Bill Alexander. Head of Children's Services for NHS Highland and Highland Council.
Session 4 - Changing Children's Services.
Recorded at Getting It Right for Every Child: Childhood, Citizenship and Children's Services, Glasgow, 24-26 September 2008.
We see it everywhere. It's all over this conference. I've heard it mentioned many times today.
But what is it?
It's simple. 'Getting it Right for Every Child' is transformational change in the assessment, planning and delivery of services to Scotland's children and families, probably unparalleled since the introduction of the Children's Hearings System and care planning processes, thirty years ago.
It's a set of principles .... that we all sign up to.
But it's even more than principles, it's also our practice, and the change management that is required to support practitioners to do things differently.
I can only skate the surface of that change this afternoon. I'll make some introductory comments about Highland's service model, which is not different to many others, talk about the change management process, and somewhat cautiously, reflect the increasingly positive feedback we are collating about the impact of change.
Most of you should be very familiar with the principles and values of GIRFEC, taken from the national guidance.
We have had enormous support from Government and colleagues across Scotland, involving many people in this room, to work out what those fine principles mean - and turn them into practice.
Highland is little different from any authority. We have our challenges. Things go wrong. We don't have it all sorted.
But, like many others, we have been working in a determined way, to achieve better outcomes.
In this morning's presentations, Anna, George and John reminded us with compelling evidence, why we need to make the shift. As John Carnochan made clear, it is our responsibility as managers, to engineer the necessary changes to the system, to make things better for children, families and communities.
We have that opportunity now. This is not the time for other new models.
We are on a journey, but we have a destination in sight, and I suggest there are increasing green-shoot indicators that we are going in the right direction.
Our own implementation has been incremental. Many months were spent in development activity, working out how GIRFEC built on existing good practice, and fostering ownership with managers and frontline staff.
It has been phased. Starting in Inverness with new-borns, introducing pre-fives, and only now beginning to involve school-age children and the rest of the authority. At certain points, we introduced entirely new processes across the system, critically including the assessment framework in all of Social Work, and new ways of sharing information from the Police.
Because we are clear that we are 'Getting it Right' for EVERY child, it means a Named Person to take account of children's needs in universal services, as well as a Lead Professional where two or more agencies are working together.
That is not a Lead Professional with special powers to take on the system, but someone who works with the reformed system, so the child's assessment not only determines the single plan, but also the services that follow - without re-assessment, scatter-gun referrals, more gate-keeping, and all of the excessive paperwork, meetings and other bureaucracy that we have developed as a comfort blanket in children's services over many years - slowing down the delivery of services to children, and stifling professionals in the process.
Fundamentally, 'Getting it Right' is a streamlined pathway for children and families through services, and the role and responsibilities of professionals and agencies to assess and meet needs along that pathway.
The pathway needs to be clear and understandable to children, families and practitioners, wherever children might be on it. It also needs to be able to respond and deal with the diversity and range of children's needs.
The model is recognisable to practitioners in all agencies. It has to be. It is the essential dictionary for our common language.
It builds from universal services by incorporating the foundations and staged interventions of public health in the early years, and additional support for learning in schools, and offers a tiered response to needs, as defined by the use of the integrated assessment framework.
Again, the model should be familiar to you. It is the national guidance.
The assessment framework provides a determination of need through the 7 well-being indicators - SHANARI. And if a child is not safe, or achieving or healthy, this is analysed against the three dimensions of the My World Triangle - the child's own development; the family support; and the wider and community environment. In complex situations, including where there is risk, we incorporate the resilience matrix.
The actions in the Child's Plan are then structured around what we are doing to help children achieve their wellbeing indicators.
We have been implementing since the turn of the year.
These are some of the milestones we have passed to date.
The first draft of the guidance has now been consulted on, and we are working on version 2. We are also updating the child protection and all other procedures to be fully compatible.
We have had three programmes of training, building to an advanced lead professional module with Stirling University.
We have put new posts and new structures in place, have introduced most of the GIRFEC processes in Inverness, and are now rolling out across the authority.
It is still very early days, but these are some of the lessons we have learned so far.
This is about change management. The whole children's services team must pull its weight, to manage and deliver that change.
Change management cannot be delivered by simply issuing the manual, and providing staff with training. It requires a co-ordinated fusion of bottom-up ownership and top-down organisational development.
Chief Officer and political leadership is crucial, as is the bottle to manage risk. And all services must be on board; this may be cross-cutting, but it is built on single agency change.
You need good coaches, to assist those of us with busy day jobs to lubricate the system, but effective change has to be rooted in operational management.
Of course, that does not mean that everything happens as intended. Some planned changes get stuck, and need either additional lubrication or a rethink. Others just take off, and you need to row fast to keep up with the flow.
And here's the test.
What difference is it making?
