Early Help Review 2020-22 Summary of Findings and Recommendations - LGA Peer Review (2019-20), EH Self-Assessment (2020), Peopletoo Review (2021-22)

1              Background and context

1.1          This report outlines the key findings and recommendations from the Early Help Review, which started at the end of 2019 with an LGA peer review, continued with a detailed self-assessment in 2020 using the new national Early Help System Guide framework; and was supported throughout 2021 by consultants Peopletoo. The purpose of the Review was to assess current Early Help and prevention activity across the city, with a view to making recommendations for reducing inefficiencies and duplication across the system, whilst addressing gaps and targeting resources to support those families most in need and at risk of multiple disadvantage. It involved analysis of how the system functions as a whole, including FCL services, wider BHCC services working with families (e.g. housing), health services (including health visiting and school nursing, child and adult mental health, and drug and alcohol services), the police, schools and voluntary / community sector services working with families.

1.2          During this time, a number of government policy and programme developments emerged, which fed into the Review and are reflected in the recommendations for a proposed future model. These include amongst others, the national Family Hubs initiative, led by the DfE; the Supporting Families programme 2022-25, led by the DLUHC; and the Start for Life programme, led by the DHSC.

1.3          Locally, needs analyses indicate that for children in families facing multiple disadvantage, the outcomes gap in the city is growing. The overarching Disadvantage Strategy seeks to bring together the range of local initiatives to tackle disadvantage, with delivery through the proposed future model for Early Help.

1.4          The context and impact of the pandemic have also played a role in shaping the recommendations. Considerations include increasing presentation of families with multiple and complex needs, the changing nature of referrals, ways of accessing support, and how data is used to identify and support families and practitioners.

1.5          Data systems, processes and information flows have been highlighted nationally as underdeveloped in Early Help, and this is reflected locally. Commitment to data transformation for Early Help is fundamental to embedding sustainable improvements in terms of seamless support for families, better information for practitioners, and targeting resources appropriately and efficiently. Developing data maturity is also a requirement of continued funding for the Supporting Families programme.

2              Structure of this report

2.1          Key recommendations are listed first in section 3, grouped under:

· Leadership and Governance

· Workforce

· Service Delivery and Practice

· Information, Comms and Engagement

· Systems and Data

2.2          These are followed in section 4 by a proposed set of activities to support transformation, grouped as above but including an additional category ‘Buildings and Assets’.

2.3          The detailed findings and recommendations from each review are contained in section 5.

3              Key recommendations

3.1          Leadership and Governance

· Develop a clear vision and strategic buy in to a citywide Family Hubs model for Early Help, including a shared family outcomes framework focused on tackling disadvantage and reducing inequalities

· Develop a Family Hubs transformation programme and governance structure, linked to wider national, city and FCL strategies and aspirations

· Develop a Family Hubs performance and Quality Assurance framework, including a cycle of monitoring, review and evaluation

· Streamline the management structure for core Early Help services

· Develop better use of data insight to inform delivery and management, evidencing impact and outcomes for families, to enable best use of existing resources

· Consider joint commissioning of services in the best interests of children and families

3.2          Workforce

· Redefine and profile core BHCC EH teams and roles to reduce duplication and ensure all required functions are delivered

· Complete skills audit of staff aligned to the family outcomes framework and levels of need

· Develop a workforce development programme aligned to the Family Hubs delivery model

· Extend workforce development to wider services

3.3          Service Delivery and Practice

· Simplify and streamline the service offer across all levels of need, with clear referral routes and pathways for family support

· Develop a multi-agency family hub pod to allocate and provide duty function

· Map and agree tools, resources and interventions using the Supporting Families framework

· Ensure all core BHCC EH teams use whole family assessment

· Create a buildings /asset plan to support development of a Hub and Spoke Family Hubs model

· Develop a robust volunteer programme to provide volunteer led groups

· Extend family hubs to include wider services

· Launch Start for Life offer as part of Family hubs

· Consider development of capacity in the system to better support ‘step across’ cases

