Future of care: Improving outcomes for children and young people by spreading innovation
Future of care – No 5, October 2017
People who work in children’s services are motivated to improve the lives of children, young people, families and communities. Across the country staff in local authorities, voluntary organisations and private sector companies want to see children thrive, families grow and young people develop into happy adults. Accordingly they are trying out new ideas and approaches to give the children and families they work with the best chance of success.
This briefing jointly produced by the Social Care Institute for Excellence (SCIE) and Innovation Unit aims to contribute to the debate about how to mobilise learning from these new ideas, so that children and young people across the country can benefit.
The briefing draws on the insights of people leading innovative change in local organisations who took part in a workshop chaired by Nigel Richardson, former Director of Children’s Services (DCS) at Leeds City Council, hosted at SCIE.
It introduces theoretical models to help with ways of thinking, draws on the experience of SCIE and Innovation Unit in supporting innovation and improvement across the country, and uses case studies to provide insights into what we can learn from each other.
Innovation is the development and application of ideas in practice. [It] is about doing new things.West et al, 2004, p. 271.
- The Department for Education Children’s Social Care Innovation Programme has put a spotlight on many new approaches; the challenge now is to maximise the impact of this work.
- Innovations in practice that benefit children and young people can be adopted and spread more effectively by drawing on both theoretical models of change and years of experience.
Case studies of innovation suggest there is
no one-size-fits-all approach, but that some
common conditions for success include:
- a clear vision of both the change being sought and the core features of the innovation that will achieve it
- as much evidence of impact as possible
- organisational willingness to be in it for the long haul
- visible and accessible leaders
- sustained engagement with children, young people, families and communities
- a willingness to learn from experience.
Issues for further discussion include how:
- organisations can introduce innovation and implement evidence-informed practice, while being responsive to the local needs of children, young people and families
- the social care system as a whole, including policy-makers and the voluntary and private sectors, can create the conditions in which innovations that deliver better outcomes can spread more effectively and make more difference to the lives of children and young people.
Innovation is a critical issue in children’s social care, with the Department for Education’s Children’s Social Care Innovation Programme providing £200 million in funding to 95 projects since its launch in October 2013. Over 50 evaluation reports have been published, plus four thematic reports drawing together threads and making recommendations.
The focus is now shifting to how to maximise the impact of this programme for the benefit of children and young people across the country. The DfE has started the process of establishing a new Children’s Social Care ‘What Works Centre’, which is expected to collate, synthesise and review the learning from the Innovation Programme, alongside other sources of research and evidence, and support the implementation of findings into practice.
At the same time Alison Michalska, President of the Association of Directors of Children’s Services (ADCS), in her inaugural presidential speech spoke about her desire to focus on
how we mobilise the learning from those projects, and other sources of innovation and excellent practice, and share it.Alison Michalska, President of the Association of Directors of Children’s Services (ADCS)
There is an opportunity to develop a collaborative approach to learning across the sector, led by the sector, and drawing on the best of innovative practice and improvement.
Ways of thinking: frameworks and reflections from experience
Theoretical frameworks and models can help think about generating and spreading innovation. Following are some models that leaders in children’s social care have found useful, as well as reflections from Innovation Unit and SCIE’s experiences of leading innovation and learning.
Facilitating organisational change: Relational approaches and the Social Discipline Window
Restorative practice is an approach to working with children and families, and to leading organisations in innovation and change, which is now being used by a number of leaders in children’s social care.
Leeds City Council used this approach in its Innovation Programme-funded children’s social care project, focusing more attention on working with families to identify ways forward with their children. The project went further, addressing how the resources of the City of Leeds could be used to work with families and children to make it a great place for a child to grow up in. (Family valued – A new approach to Children’s social care in Leeds)
At the heart of restorative practice is a hypothesis that human beings are more likely to make changes in their behaviour when those in authority do things with them, rather than to them or for them (Wachtel & McCold, 2001). It is represented in the model of the Social Discipline Window.
Figure 1 Model of the Social Discipline Window
Adapted from: Wachtel, T. & McCold, P. in Strang, H. & Braithwaite, J. (eds), (2001) Restorative Justice and Civil Society, Cambridge University Press, Cambridge
Learning from experience
Innovation Unit has identified key points from their ten years’ experience of supporting innovation across the public sector. These can be summarised as:
- It is important to differentiate between improvement (better use of existing resources to achieve incrementally better outcomes against existing metrics) and innovation (using different resources in new ways to achieve dramatically better outcomes against new metrics). Both are needed in a flexible, high performing system.
