Summary of the impact

Improving outcomes for children, young people and families focuses on supporting the development of health and social care initiatives to promote social inclusion and improve quality of life, family cohesion, and health outcomes for `troubled', at risk, and disadvantaged families, demonstrating the following impact:

• Guiding practice, strategic decision-making and organisational change in partnership with local authorities and voluntary sector organisations, resulting in positive outcomes for children and families;
• Influencing national policy development in relation to improvements in health and social care services, resulting in reduced dependence on services.

Underpinning research

The key researchers and positions they held at the institution at the time of the research are as follows: Tony Long, Professor of Child & Family Health (from 2002, Professor from 2006), Dr Joan Livesley, Senior Lecturer in Child Health (from 1986), Michael Murphy, Senior Lecturer in Social Work (from 2003), Michael Ravey, Senior Lecturer in Learning Disabilities (from 2007), Dr Debbie Fallon, Senior Lecturer in Child Health (to 2012) School of Nursing, Midwifery and Social Work.
Context: `Troubled families' are those with problems which lead to their disadvantage and negatively affect the communities around them, at high cost to the public sector. Government data collected in October and November 2011 estimated that £9 billion is spent annually on troubled families — an average of £75,000 per family each year. Of this, an estimated £8 billion is spent reacting to the problems these families have and cause, with just £1 billion being spent on helping families to solve and prevent problems in the longer term; Communities and Local Government. Long et al undertook a programme of research with local authorities and voluntary sector organisations across the UK to assess the effectiveness of joint health and social care services, working with practitioners across different agencies to improve organisational culture and joint-working practices, as well as learn wider lessons for policy in support of improving outcomes for children, young people and families. The impact of this case study is underpinned by the following research:

• 2006-2012: A series of impact evaluations established the elements of health and social care interventions and associated factors that promote social inclusion, quality of life, family cohesion, and health outcomes for troubled, at risk, and disadvantaged families in single boroughs; on the footprint of NHS primary care services; or across the UK, with a range of local authorities, PCTs and national children's charities.
• The research team's expertise culminated in a UK-wide, 4-year longitudinal research project with Action for Children to establish the factors making interventions for neglected children more successful. The groups studied included chaotic families; teenagers (in relation to pregnancy, young parents, access to health services); black boys and young men; multi-ethnic communities; and children at risk of harm. Ineffective practice was identified and essential practitioner behaviours were clarified. More effective means to engage young people, service-resistant families, and neglectful parents were developed.
• The research also included reviewing the corresponding workforce and deriving new structures and processes to provide better support for the groups that were of concern. An integral part of the project was to work with Action for Children to enhance the quality of data through the introduction of a new assessment tool and development of additional elements of the standing in-house electronic database; and to improve practice and outcomes through shared learning.
• Key findings of the research include:
• Managing neglect is complex. The chronic and multi-faceted nature of the problem needs a joined-up approach with a blend of services tailored to individual needs over a long period of time.
• A multi-agency approach is vital; local area organisers need to focus on ensuring services and professional staff are coordinated effectively, including potentially, pooling budgets;
• Short-term intervention is not cost-effective for families with multiple problems. Lasting results require intensive interventions from multiple services over an extended period of time;
• Professionals should ensure parents feel valued and respected during assessments and interventions. Service providers need to be more aware of effective `customer relations' to build trust and engagement;
• Immediacy of response is crucial. Delays caused by bureaucracy disengage parents. Service providers need to honour promises promptly.
• The research is ground-breaking owing to its approach in developing a research programme combining health and social care professionals to address the complex problems faced by vulnerable children, at-risk teenagers, and chaotic families in an integrated manner, making recommendations about the application of its findings in partnership with a range of health and social care providers.

References to the research

Key evaluation reports

9. Four year longitudinal evaluation of the Action for Children UK Neglect Project (PDF)

10. The RNCM Medical Notes project at the Royal Manchester Children's Hospital: outcomes for children, families, musicians and hospital staff (PDF)

11. Evaluation of the RU Different? social norms programme: Salford Authority, Year 9, summer 2012

12. Evaluation of Blackpool Springboard project (PDF)

13. Understanding the children's social care workforce (PDF)

14. Evaluation of teenage pregnancy intervention strategies in Wigan

15. Exploring the impact and effectiveness of the Wirral Health Services in Schools (HSIS) Programme

16. Evaluation of the Lancashire Holding Families project (Early Break)

17. Evaluation of the Action for Children Supported Housing, Supported Tenancy and Teenage Pregnancy Floating Support Services.