3.4          Information, Comms and Engagement

· Build consensus for service redesign through ongoing coproduction and engagement with practitioners, children and families, communities and partners

· Develop a digital and comms strategy and delivery plan for Family Hubs

· Map digital and locality information sources currently and potentially used by families

· Develop self-service options for accessing information

· Develop a consistent and robust service user feedback approach

· Ensure a consistent approach across core BHCC Early Help services to completing whole family assessments and recording information

3.5          Systems and Data

· Develop a data transformation plan, building on existing corporate transformation activity and focused on integrated data management

· Ensure appropriate data sharing becomes a partnership priority for all those involved in delivering early help services

· Ensure all core Early Help BHCC services use the same case management system

· Develop and implement a single view record of a child/family’s support available to professionals, to support risk assessment, improve coordination and reduce duplication

· Develop analytics and insight modelling capability to identify multiple disadvantage and ensure resources are targeted at those most at risk of disadvantage and costly interventions

· Develop better evaluation of the impact of Early Help interventions and services on family outcomes

4              Transformation proposals

4.1          Subject to approval, the following activities are proposed as part of a two-year Transformation phase:

	Leadership and Governance	Workforce	Service Delivery and Practice	Information, Comms and Engagement	Systems and Data	Buildings and Assets
Year 1	· Agree vision and principles for EH and Family Hubs model · Establish Transformation Programme Team · Develop detailed Transformation Programme Plan incorporating national and local strategies · Complete budget profiling · Agree governance structure for Family Hubs · Develop family hubs performance and QA framework · Increase use of data insight to inform planning, delivery, evaluation and management · Develop Business Continuity plans	· Redesign and profile core BHCC EH teams including frontline, management and service/business support · Undertake staff consultation and restructure · Complete skills audit of staff · Design workforce development programme aligned to family hubs delivery model	· Define FDFF / Family Hubs interface · Agree EH referrals process, including contacts, forms, alignment to 10 SF themes, triage and allocations, data management, case management interactivity, duty function and operational instructions · Develop multi agency family hub pod to allocate and provide duty function · Agree service offer across all levels of need with clear pathways and mapping of needs / interventions aligned to SF themes and outcomes, operational instructions · Map and agree tools, resources and interventions aligned to SF themes · Ensure all core BHCC EH teams use whole family assessment · Develop standardised EH supervision policy and practice · Launch Supporting Families programme (Oct 2022)	· Develop Comms & Engagement Plan including public consultation · Deliver ongoing coproduction and engagement including with children and families · Develop robust service user feedback processes · Map information sources for digital service · Develop digital service proposals for family hubs	· Develop data transformation project plan, building on existing corporate transformation plans and SF priorities · Move all core BHCC EH users to the same case management system - Eclipse · Develop Family Hubs dashboard linked to performance and QA framework · DPIAs / Information Governance strategy · Launch Supporting Families programme (Oct 2022)	· Carry out asset mapping for main hubs and spokes including buildings and IT infrastructure · Identify required delivery space and existing capacity for core and extended services · Develop building/asset plan
Year 2	· Soft launch of Family Hubs April 2023 · Implement family hub performance and QA framework · Embed cycle of monitoring, review and evaluation · Consider joint commissioning of services in the best interest of children and families	· Extend workforce development to wider services	· Develop intervention directory · Develop robust volunteer programme to provide volunteer led groups · Extend family hubs to include wider services · Launch Start for Life offer as part of Family hubs	· Deliver ongoing coproduction and engagement including with children and families · Launch digital service · Develop self-service options for accessing information	· Develop and implement a single view record of a child/family’s support available to professionals (Customer Index) · Data sharing and information sharing agreements in place	· Identify additional spokes for Family Hubs partnership