- Innovation requires different practices, processes and habits. In children’s social care, these have to apply across complex systems, and involve taking risks in a risk-averse culture. New voices are required to provide the stimulus for change: young people, carers and families, as well as practitioners.
- The confidence to innovate comes from strong relationships. As in children’s lives, so in organisations – relationships of trust are transformational. So how an innovation is developed is as important as what is developed.
- Successful scaling and spreading of innovation is also relational. Some of the most successful DfE Innovation Programme projects, such as the Pause project, which works with women experiencing, or at risk of having, repeat removals of children from their care, comprise a partnership of a national lead working with a group of local sites to innovate and learn together.
SCIE has developed the Learning Together approach as a different way of learning lessons from safeguarding issues, including Serious Case Reviews (SCRs). This approach has a number of characteristics:
- The Learning Together approach moves away from identifying what did not happen and what should have happened, and towards an understanding that in a complex adaptive system things will always go off course, and an effective response requires continual adjustment, not more tightly specified processes.
- Learning Together requires collaborative learning across hierarchies and boundaries within and between organisations, and leads to ongoing dialogue between people in different roles and functions about their part in the system and their perspective on the system.
- Learning Together is not a ‘manual’ for completing a SCR, but an approach to understanding how learning happens in that locality and how it can be cultivated and grown.
Find out more: Learning Together
Spreading innovation: organisational learning models
Theories about how innovation spreads in a public service environment can help to consider how positive innovations that are introduced in one place can be adopted and adapted for another. Theoretical issues arise such as:
- The distinction between ‘explicit’ and ‘tacit’ knowledge – not just what is written down but what is embedded in individual and group practices (Nonaka & Takeuchi, 1995).
- Whether knowledge can be ‘transferred’ or whether it has to be adapted and reinvented.
- The role that networks and social learning environments play, such as Communities of Practice (Wenger, 1998).
- The motivation of the source organisation to share innovation and the recipient organisation to learn (Langer et al., 2016).
A useful conceptual model of how interorganisational learning takes place was developed by Rashman et al. (2009). It suggests that attention needs to be paid to both the source and recipient organisation, the relationship between them and how they interact, and the context in which they operate.
Figure 2: Inter-organisational learning model
- Source (Organisation, social network, unit)
- Policy & Practice Context
- Recipient (Organisation, social network, unit)
- Communities of interaction
Source: Rashman et al., 2009
Research on spreading innovation would suggest that activities expected to result in the recipient organisation having enough information to implement the innovation in their own place are likely to have four characteristics:
- Social engagement - people connecting face-to-face to uncover tacit as well as explicit knowledge.
- Situated engagement - enough information to be able to understand the characteristics of the source organisation, and to reflect on those of the recipient organisation.
- Sustained engagement - over time to build trust and enable responses to issues as they emerge.
- Start from the question of the learner - led by those who want to adopt.
Doncaster Children’s Services Trust’s Innovation Journey
The Doncaster Children’s Services Trust is an independent organisation set up to deliver social care and support services to children, young people and families in Doncaster, following a history of service failures within the local authority. The Trust has received Innovation Programme funding for projects to tackle child sexual exploitation (CSE) and the impact of domestic violence, and to introduce the Mockingbird fostering model and Pause model for mothers in repeat care proceedings. The evaluation of the Trust was published in July 2017.
The Trust inherited a social care workforce that had been through very difficult times, and with low morale. Turning this around was the first priority. The Trust was able to recruit new staff to set up its finance, HR and other support functions, ensuring that they were motivated to support the new organisation. The senior managers focused on increasing the connection with staff, through increased visibility and encouraging staff to contribute to decisions about the future of the Trust. The key turning point came when there was a serious incident and the managers went to see the team, not to read the riot act, but to offer support. This demonstrated consistent supportive leadership, even when under pressure.
Staff morale was now changing, with 78 per cent of staff recently reporting they were happy at work, and all of the team managers being permanent staff. One young person had recently reported that she’d had the same social worker for two years; the previous year she had had seven.
