experience?2. Where should we focus our efforts to improve outcomes? Which

geographic areas, population groups?3. Do we know what works? 4. What can we do together?

CHILD FRIENDLY CITY

Michele Farmer

Next Steps