5              Detailed findings and recommendations from each element of the Review

LEADERSHIP AND GOVERNANCE	LGA REVIEW (Published March 2020)	EH SELF ASSESSMENT (Published Dec 2020)	PEOPLETOO REPORT (Published March 2022)
What’s working well and what we can build on	- Commitment across leaders and practitioners in many agencies to make a positive difference to the lives of children and families and to the principle of the whole family approach - Emphasis on earlier interventions to support families with emerging needs - Some aligned commissioning across partners, aided by good relationships and shared priorities	- Good working relationships between local leaders at all levels and across the wider Early Help system, including VCS and public bodies - Sense of collective responsibility for supporting families facing multiple disadvantage - A ‘think family’ approach is increasingly employed by partners across the system - Joint work around some prevention initiatives	- The Early Help Partnership Board has most of the key stakeholders and partners and is “finding its feet” in setting the strategic direction - Commitment across senior leaders within the council and partners to improve outcomes for families and an emphasis on earlier interventions - Commitment to identifying and addressing areas of disadvantage through the citywide disadvantage strategy - Agreement to embed Whole Family Working across Early Help and a best practice strategy developed
What needs to change or improve	- Lack of visibility or clarity of purpose of the Whole Family Partnership Board (WFPB) # - Lack of clarity at all levels about where the WFPB sits within the framework of other existing partnership boards - Broad membership of the WFPB but continuity and seniority of representation required to agree and effectively implement strategy - Lack of clarity about what ‘preventative services’ means across partners, and confusion regarding the distinction from ‘early help’ - The whole family approach and what this means in practice is not well understood - The Whole Family Working Strategy (2018), needs to be promoted more widely, with consistent and well understood terminology used across the partnership - Lack of Joint Commissioning Strategy leads to inconsistent approach and opportunities to maximise resources from all partners are missed - Lack of ability to demonstrate the impact of the preventative approach on reducing demand and improving outcomes	- No shared ownership of a family outcomes framework across the partnership - Lack of joint commissioning or system design to support a shared outcomes framework	- Early Help strategy and vision driven by the local authority, with limited ownership and contributions from some EHP Board partners - EHP Board is led, chaired, with the agenda set by the local authority and does not feel like true collaboration between all partners - EHP Board is operating to provide updates and discussion rather than to direct activity and manage programmes of work - Currently no structures underneath the EHP Board to drive delivery and shared working and manage operational priorities - No clear, shared understanding of Whole Family Working and the contribution each partner makes. Often it is seen as a local authority responsibility and there is limited evidence of its use outside of Social Work and ITF - Little understanding of what the barriers are to embedding Whole Family Working - Many services have not been commissioned or set up to work in a Whole Family approach - The core BHCC Early Help services sit within different teams and management lines - There is no FCL lead for data transformation and no formal FCL governance. This has resulted in lack of clear direction and ownership
Recommendations	- To ensure the success of the whole family approach, all partners need to own and drive the vision, agree cohesive governance arrangements and be actively engaged in the Whole Family Partnership Board (WFPB) - Partners should agree and define what constitutes preventative services and the terminology to be used - Strategic leaders should ensure that the whole family approach is communicated effectively across all levels of the partnership and delivery teams and is well embedded - Strategic leaders should give greater attention to evidencing impact and outcomes for families, to enable best use of existing resources and with a view to developing the business case for further investment in preventative services - The WFPB should develop and implement a joint commissioning strategy across the Council, CCG and other key partners in support of the whole family approach - As part of that joint commissioning strategy, the WFPB should work with the CVS to identify additional preventative services they may be able to offer and map against existing provision.	Strategic buy in to developing a citywide, clearly defined model for Early Help including: - a shared outcomes framework for families, focused on tackling disadvantage and reducing inequalities	- A review of Terms of Reference and chairing arrangements for the Early Help Partnership Board is required to drive ownership and accountability across all partners and ensure the board is established to drive delivery of the new approach - A clear vision should be developed and agreed for Early Help and Whole Family Working based on the recommended model - Clear and robust delivery mechanisms are required, to ensure actions are owned and driven by all partners - Review the management structure for core Early Help services

