Changing Professional Practice and Culture to Get it right for every child

9 June 2010Aberdeen

Bill AlexanderNHS Highland & Highland Council

• Assessment determines the help that children get, without gate-keeping and referral processes.

• Responses to need are appropriate, proportionate and timely.

• Less bureaucracy.

• Strengthens the capacity of families and communities to meet the needs of children.

• Everyone working with children and young people uses a consistent and equitable approach - think whole child

• Explicit threshold for compulsory measures.

• Delivering better outcomes for children.

Core components1. Focus on improving outcomes for children and families based on a shared

understanding of well-being

2. Common approach to gaining consent and to sharing information

3. Integral role for children and families in assessment, planning and intervention

4. Co-ordinated and unified approach to identifying concerns, assessing needs, agreeing actions and outcomes, based on the Well-being Indicators

5. Streamlined planning, assessment and decision-making processes that lead to the right help at the right time

6. Consistent high standards of co-operation, joint working and communication where more than one agency needs to be involved

7. Lead Professional to co-ordinate and monitor multi-agency activity

8. Maximising the skilled workforce within universal services

9. Confident and competent workforce across all services for children, and families

10. Capacity to share demographic, assessment, and planning information through the national eCare programme

Early Years Framework:Elements of transformational change

1. A coherent approach

2. Helping children, families and communities to secure outcomes for themselves

3. Breaking cycles of poverty, inequality and poor outcomes in and through early years

4. A focus on engagement and empowerment of children, families and communities

5. Using the strength of universal services to deliver prevention and early intervention

6. Putting quality at the heart of service delivery

7. Services that meet the needs of children and families

8. Improving outcomes and children's quality of life through play

9. Simplifying and streamlining delivery

10. More effective collaborations

Early Years Framework:Elements of transformational change

1. A coherent approach

2. Helping children, families and communities to secure outcomes for themselves

3. Breaking cycles of poverty, inequality and poor outcomes in and through early years

4. A focus on engagement and empowerment of children, families and communities

5. Using the strength of universal services to deliver prevention and early intervention

6. Putting quality at the heart of service delivery

7. Services that meet the needs of children and families

8. Improving outcomes and children's quality of life through play

9. Simplifying and streamlining delivery

10. More effective collaborations

successful learners

confident individuals

responsible citizens

effective contributors

Highland’s core components

• Pathway through services

• Common language

• Engage and empower children and families

• Named person and lead professional roles

• Assessment framework, that builds from birth

• Assessment determines plan and service delivery

• Single Child’s Plan

• Fewer meetings, and single Child’s Plan meeting

• E-solutions

community

family

child

Implementing Additional Support

Universal Core Curriculum / Programme

All children offered core curriculum / programme

Needs Assessment

Universal Core Programme/ Curriculum

Additional support Multi-agency support

Child’s Plan consideredat Liaison Meeting

Level One

Level Two

Level Three

Developmental stage• Mapping of existing business processes

• Elaboration of GIRFEC principles and core components – what do they mean in practice?

• Confirmation of GIRFEC model

• New business processes established drafting of multi and single agency guidance

• Confirmation of assessment model

• Information sharing policy

• Tools developed

• Requirements for e-solutions

Implementation stage = change management

• Transformational change across children’s services

• Support from dedicated team

• Governance structures

• Change management structures

• Training programmes

• Some new posts and structures

• Practice guidance

• Business process change

• Implementation Plan

Implementation Plan

• New borns 0-5s school-age

• Roll-out from one geographical area

• New processes in each agency

• New inter-agency processes

• QA and review

• Sustaining Change

Scottish Government

Strategic Chief Officers

Strategic Management Forums

Area Service Managers

Groups

Head of Service, Project Manager

and change team

ReferenceGroups

Service Delivery

Evaluations

• Self-evaluation by Highland Council Services (rated ‘very good’ by HMIe)

• User evaluation by Highland Children’s Forum

• Edinburgh University

• Analysis of Business Processes by Edinburgh University and Scottish Government

• HMIe Child Protection Inspection – April 2010

Evaluations• Wider understanding in universal services about

concerns and needs.

• More systematic information sharing between agencies (e.g. Police to Education & Health) and within agencies (e.g. HV to School Nurse).

• Concerns being shared about more children.

• More holistic assessment of children.

• More effective early intervention by both universal and targeted services.

• Reduced bureaucracy means staff have more time for direct work with children and families. - fewer formal meetings and reports for all agencies- fewer inappropriate referrals to Social Work- reduction in SW caseloads- 2/3 of SW time now working with children and families

Evaluations

• Duplication in paperwork significantly reduced, but reliance on paper documents will remain time consuming until electronic information sharing is introduced

• Reduction in unnecessary referrals to the Reporter - down by 70%- Reporters and Panels have more time for more serious cases- better evidence-based information top the Reporter.

• Reductions of around 50% in the number of children regarded at risk of significant harm.

• Less cumbersome processes for children and families

• Families like the single team approach. They say they know what is intended and when it will happen.

• Improved outcomes for a majority of children.

Challenges• Turning ideas, goodwill and enthusiasm into

actual practice change

• Managing the pace of change: - too slow or too fast? - different agencies at different speeds

• Maintaining clarity in practice; the nuts and bolts as well as the vision

• Ensuring the structures and posts in place to support the new processes

• Implementation at a time of reducing resources

• Sustaining the change

• E-solutions

Some lessons learned in implementation The whole team must pull its weight, to

plan, manage and deliver change

• It’s total system change

• It must make sense of, and bring together all of the change agendas

• Political and Chief Officer leadership is crucial

• Capacity and systems to manage risk

• All services must be on board; it’s cross-cutting, but it’s also single agency change

• You need good coaches

• Change has to be managed – but when opportunities arise, you must often be bold and go with the flow.

Changing Professional Practice and Culture to Get it right for every child

9 June 2010Aberdeen

Bill AlexanderNHS Highland & Highland Council

The history

• Kilbrandon Report, SW (Scot) Act, children’s hearings system

• For Scotland’s Children

• Significant Case Reviews

• It’s Everyone’s Job to Make Sure I’m Alright

• Review of the Children’s Hearings System

• Additional Support for Learning Act 2004

• Health for All (HALL4)

• A Curriculum for Excellence

• More Choices More Chances and 16+ Learning Choices

• The Early Years Framework

• Many children still have poor life chances from an early age:

– high-risk behaviour during pregnancy and the early years can have a serious impact on a child's health, development and outcomes

– clear gaps between the development of children whose parents face stresses and those brought up in less stressful households - these gaps continue through life

• Children at risk of harm and neglect

• Children and families excluded from services

• Community concerns about youth offending and anti-social behaviour

System Failures• Failures in:

– information sharing, – assessment – resource allocation – review processes

• Children and families experience having to tell their stories again and again, many meetings, many reports, confusing plans ….

• Children’s Hearings System choked by inappropriate referrals

• Practitioners overwhelmed by bureaucracy

• Emphasis on reaction and managerial gate-keeping, not early intervention and preventative services