Baby Met PoliceMunro recommended that authorities provide struggling families with an Early Help Offer, as an addition to universal preventative services. For troubled families with more complex needs Marisa De Jager argues this, aligned with MASH (multi-agency) model, is the most cost-effective form of early intervention

Children and young people are often the most vulnerable members of our communities with local authorities and their partners providing social care support to those experiencing the highest levels of problems. Nevertheless, it is important that all partners and communities provide effective and co-ordinated help and support to children and their families at the earliest opportunity, to prevent them from having to experience such difficulties and related distress in the first place.

The Early Help and Troubled Families programmes are considered to be dynamic connections to the multiagency safeguarding hub (MASH). This system ensures identification, risk assessment and analysis and close coordination between family and professionals at the earliest opportunity; it is set up when cases are received from professionals (or parents) in the hub environment.

For those families experiencing multiple or complex issues it is vital they have access to a co-ordinated package of Early Offer of Help services delivered over a continuum and from universal preventative services to more targeted and or specialist services. This will ensure the appropriate help and support to families at the earliest stage. A range of partners need to work together to plan and deliver services – it is essential that these strong partnerships understand the role each agency plays and the impact each service has on supporting families. Any disconnect will jeopardise any interventions.

Putting children and families first

According to the review by Professor Eileen Munro in 2011 it was recommended that the government place a statutory duty on local authorities and their partners to ensure enough early intervention services are in place. This would ensure the need to make every child and family who fall beneath child protection thresholds an ‘Early Help Offer’, effectively of tailored services and resources. The wider Early Offer of Help refers to support in the critical early years of a child’s life when the fundamental building blocks of a child’s development are laid. This also gives support throughout a child, young person’s or family’s life and enables them to respond quickly when issues emerge. It helps to prevent difficulties escalating or becoming entrenched.

Preventative services and appropriate identification are more efficient for families and more cost effective than reactive services. They are also more effective in improving the life chances of children, young people and their families.

Universal preventative services, including pre natal support, are widely available to the whole population, to prevent problems developing in the first place.

There are processes in place for assessing whether a child or family is in need of Early Help and Prevention. It is accepted that most families achieve these outcomes and while only accessing universal services, such as health visitors, schools, GPs etc. The key principles for consideration are:

● Child first – ensure that the welfare of children and young people is the main priority and that the view of the child is considered at all stages.
● Family focused – acknowledge that working with families as a whole is often vital in achieving wellbeing for children and young people. Parenting skills and practices, for example, will have a major impact on outcomes for children and young people.
● Staying safe – be certain that any issues relating to the safety of children and young people are effectively and rapidly identified and addressed.
● Easy access – enable people and practitioners to gain access easily to appropriate support.
● Early Help – provide appropriate support as early as practicable to prevent problems escalating, thus reducing the demand for more intensive and expensive services.
● Consistent approach – provide consistent information, advice and support by ensuring local agencies are working to consistent approaches and processes.
● Skilled generalists – these are practitioners assigned to families and individuals facing a wide range of issues and problems that meet certain needs thresholds. This will help to provide co-ordinated and consistent support to people and avoid them having to deal separately with a wide range of services.
● Promoting independence – encouraging and enabling families to maintain their quality of life through accessing provision in their local community (helping them to help themselves).
● Accessible and delivered locally – where practicable, providing services within local communities.
● Trust and respect – trying to develop a trusting relationship between children, families and support services, ensuring the views of all are respected when trying to work together.
● Strengths-based approach – recognising people’s strengths and building on them to help reduce risk.

Approach to more severe and challenging problems

Nevertheless, there are some families that experience greater difficulties, and are more likely to access high cost services. They are also more at risk of achieving poorer outcomes than their counterparts.

Targeted interventions are initially offered to identify the children, young people and their families with existing risk factors to mitigate the severity of problems that have started to emerge, to prevent further escalation (and avoid entrenchment if left unaddressed).

There is a strong ethical, financial rationale and evidence base for early help within a whole family model. Several publications have highlighted the need for partners to deliver a co-ordinated, targeted and evidence-based early offer of help; particularly to those families who are most vulnerable or have more complex needs.

Professor Munro also said: ’Although the co-ordination of early intervention services was best delivered locally, the government needed to provide a clear legal framework to set out what vulnerable children and young people and their families should expect from local agencies.’

Local authorities therefore should aim to review and develop their Early Offer of Help alongside their partners to embed a whole family approach. This will ensure families have increased resilience and increased protective factors, reducing expenditure on expensive reactive services and ad hoc purchasing.

The current challenging financial context, however, requires exploring innovative methods of achieving this and it is important to consider how best to support and deliver early intervention and focus on the families that are increasing costs (known as Troubled Families).