WORKFORCE	LGA REVIEW (Published March 2020)	EH SELF ASSESSMENT (Published Dec 2020)	PEOPLETOO REPORT (Published March 2022)
What’s working well and what we can build on	- Staff across agencies are committed, enthusiastic and proud to work in Brighton and Hove	- Comprehensive workforce development offer, free at the point of access and shared with partners across the system	- Staff are generally motivated and open to change - Staff reported a high focus on training and development and there are a lot of specialist skills within the service - Staff feel able to openly share challenges and issues with managers - There are strong examples of joint working between teams and agencies at the frontline. This was continually highlighted by staff in engagement sessions. The majority of staff felt they had built good relationships with their counterparts in other organisations and that they were able to work together effectively to best support families.
What needs to change or improve			- Staff reported not being clear on the overarching vision for Early Help and how their role fitted into it. - Staff reported lack of clarity on remits of certain roles as thresholds and remits of other services have changed over time. - The role of the Early Help Coordinators is not clearly defined. In some cases, they are acting as a triage and decision-making point, and in others they are holding cases and providing direct interventions. This is often to mitigate the impact of waiting times in other services, however, it results in further confusion of pathways. The original role of the EHCs was to provide a connection role and support for partners, however, this has changed over time.
Recommendations			- Re-definition of some roles is required to reduce duplication and ensure all required functions are delivered. Early Help Co-ordinators are a key role that requires re-definition.