I am very cautious about making claims on just eight months of activity. But I appreciate that people want some indication of outcomes.
So, I'll repeat Bob Stradling's phrase again. These are green-shoot indicators.
Many of them are still about processes, rather than real outcomes. But I do believe that changed processes are starting to evidence improved actions for children, and colleagues are genuinely excited by what is happening, and that's not a bad outcome in itself.
This is a mix of operational and strategic reports from children, families and practitioners.
Sharing concerns = earlier intervention
Wherever GIRFEC has rolled out, we have achieved significant and sustained change in the number of children referred for compulsory measures, down to about 20% of what they had been. In the last 9 weeks, of 250 child concerns reported by the Northern Constabulary, only 53 were submitted to the Children's Reporter. Previously, all would have been referred.
In the other 80%, that information went directly to the named person in health or schools, and where appropriate, plans and actions were put in place.
That should also ensure prompter responses for the 20% of concerns that did proceed to the Reporter. Hearings are being held on more children, suggesting that more of the right children are now being referred for compulsory measures.
Following a cluster of Child Concerns submitted by the Police about underage drinking in one community, the local secondary school adapted its PSD curriculum, and used the assessment framework to promote group discussion about the effects of alcohol on children's health and achievement.
School staff report they are finding it easier to talk to parents and children about their difficulties, because more information is being shared early. They say this is contributing to a culture of early engagement with families, about what were previously regarded as 'sensitive' issues.
Voluntary agencies are reporting greater involvement in children's plans. They are receiving relevant information effectively and say that they feel more equally included in the team around the child.
SHANARI = holistic interventions
A 7 year old girl's behaviour in school and at home was deteriorating. This was not only having an effect on her achievement, she was not being included by her peers. A multi-agency solution focussed approach, identified family relationship issues, and the need for the child to come to terms with a family bereavement.
Social work and voluntary agency supports were introduced by the school. Family relationships improved and on review after 10 weeks, it was decided that improvements were such, that additional support was no longer required.
Two children, aged 6 and 4 were removed under emergency measures, when both parents were using alcohol. The parents were hard to engage. The social worker used the assessment framework to help the parents understand the impact of their actions on the children, identify the strengths in the family, and confirm and commit to the changes they needed to make.
Families of children with disability say the assessment framework is more inclusive, and is also less stigmatising for the siblings who need support. It takes a whole family approach, and families say they feel 'more equal', because the same process is used for all children. For them, this promotes a welcome culture of 'child first, disability second'.
less bureaucracy = better support
Social Work Team Managers report a significant reduction in inappropriate requests for a qualified social worker. There is increasing trust in the assessments of other agencies, and this is reducing duplication for social work staff, and importantly, for children and families.
As part of that, social workers are also getting more appropriate requests for services much earlier, rather than waiting till crisis.
Midwives and Health Visitors say they are no longer 'scrabbling' around in the search for services and resources. They are clearer about what is needed, who can help, and say they can access that help more quickly.
Child protection registrations, and I am particularly cautious about reporting this, have been consistently lower for a sustained period. Practitioners report this is because the process is more focussed, and all agencies have more confidence in the system, including that multi-agency plans and actions will be in place whenever required, not just because of the registration label.
Common language = focussed action
Both families and practitioners say they like the assessment framework and the single child's plan meeting. Feedback indicates that the meetings are more focused, and that planning takes less time. Goals and actions are clearer, and the focus is on the tasks to be addressed, the support that is being provided, and the difference it is making.
Families are giving positive feedback on their part in the use of the My World Triangle. They say it makes them feel more involved, and not only do they know what the partners to the plan are signed up to doing, they understand better what they can also do to help their children and achieve change.
There are of course, continuing challenges.
It would undoubtedly have been easier to implement GIRFEC during most of the last 10 years, when services were growing. It is sometimes difficult to take colleagues with you, during a period of reducing resources. But then, as was said this morning, that's even more reason to make sure those resources are effectively managed.
Because assessment does determine service delivery, without further bureaucracy, there must be absolute clarity about the needs that are addressed by different services, and the safeguards that ensure they are being used appropriately.
Also, and especially if we are to have effective early intervention for all children who need it, we need an equity of early intervention services across communities. That means challenging traditional resource allocation models.
While we have been developing tools for use in children's services, we have recognised the need to undertake more work within adult services, both to support activity with parents, and also to better manage transition into young adulthood.
Through all of this, you grapple with the pace of change. It can often feel frustratingly slow, that we should be making more progress, but you must judge risk, and consolidate as you move forward. And you must more forward.
Finally, it is clear that the objectives of 'Getting it Right' cannot be achieved, if we continue to be dependent on paper, photo-copiers, stamps and envelopes. We absolutely have to have e-solutions. But thankfully, that is someone else's job, so I'll finish there ...