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.

Key messages

Policy context

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

Figure 1: X axis, Support. Y axis Challenge.

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:

Learning 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:

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:

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

Relationship Characteristics

  • 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:

Case studies

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

Key issues

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:

Challenges

Enablers

Future issues

Individual organisations

Future issues for individual organisations, including councils, include:

The children’s social care system

Future system-wide issues to consider include:

Conclusions

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.

Sharing innovative practice

We would like to hear from you if you have examples of innovative practice that you would like to share with colleagues, or successful approaches to spreading innovations with other organisations. Please contact ewan.king@scie.org.uk

Useful links

References