SERVICE DELIVERY AND PRACTICE (including role of communities and VCS)	LGA REVIEW (Published March 2020)	EH SELF ASSESSMENT (Published Dec 2020)	PEOPLETOO REPORT (Published March 2022)
What’s working well and what we can build on	- There are a number of good services, provided by a range of agencies and partnerships - ITF is making a real difference to families, with the work of the Family Coaches being particularly valued - Capacity is enhanced through a vibrant, strong and well-resourced Community and Voluntary Sector - The seven children’s centres are a valuable resource and potentially a key element in a more effective approach to whole family, preventative services.	- Relationship-based practice is integral across the system  - An established whole family support service (ITF), which is well regarded  - Much focus is placed on strengthening family and parental relationships  - The ‘team around the school’ model is well regarded - An increased focus on addressing wider issues outside of initial reason for referral e.g. the six TF themes	- There are many good services across Brighton which are well thought of by families and are leading to better outcomes for families - There is a vibrant voluntary sector in the city with a wide range of services. VCS organisations are keen to work more closely with the council and grow and develop services in areas that are currently gaps, as evidenced by the range of VCS organisations active and observed through conversations as part of this review. - Virtual working has facilitated joint working and brought opportunities to work with families differently. For example, staff reported being able to better engage with difficult to reach families and being able to deliver interventions outside of traditional working hours, which better suited many families. - Social Work and ITF evidence effective Whole Family Working. The impact of this is really felt by families and was a key theme picked up in Family Journey Mapping. - There is a strong ambition and commitment to embedding a trauma informed approach through the Safeguarding Partnership. - Relationship based practice is well embedded across the system. - There is a strong Children’s Centre model that has examples of good community activity and development work, and examples of local delivery and understanding needs of communities / specific groups. This has been facilitated by work carried out during the pandemic, for example the Food Bank.
What needs to change or improve	- The whole system is not yet coherently aligned to make the best and most efficient use of resources - There should also be a more integrated approach to service delivery. From the point of contact, there is evidence of inefficiencies in the screening, decision making and allocation of cases and this is leading to repeat contacts, waiting lists and lack of timely interventions - The preventative service offer may be too complex and the range of direct and indirect referral routes to access early help services would benefit from being streamlined and clarified - There are separate routes into children’s mental health services and the Wellbeing Service and these multiple routes can cause a lack of clarity and may lead to delays - Some of the work of ITF appears in effect to be compensating for gaps and capacity issues in other services - More efficient working with partners and increased utilisation of the CVS may release further capacity to support the whole family approach	- Limited coordination across the Early Help system, with many elements working well but independently from each other e.g. multiple points of triage / access / allocation / intervention - Systemwide practice model is not well defined, although good practice does exist within individual services - Limited case working of whole families outside of ITF, social work and Early Help Coordinators	- The whole system is not coherently aligned. There is a range of different services provided by BHCC and partners and the pathways between these are not clear - There are high waiting times for ITF and no capacity for ‘step across’ which is likely resulting in increased complexity and re-referrals. However, it was not possible to obtain data on the number of cases requiring ‘step across’ support. There is likely to be an invest to save case to increase capacity in ITF. - Partners, particularly schools, reported being unclear on the pathways and what Early Help services could offer. They reported increases in volume and complexity of issues presenting in families and felt families were often falling through the gaps when they did not meet the threshold for services. They reported that this often resulted in families’ needs escalating and referrals being made at a higher level than would have been required had support been available earlier. - High waiting times for statutory services (particularly CAMHS) impact on level and complexity of EH demand. - Family Journey Mapping, and previous evidence gathered through the LGA review, suggests that families find the system difficult to navigate and often experience involvement of several different professionals with limited co-ordination. - Prior to the pandemic, universal services were provided by Children Centres and significant resources are allocated to this. These resources could be better focused on targeted interventions. - The approach to Early Help is not currently on any kind of locality footprint which does not lend itself to a variated approach based on local need - There is limited integration between Early Help and other areas in the council, particularly Adult Social Care and Housing. Whilst staff are often able to work together to solve specific problems, there is limited join up in services which could support the whole family.
Recommendations	- The WFPB should consider the development of a fully integrated preventative model, based on multi-agency and multi-disciplinary teams, potentially located within the existing children’s centres - Maximise capacity by reducing duplication alongside simplifying the service offer and referral routes	Strategic buy in to developing a citywide, clearly defined model for Early Help including: - a shared strength and relationship-based practice model for early help with evidence-based interventions, consistent with the model used by social work and supported by workforce development - a more systematic approach to whole family assessment, commissioning for improving family as well as individual outcomes, and better use of resources such as TF Employment Advisors	- The future model should ensure clearly defined pathways and simplification of referral routes - Capacity should be created in the system to support ‘step across’ cases within ITF - The future model should focus support around clear locality footprints in which services are co-ordinated and work jointly to support families

INFORMATION, COMMS AND ENGAGEMENT (including family voice and coproduction)	LGA REVIEW (Published March 2020)	EH SELF ASSESSMENT (Published Dec 2020)	PEOPLETOO REPORT (Published March 2022)
What’s working well and what we can build on		- There is a lot of information and support available to families, with services and organisations willing to go the extra mile to ensure families can navigate and access this - Some co-design and coproduction work is taking place with families as well as young people, to help shape both strategy and service offers - Feedback is used by individual services to support changes in practice - Some work is underway to impact demand by building community capacity	- The Council website has a lot of useful information and resources and some staff said they regularly use it to find support for families
What needs to change or improve		- Sometimes multiple service involvement without coordination of a single assessment, plan or approach; leading to families having to tell their story several times and on occasion, practitioners being unaware of the role of other professionals - Outside of safeguarding, limited data sharing between partners - Service user feedback is not systematic or consistent between services, and is often recorded on paper or in emails	- Strengthening Families assessments are not consistently used by partners. Performance data shows that only 45 EH assessments and 38 EH plans were completed by partners in 2020/21. All but 2 of these were completed by Health Visitors. - There is no standardised or digitised approach to capturing family voice to help shape EH services - Whilst there is a vibrant voluntary sector, there is a lack of a collaborative approach to Community Development at local level. The VCS report lack of pro-active intelligence sharing on gaps in provision to facilitate the development of new offers. - There are no clear and up to date maps of services and community assets currently available in local areas - Children’s Centres websites are not up to date or utilised as effectively as they could be - There is limited use of Social Media - Self-service options and interactive information solutions (e.g. chat bots) are not currently available digitally - Some key stakeholders across the system reported that they often felt that communication of changes made following reviews and transformation projects was poor. They felt there was a lot of information gathering but they were not always clear on the outputs or changes made.
Recommendations		Strategic buy in to developing a citywide, clearly defined model for Early Help including: - involving families in the codesign and coproduction of planned service changes e.g. the possibility of developing Family Hubs	- A consistent approach to completing Strengthening Families Assessments and recording information is required. - There is a need to better understand, and evidence needs at a locality level and utilise this data to plan and deliver services - There is a need to understand services and community support available within localities and ensure this is maximised