The next challenge was to continue the work with local partners to increase their confidence in the service, repairing over ten years of difficult relationships.
West Berkshire District Council: Innovation through restorative practices
:The restorative practice approach and a focus on relationship-based practice underpinned the work being undertaken with communities in West Berkshire, across both adults and children’s services. Using the Social Discipline Window, teams discussed how to move from ‘doing to’ and ‘doing for’ to ‘doing with’, and how to use skilled conversations to engage families and communities.
The Communities Directorate within West Berkshire Council has made four commitments:
- We will work with, not ‘do to’ or ‘do for’.
- We will see people as a collection of strengths and assets, not as problems and issues.
- We will be interested in people’s lives, not in our services.
- We will stop saying ‘no’ and learn to say ‘yes’ differently.
In children’s services a restorative practice approach was used in setting up an Emotional Health Academy to develop the Future in Mind recommendations. The key features of this innovation were the recruitment of new staff that had a psychology background but were not pursuing a clinical pathway, and a series of ‘doing with’ conversations with children and families about their experiences and how they wanted emotional and mental health support delivered. Where children said they did not feel safe talking to people in their school, services were set up in the community; whereas in the past a one-sizefits- all approach would have been taken.
The outcomes of this work included a 43 per cent reduction in the tier 3 child and adolescent mental health service (CAMHS) waiting list, and resolution of a number of practical issues such as housing and family income that were worrying children and young people, through the staff team taking action to engage other council services.
The restorative practice approach has now been adopted by the Council’s corporate centre, which has established a Building Communities Together team to take this work forward.
Improving access to mental health services: The Children’s Society Birmingham Pause Service
The Children’s Society’s Pause service is a drop-in emotional wellbeing and mental health service in Birmingham City Centre. It is commissioned as part of an integrated mental health service for children and young people up to 25 years old, which also offers a 24-hour telephone access service, and tier 3 and 4 CAMHS. Young people came up with the name Pause to convey taking time for a break from the pressures they were facing and talking to someone when they needed to.
Consultation with young people as experts-byexperience showed that they wanted a place that was a cross between an electrical store, where you can browse, pick up information, but only have to speak to a member of staff if you want to; and a coffee shop, where everyone can sit and chat informally. The service is staffed by people from a range of professional backgrounds, including therapists, youth workers and nurses, and with a large group of regular volunteers. Young people, or parents with young children, or those who are worried about their son or daughter, can walk in any time between 10 am and 6 pm, seven days a week, and talk to someone in an open area or a private room, as they choose.
In the first year of operation the service has seen 7,500 walk-ins, comprising 3,500 individual visits. This had doubled the capacity of the overall CAMHS service at five per cent of the cost. Staff say that parents and children often arrive stiff with fear at entering a mental health service for the first time, but leave visibly relaxed and at ease.
The service is now holding regular open days, and supporting an action learning set, to enable people from other NHS trusts, voluntary organisations and local authorities to learn from the approach.
Creating the conditions for successful innovation
From the case studies, it is clear that there is not a one-size-fits-all approach to innovation, but that some themes can be identified as key to creating the conditions for success:
- A clear vision of both the change being sought and the core features of the innovation that will achieve it, for example same day access without appointment in the Birmingham Pause service. This vision should guide the change throughout, even if the way it is implemented may alter. Being specific about what you want to change helps with reducing uncertainty for staff and partners alike.
- As much evidence of impact as possible, even if it needs to be drawn from disparate sources, to reinforce the case for change.
- Organisational willingness to be in it for the long haul. For example, it took the Doncaster Children’s Trust nearly three years of relationship building before partners began to believe that change was happening.
- Visible and accessible leaders who understand that it is building quality relationships with staff that will inspire change in their behaviour, rather than simply changing structures or processes.
- Sustained engagement with children, young people, families and communities throughout design, implementation and operation, to understand what it is like to be a child or young person experiencing your services. Professionals need to be prepared to ‘play an away game’ rather than a ‘home game’, i.e. working with families on their terms through conversations such as Family Group Conferencing.
- A willingness to learn from experience once the innovation is introduced – a commitment to learning, reviewing and improving.
- The challenge of finding metrics or indicators that capture the quality of relationships being developed, and the impact on children, young people and families’ lives, rather than changes in presenting problems or inputs and processes.