Governance and accountability

The delivery of Early Help is not the responsibility of a single agency and should be owned by all partners/stakeholders who work with children and families including health, police, schools/colleges, probation, adult services, housing and the community, voluntary and faith sectors.

The Working together to safeguard children report (2013) requires all local agencies to have effective ways of working together to identify emerging difficulties and potential unmet need for children and their families. It also requires partners to work together to develop processes for the effective assessment of the needs of children who may benefit from early help services.

Leadership and governance should be provided across a partnership with a defined way of targeting and an overview and scrutiny provided, for example, by the Local Safeguarding Children Board, the Children and Young People’s Partnership and the Health and Wellbeing board. This will ensure that governance arrangements will wrap around the whole system robustly to support total management overview. If leaders are aware of gaps in their communities they will be able to evaluate strategic linkages and build networks to support this.

Strategic boards therefore will deliver implementation of projects and will monitor progress against objectives within specified timescales. The Local Safeguarding Children’s Board will offer support and challenge on the effective delivery of a strategy via regular checkpoint, highlight and issue reports.

Early Interventions in a time of austerity

There is no question that providing early help is much more challenging and more urgent when there is significantly reduced public expenditure. With limited resources, it is more necessary to ensure these resources are correctly targeted where they will make the most difference.

Correctly delivered, an Early Offer of Help has the potential to deliver services in the most cost effective way, reducing the need for more expensive intensive interventions as family situations become more complicated and entrenched, often across generations of the same family.

It is worth flagging up that while intervening earlier is more cost-effective in the long term and can be financed by disinvestment in more costly interventions, in the short to medium term it will require a refocusing of already limited resources. It should also be noted that in the short to medium term the Early Offer of Help may escalate costs because of raised awareness and increased demand at lower tiers of provision.

In addition, there will always be those children, young people and families that require more intensive and costly ongoing support.

Currently, services are operating within the context of rapid change. The key local/national drivers that are impacting on the Early Offer of Help are:
● The transformation agenda
● Reduction in public sector spending
● An increased focus on safeguarding of vulnerable children and families (The Munro Review Of Child Protection – A Child Centred System, 2011)
● The Children and Families Bill (2013), particularly those sections pertaining to SEN, Early Years
Family Justice reforms and, most significantly, the requirement placed on local authorities to deliver a local offer in partnership with children, young people and their families.
● NHS reforms – the development of CCGs and public health nursing (Children’s Community Nursing services, HV implementation plan, a call for action 2011 -2015)
● The Welfare Reform Act (2012),its impact on families who are already at risk of poverty.
● The Police Reform And Social Responsibility Act – puts greater emphasis on police and crime commissioners to support preventative measures in the community.
● Policies focused on early help and ’turning around the lives of children with multiple and complex needs‘, local authorities and their partners are required to secure sufficient provision of early offer of help services where children and their families do not meet the criteria for children’s social care.

Effective funding

In the Early Offer of Help field, many are looking to social investment as a potentially innovative way of diversifying funding to allow for an expansion of Early Help services, without reducing funding to other areas – addressing one of the most challenging aspects of shifting spend to an offer of help.

Currently one of the best known forms of social investment of interest to public sector agencies and their partners is social impact bonds (SIBs). SIBs are a specific type of outcomes-based, or Payment by Results (“PbR”) contracting. As with PbR contracts, SIBs involve a commissioner buying a service from a service provider (usually a Voluntary and Community Sector provider, VCS). Instead of paying for the service upfront, payments are conditional on the achievement of a set of pre specified, clearly measured targets for the outcomes the service achieves.

SIBs, however, are different from a direct PbR contract because they involve bringing in outside (social) investors to finance the provision of the service, rather than having that burden and financial risk placed on the service provider or commissioner.

These times of austerity will require that we need to control resources more effectively and be more creative about using our resources available by close liaison with partners. This ensures that there is tailored support at a local level, appropriate identification of an early need and support required and by developing our staff’s skills.

It is important to be aware of current and future political agendas that will influence practice and budget decisions. At present there is a continuing commitment to the principle of early intervention to counter the effects of disadvantaged families and there is also a renewed commitment to reform social work and strengthen training. The focus is on greater autonomy and innovation at practice level and also how we deliver services. These are likely to bring changes that will significantly impact on the manner in which the welfare of children are promoted and safeguarded.

Managers in this field should be able to make decisions based on limited budgets and conflicting needs and still ensure that children and their families are kept safe while staying within budget. This, of course, is an incredibly difficult task, but can be achieved by working closely with commissioners and being clear about services needed now and by keeping an eye on changing needs.