Plymouth an integrated system

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Plymouth - an integrated system

• The journey to developing
• Plymouths Hidden Harm Agenda

Plymouth DAAT
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A Plymouth story...

• Every partnership has its own story...
• Our challenge still remains hard and is difficult
• This remains a very complex and challenging
  agenda
• Hope there are experiences here which you find
  useful
• We are still learning, not always getting it
  right, but learning and making progress

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3 years ago...

• ACMD Hidden Harm Report 2003 but little local
  progress made
• Serious case reviews
• Strong focus on improving childrens social care
• Strong focus on treatment sector redesign
• Communication between treatment sector and
  childrens services immature
• No strategic coordination or steer on this work
• Ad hoc development to provision
• Very limited capability amongst universal
  services to meet need linked to substance use /
  misuse and parenting capacity.
• Very little evidence of staff having undergone
  appropriate training or staff that are competent
  to deal with substance misuse and parenting
  issues together

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Local Drivers for change

• Young Peoples Lead for Drugs and Alcohol moves
  from DAAT to Childrens Services enabling
  access to Childrens Services Assistant Directors
  and Heads of Services / breaking down barriers
• Parent and Family Support Strategy - process
  identified substance misuse as a priority task
  and finish group led to important report covering
  universal and targeted levels of provision
• High Focus Area Status Hidden Harm Theme taken
  on by Plymouth. CEO of City Council and then
  Chair of Safeguarding Board gives OK to place
  work within Safeguarding Board.
• Hidden Harm Work agreed by Safeguarding Board
  establishment of Hidden Harm Working group with
  key task to produce strategy

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Local Drivers for change

• DAAT support Safeguarding Boards Hidden Harm
  Working Group. In a letter to the treatment
  sector the DAAT states, Plymouth DAAT
  recognises that as a sector we need to develop a
  more coherent and consistent response. All our
  specialist providers need to be central to the
  multi-agency context within which safeguarding is
  carried out.
• Safeguarding Register Review Multi-Agency Group
• Childrens Trust - move to Trust status and
  increasing coherent approach to working with
  substance misuse

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Hidden Harm Strategy

• Analysis of Need 2008
• Inclusive of all levels of need not just those
  most at risk - this allows opportunity to develop
  integrated response
• 17 key findings including
• identifying different levels of need at the
  treatment level stable periods of chaos
  chronically chaotic
• identification of possible outcomes for both
  adult and childrens services
• recognising the challenge alcohol Hidden Harm
  e.g. treatment capacity
• gap at targeted level for families or parents
  and need to link universal provision to
  treatment services

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Analysis of Need

• We have estimated that between 3900 and 6500
  children in Plymouth live in families where there
  is problematic parental alcohol misuse
• We have estimated that around 1800 children in
  Plymouth live in families where there is
  problematic parental drug misuse
• In Plymouth we estimate that between 725 and 1268
  people who are in specialist substance misuse
  treatment have children who are dependent on them
• Two thirds of young people in treatment from
  families with substance misuse problems many
  known to adult treatment services
• This process was supported by excellent work
  undertaken by the local Public Health Unit /
  Director of Public Health who produced an Atlas
  of Substance Misuse Need.

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• Plymouth Safeguarding Children Board CONFERENCE
  2008 Hidden Harm Developing the Citys Response
• High level engagement and commitment
• Chair of PSCB and Chief Executive of Plymouth
  City Council
• Director of Childrens Services
• DAAT Manager
• also
• Vivienne Evans Chief Executive, ADFAM
• Brynna Kroll and Andy Taylor
• 170 people attended 40 from adult services
• Commented on needs analysis and contributed to
  priorities for strategy

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Hidden Harm Strategy

• 20 recommendations
• Strategic objective to improve the outcomes for
  all children and young people living with the
  impact of parental alcohol or drug misuse
• Key recommendations cover
• Agree outcomes
• Listen to children and young people
• Agree data and annual analysis of need
• Collaborative commissioning
• Carers
• Working together and information sharing
• Effective communication
• Alcohol link to LSP
• Hard to access services contracts / SLAs
• Workforce development HH Training

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• Joint outcomes agreed
• Reduction in the number of looked after children
  where parental substance misuse is significantly
  implicated
• Reduction in the number of children with a child
  protection plan where parental substance misuse
  is significantly implicated
• Support children, in families where parental
  substance misuse is a factor, in achieving
  improvements across all 5 Every Child Matters
  outcomes
• Support families to stay together safely
• Improvement in parenting skills and capacity in
  substance misusing parents
• Very similar to DCSF / NTA protocol

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Safeguarding Register Review