- The challenge of a lack of shared understanding of what ‘success’ looks like for children, families and communities, rather than as represented by the regulatory framework.
- The challenge of managing different accountabilities, for example to national and local politicians, to regulators and partners, and to the children, young people and families being worked with.
- The importance of time and space for staff to reflect on their practice together.
- The critical importance of listening and responding to the problems of children, young people and families, and designing services around their solutions. An example of this was West Berkshire’s acceptance that, in areas where children did not feel safe sharing their concerns at school, community-based rather than school-based emotional wellbeing services needed to be developed. Local authorities were generally better at listening to children in the care system than others, for example where there were concerns about neglect.
- The benefit of a focus on shared outcomes, enabling a common language among partners.
- The value of developing partnerships with ‘unusual suspects’ to allow different voices to be heard.
Future issues for individual organisations, including councils, include:
- Understanding the ‘how’ of introducing innovation, as well as the ‘what’ of identifying what to change.
- Turning a negative experience, such as a poor Ofsted inspection judgment, into a positive, strengths-based change programme.
- Implementing evidence-based practice, while also responding to the local needs of children, young people, families and communities.
- Harnessing the capabilities of elected members to help to create the conditions for innovation.
- Distinguishing between innovation that works because the model is effective, and that which works because the organisational conditions are favourable.
- Identifying the conditions for success for particular innovations; for example, are they the same for introducing digital innovations or are different or additional considerations required?
The children’s social care system
Future system-wide issues to consider include:
- The balance between outcomes and cost: Is a focus on innovation just a cover for cost cutting? For example, is the focus on new fostering models really about avoiding expensive residential provision rather than understanding outcomes?
- Learning from failure: Innovation implies that some ideas will fail, but it is noticeable that very few of the DfE Innovation Programme projects received a negative evaluation. Was this because risky, but potentially effective, projects were screened out at the application stage? Children’s social care is a risk-averse culture where failure is likely to be buried rather than shared, but there is much that can be learnt from ideas that do not succeed. What would it take to be able to fail quickly and safely to enable rapid learning?
- The role of the private, voluntary, community and social enterprise sectors in introducing innovation: How can each sector be included in conversations about what success looks like and how innovation can spread?
- ‘Freedoms and flexibilities’ from legislation and guidance: Why have so few innovation projects successfully requested ‘freedoms and flexibilities’ from the DfE?
- Innovation and integration: What role can innovation play in integrating features that have been unhelpfully split, such as health and social care or assessment and treatment?
- Additional capabilities: What additional capabilities, for example in understanding and working with communities, does social work need to develop or enhance to ‘work with’ more effectively?
- Policy-makers’ role: How can policy-makers be encouraged to understand and facilitate the organisational and systemic conditions for innovation to take place, outside of a dedicated funded programme?
- While there is no one-size-fits-all approach, there are common themes in the ‘conditions for successful innovations’ across all the case studies. These include: a clear vision, evidence of impact, being in it for the long haul, visible leadership, sustained engagement with children, young people, families and communities, and a willingness to go on learning. It is also possible to identify common enablers and challenges being faced by organisations innovating in children’s social care.
- There are helpful models and useful experiences to draw on as we think about how organisations learn and innovation spreads, including in public services.
- There are plenty of encouraging examples of innovative practice in both the public and voluntary sectors from which other organisations can learn, including organisation-wide change and the introduction of new services and ways of working.
- The importance of relational approaches is increasingly recognised, both in services for children, young people and families, and in underpinning organisational change and innovation.
The most important condition for success was found always to be the quality of the relationship between the child’s family and the responsible professional.Child Protection, Messages from Research – Department of Health 1995
However, the research also concludes that there are many issues that local public service organisations are still juggling with, including how to balance implementing evidence-based practice while genuinely listening to children and young people; the role of elected members in creating the conditions for change; and how to turn a negative trigger (such as an adverse Ofsted judgment) into an opportunity for change.
There are also issues for further discussion about how the children’s social care system can continue to be innovative and spread successful innovations more effectively. These include the role of the voluntary and private sectors in introducing and spreading innovations, whether there is a need for ‘freedoms and flexibilities’, and how in a risk-averse culture to encourage innovations that have the potential to fail and yet still provide useful learning, as well as encouraging those that succeed.