Details of the impact

Guiding practice, strategic decision-making and organisational change in partnership with local authorities and voluntary sector organisations, resulting in positive outcomes for children and families:

• The 4-year longitudinal evaluation of the effectiveness of interventions for neglected children commissioned by Action for Children has supported the development of effective measurement tools to guide assessment and review, and also established links between presenting circumstances, interventions and outcomes for children. Clear explanation of the factors resulting in reduction of risk to the level of universal services has proved valuable to the national charity and to other organisations across the UK. Long et al's research established that for some children, referred too late for effective early intervention, proceeding into care could be accelerated as a result of the rigour of the assessment process which was found convincing in court.
• The Evaluation of the Springboard Project in Blackpool developed a range of findings, applicable in a range of settings to the extent that they influenced the development of similar projects in local authorities in the UK, based on the compelling conclusions of the Evaluation that; "the sum of this sustained partnership effort had left Blackpool, as an local strategic partnership, with a far stronger collaborative agenda in commissioning, organisational development and practice than it enjoyed before the Springboard process began."
• For example, Three Rivers District Council used the Evaluation to structure its `Think Family' Project: "The Springboard project in Blackpool is one of the most advanced Think Family projects in the country and the University of Salford's published research into Springboard states the many benefits that the `Think Family' approach can bring across a wide range of performance indicators from smoking cessation through to the reduction in repeat incidents of domestic violence."
• The Evaluation of the Springboard Project has been shown the approaches taken in the Project to be effectively applicable internationally: An exploration of the effective use of intensive family support services to address child abuse and neglect:"The success of the project to date has been captured by the external evaluation undertaken by Salford University over two years. It identified the huge culture change that had taken place across services; "...A mindset has been established of sharing information and problems, then sharing solutions." It is evident from the evaluation that this initiative has had a significant impact on the quality of the lives of families and a systemic change in the way services are delivered.....The Springboard model of family preservation should be trialled across Queensland with a full commitment across government to promote its success" (Boyle 2012).

Influencing national policy development in relation to improvements in health and social care services resulting in reduced dependence on services:

• The Northern Ireland Assembly has noted the impact of the 4-year longitudinal evaluation of the effectiveness of interventions for neglected children study: "It is rewarding to see the positive impact that the Clooney Family Centre is having on the lives of the families it engages with and I commend the work carried out by Action for Children through its many life-changing projects which span all areas of Northern Ireland," said Junior Minister Bell after a visit of Northern Ireland Executive Ministers to a family centre in Derry/Londonderry: "The Ministers were there to see, first-hand, the centre's involvement in the UK wide Child Neglect Intervention Pilot. Action for Children has developed the UK neglect intervention project to identify effective and timely interventions with children and families. This project is the subject of a longitudinal evaluation by the University of Salford."
• Long et al worked in close partnership with health and social care professionals to evaluate, learn from and make recommendations for improved approaches to lead to improved outcomes. Models resulting from Long et al's research have informed central government policy and strategy for interagency working:
• The innovative research approach led to the development of new ways of working and cultural change in workforce attitude often referred to as the "no wrong door" approach. Professional and support workers have come to recognise the needs of whole families and to work across traditional professional boundaries to the benefit of children and families, evidenced in the All Party Parliamentary Local Government Group report "Primary Justice".
• The research contributed to the development of the UK government's Troubled Families Programme, which has turned around the lives of 14,000 of England's toughest to tackle households in 15 months, with 50,000 families being worked with by mid-2013. Working with Troubled Families: A guide to the evidence and good practice DCLG 2012 identified the importance the skills of individual workers, in family intervention work both in building an honest and productive relationship with a family and influencing the actions of other agencies around that family identified in Long et al's research: "Family intervention workers are dedicated to the families and provide an antidote to the fragmented activity from many different agencies that usually surrounds a troubled family. They `grip' the family, their problems and the surrounding agencies and are seen to be standing alongside the families, their difficulties and the process being put in place, which can lead to new approaches to dealing with long standing problems."

Developing the workforce and guiding training:

• "This approach will have a major influence on how we progress the social care professional framework and moves the emphasis away from a large number of individual learning routes to a more simplified model. The framework should empower employers and learners to make informed decisions about the most appropriate training that best suits their needs by providing relevant and timely information." Ann Harrison, National Manager for Social Care former Children's Workforce Development Council

Sources to corroborate the impact

a) Working with Troubled Families: A guide to the evidence and good practice DCLG 2012 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/66113/121214_Working_with_troubled_families_FINAL_v2.pdf

b) Northern Ireland Assembly http://www.northernireland.gov.uk/index/media-centre/news-departments/news-ofmdfm/news-ofmdfm-march-2012/news-ofmdfm-220312-junior-ministers-visit-clooney-family-centre.htm

c) All Party Parliamentary Local Government Group (2009) Primary Justice: an inquiry into justice in communities. http://pressitt.com/public/files/2009/07/19/205/LGiU-Primary-Justice.pdf

d) Hertfordshire County Council (2009) Investment of countywide performance reward grant `Think Family'.
http://www.threerivers.gov.uk/GetResource.aspx?file=09%2011%2011%20LSP%20i%20-%20(8a)%20Think%20family.pdf

e) Boyle C (2012) An exploration of the effective use of intensive family support services to address child abuse and neglect. Queensland: The Winston Churchill Memorial Trust of Australia.
http://www.childprotectioninquiry.qld.gov.au/__data/assets/pdf_file/0004/175999/Boyle_Chris.pdf

f) Children's Workforce Development Council
http://webarchive.nationalarchives.gov.uk/20120119192332/http://cwdcouncil.org.uk/sociaI-care/research-events

g) David Derbyshire, Director of Practice Improvement, Action for Children, Letter attached.