How We Did It: Using outcomes focused relational working to reduce demand on statutory services
Using outcomes focused relational working comes with its challenges, but it has the potential to reduce demand on statutory services and help local authorities to effectively deliver preventative interventions.
We put Suffolk County Council’s Graham Beamish and Marie Pye from Bridges Outcomes Partnerships in our ‘How We Did It’ hot seat to understand how the Stronger Families programme is working to deliver evidence-based family therapy, supporting more children to stay at home. This preventative work across Suffolk and Norfolk County Councils has saved 1000 years’ worth of care days for children and young people.
Interview highlights
On the genesis of the programme in Suffolk:
Graham: In a nutshell, the aim of the programme is to try and reduce the number of adolescents coming into care and to support reunification where that’s a possibility. If there is dysfunction happening at home perhaps around going missing, exploitation, difficulty engaging at school, when adolescents come into care, it doesn’t necessarily cure that – it can just present it in a different way. They experience difficulties achieving a sense of belonging and building that attachment with what might be a very new family in a very different circumstance. A key motivation for this project is to do the right thing for adolescents and families, which is trying to, wherever possible and safe to do so, just to keep them together.
There’s a danger that more and more of our funding is spent in a reactive way, dealing with issues, rather than being able to invest in prevention and early intervention.
The second aspect to this is the financial context, which is unavoidable. The cost of children in care, certainly in Suffolk County Council, is around half of our entire children’s services budget. It’s a huge amount of money spent on essentially reactive support. And there’s a danger that more and more of our funding is spent in a reactive way, dealing with issues, rather than being able to invest in prevention and early intervention, which we ultimately know is the right answer.
On the value of payment-by results:
Graham: The project is a very good application of a Social Outcomes Partnership, sometimes thought of as payment-by-results. There is a clearly defined cohort: adolescents at risk of coming into care. There’s a really clear target outcome: sustainably keeping them out of care. And there is a financial value that the council can recognise: the avoided cost of coming into care. Payment-by-results gives Bridges Outcomes Partnerships (BOP), the partnership co-ordinator managing the social investment, a really sharp focus as well as the therapist team – Family Psychology Mutual.
It’s such a clear target they’re aiming for and it’s a win-win type of arrangement. Some contracts can be adversarial, one party wins and the other party loses. Here it was absolutely in our interest to have children remain out of care. It’s absolutely in the interests of BOP as the counterparty to the contract to achieve that, because that’s the basis on which the payment is made.
Overall, I think it was attractive to councillors and other decision makers because it shifts the focus from activity towards outcomes. And that’s what we’re all about really.
On the partnership approach:
Marie: We work together collaboratively, but each partner brings in different ingredients. BOP provides the flexible working finance from pooled social investment and we bring in the oversight, the development, the collaboration – making sure that we’ve got this real laser focus on those outcomes. And then we have our delivery partner, Family Psychology Mutual, who have an amazing wealth of clinical expertise. There is a separation between those two things; there’s no sense of the clinical needs of the family being outweighed by the outcome. So we’re always working together, all of the parties are really focused on that common goal of supporting families to stay together and long term preventative services.
We work together collaboratively, but each partner brings in different ingredients.
On how family therapy works in practice:
Graham: Functional Family Therapy is a model that involves a team of therapists that work with the whole family. Take what we might call an index child, a particular child that we’re most worried about being on a trajectory to care. There will be a whole family intervention, in the family home with mum, dad and the different siblings there as far as is possible. It will only take place where those conditions are met which is a bit different to a lot of social work practice where a lot of work takes place individually, either with the young person individually or with the parents. This is very much about a relational practice involving the whole family together.
The therapists aren’t seen as social workers from a family point of view. Some families may have had negative experiences or be less open to engaging with social workers than they are with skilled therapists that are able to support them to draw their family back together again.
On lessons learnt and barriers faced:
Marie: At the beginning I think we were maybe a little bit naive in thinking that this could be an edge of care intervention. When we talk about edge of care, we mean a child that might be six weeks from coming into care. We found out quite quickly that the nature of the intervention that we’re trying to provide does need some residual attachment – the young person and the family can’t have reached the stage of completely giving up. Now we talk about the intervention being on a trajectory to care and our main learning is that you can’t intervene too late. If someone has got a foot in care already, it can be difficult through this intervention to wind back on that. And because it’s a talking therapy, it does need the ability of the young person and the parents or carer to be able to engage in the intervention in a reflective way, reflect on their behaviours and learn together.
On what has happened as a result of this programme:
Graham: I don’t know if you remember the old Ronseal advert, it says it does what it says on the tin, that’s the thing that always comes to my mind here. There have been over 250 completed interventions with families in Suffolk, and of those, 93% have sustainably remained out of care.
We’ve also collected feedback from the families and young people as the project has gone along and 96% of them rate the quality of the service delivery as good or excellent, 95% said that it’s helped them deal better with the behaviours and issues that have arisen in the family.
On making the case for prevention:
Graham: Our motivation was that this is very much the right thing to do for children and families, to give them every chance to stay together. The financial context is somewhat secondary, but it’s an unavoidable part of our environment. For adolescents in particular, those coming into care aged 11-14, that can be very costly for the council: a foster care placement might average £1,000 a week, a residential placement, £5,000 a week per child, and at the top end, unregistered placements where we’re unable to find any sort of market alternative. £10,000 per week per child. So cost is an important driver.
It’s the right thing to do for families and the right thing to do for council budgets.
The nature of this contract being payment-by-results has meant that it is key to sustainably keep young people out of care that; it doesn’t actually do any good necessarily to delay an adolescent coming into care for six weeks or two months, that can actually make the situation worse. The outcomes payments are structured over a couple of years, measured by those children continuing to stay out of care – the avoided cost are potentially enormous. I think it stacks up in both senses – it’s the right thing to do for families and the right thing to do for council budgets.
Photo by gilber franco on Unsplash.
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