SYSTEMS AND DATA	LGA REVIEW (Published March 2020)	EH SELF ASSESSMENT (Published Dec 2020)	PEOPLETOO REPORT (Published March 2022)
What’s working well and what we can build on		- Quality assurance of Early Help practice, with ITF and FDFF monitored through the FCL Performance Framework	- Significant work has been undertaken by FCL performance team to identify the datasets required and the current challenges as well as outline a desired future approach to matching data and develop short term workarounds - Corporately, BHCC has developed a Customer Index which has the ability to pull data from several council systems to create a single record. Conversations have begun about how this could be utilised to support the data matching required for Early Help. - FCL is in the process of implementing a new case management system, Eclipse, which is likely to provide improved customer journey flow and therefore improved opportunities for data reporting and matching
What needs to change or improve	- Rationalisation and further integration of information systems across the partnership would better support the whole family approach, and enable more effective integrated working across agencies - The new case management system for children’s services should be used to develop better integration with other agencies and systems - Improved data analysis would enhance strategic decision making and help frontline practitioners better understand outcomes	- Multiple case management systems with limited interoperability, making it difficult to see a whole family picture and bring together information without time-consuming, costly manual processes - Limited data-driven analysis to inform strategic decision-making, service and practice development, insight modelling and needs analysis	- It has been very difficult to obtain data to accurately evidence demand across the system - Data that has been obtained suggests a lack of clearly defined model and pathways and that there is duplication and also gaps in provision across the system. For example, data provided by the Early Help Co-ordinators, shows 47 different services received referrals from them, and feedback from engagement sessions with staff suggested an even wider range of services and varying referral routes. As this data has been gathered through a spreadsheet, with significant free text, it is not possible to determine the proportion of the ‘referrals’ that are referrals for services and those that are information sharing. - Multiple systems are used across services and organisations and there are currently no mechanisms for data sharing and providing a single view across systems. Currently many services, including Children’s Centres do not have access to information on Eclipse - There is limited demand, capacity and productivity data to support workforce and service design decisions. For example, it was not possible to gain a standard report on caseloads and throughput across each service. - There is currently no systematic gathering and reporting of data to show demand, needs and outcomes at local level to inform service delivery and commissioning across the system, although some data is available for services that record on Eclipse - Due to lack of clarity on referral, assessment and recording processes and multiple systems utilised across partners, it is not possible to access information to show to number of families supported by each partner, along with outcomes.
Recommendations		Develop an integrated data management approach including: - single view of the family, to support risk assessment, increase coordination and reduce duplication - integration of the new case management system Eclipse with other systems used across the council and the city - better evaluation of the impact of Early Help interventions and services on family outcomes - insight modelling capability to identify multiple disadvantage and ensure resources are targeted at those most at risk of disadvantage and costly interventions - linking with wider digital transformation work underway in the council - ensuring appropriate data sharing becomes a partnership priority for all those involved in delivering early help services, including the council, police, health, education, DWP and VCS - learning from other cities and local areas	- The future model requires a significant focus on digital and data transformation.  Without this, it will not be possible to deliver the full benefits of a new approach and evidence outcomes.