• Multi-agency group set up to undertake a review
  to identify if there were issues of threshold,
  quality of practice, availability of services
  that were contributing to the high numbers of
  registrations,
• Following a multi-agency Safeguarding Register
  Review key areas for action required the
  following to be achieved.
• Agencies to monitor engagement of staff in Child
  Protection Conferences and Core Groups
• Agencies providing reports to be a good standard
  and must identify the impact on the child of
  parental issues
• Staff need to be competent around child
  protection and safeguarding
• The organisation must ensure management
  accountability over achieving these to ensure
  quality and consistency
• Action plan agreed to deliver these in the
  substance misuse field

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The Bulls Eye Model Parents in treatment
Yellow - Assess, Support, Prevent - Drug Service
Lead (1100 -2200 parents) Blue - Enhanced Support
to Parent and Child(ren) Joint Work (110-220
parents or between 15 of those in
treatment) Green - Full Child Protection led by
Childrens Services (55-110 parents or between
3-5 of those in treatment)
Children Centres
Childrens Social Care
FIP
Parenting Programmes
Workshop in next session will provide some
perspectives from these services
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Bulls Eye Model

• Childrens Social care work with treatment sector
  shaped by Safeguarding Register Review progress
  re engagement and reports
• FIP has capability to deliver intensive support
  for family FIP employing treatment worker
• Children Centres identified as having very
  significant role in providing early years support
  and parent and family support ( we found that
  many under 3s who were on a child protection plan
  had little engagement with this support) pilot
  programme commencing to link parents in treatment
  with under 3s to Children Centres
• Parenting Programmes developing capability of
  strengthening families and incredible years
  programmes to support families where substance
  misuse is a factor -

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Progress

• Implementation Plan agreed Summer 2009
• 22 actions implementation early stages
• Different world to 3 years ago strategic
  coherence profile activity
• Desire to engage across partners
• Good relationships between adult and childrens
  commissioners meeting on a need to meet basis but
  work to do re formalised structures
• Good progress re linking treatment to childrens
  services
• Hidden Harm Safeguarding Training programme well
  established 1 and 2 day courses available on a
  monthly basis
• Successful capital bid
• DVD

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Key Challenges

• Moving Hidden Harm into developing Think Family
  governance within Childrens Trust time to
  go....
• Progress being made but recognising some
  difference in speed re strategy development and
  drive v operational delivery
• Big cultural and capacity issues within treatment
  services
• Capacity issues of parenting programmes / FIP
  Children Centres v need identified
• Big learning curve underway across both
  childrens and adult services
• Resource pressures but desire to be innovative
  and collaborative
• Recognition that Childrens Social Care /
  Treatment Service and other key services under
  significant pressure
• Reminding all that we have made significant
  progress and celebrating this

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Learning

• Breaking down barriers
• Lead Role -
• Communication mutual understanding trust
• Shared understanding of work and pressures
• Awareness of own weaknesses and strengths
  constructively critical
• Analytical / Good Needs Analysis / Excellent
  Public Health Atlas
• High level commitment
• Safeguarding Board worked for us clarity of
  focus and purpose
• Coming together of a number of key strategic
  drivers Safeguarding Board Hidden Harm Group /
  Safeguarding Review / Parent and Family Support /
  DAAT very helpful
• Showcase conference to raise profile and engage
  with stakeholders
• Passionate people
• Can do approach / willingness to make things
  happen

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• Need to continue to communicate with all
  stakeholders about challenges and progress
  taking people with you
• Growing awareness of need to think laterally e.g.
  getting staff to problem solve together, meet
  together, x-fertilisation between adult workers
  with children services and vice versa
• Recognised that there is a lot to learn from
  treatment services experience with criminal
  justice developments
• Co-location a serious emerging aspiration
  (children's services social workers co-located
  with adult substance misuse workers??)
• Commissioners from adults and children's services
  can agree on joint outcomes and work together
  find solutions together positive

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Coming Up!

• Work with Probation who are part of the Hidden
  Harm Working Group has identified that they are
  working with significant numbers of parents /
  carers where alcohol is implicated in their
  offending initial work on how our model could
  work with probation taking place
• Work by the Childrens Trust has identified that
  another route to support for children and their
  families where parental substance misuse is a
  significant concern is through SENCOs. Children
  and young people with emerging behavioral,
  emotional or social needs linked to Hidden Harm
  are referred to SENCOs within schools. We are
  beginning to link Parenting Programmes to SENCOs.
  

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• Use of our DVD for induction and training with
  all key staff in City powerful voices of
  children
• Aiming to be fully integrated into whole think
  family structures for city
• reviewing all parent and family provision to
  inform commissioning that will supports think
  family agenda including support linked to
  substance misuse

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• Overall very significant change from 3 years ago
  
• more coherence
• more understanding
• discussion more on how then why
• lot of activity
• big issues to overcome (resources / capacity)
  but positive

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Thank You If you have any queries or questions
please complete the forms handed out and we will
endeavour to respond to you over the next few
weeks. Alternatively email dave.schwartz_at_plymou
th.gov.uk
Children Centres
Childrens Social Care
FIP
Parenting Programmes