Last year, Social Care Institute for Excellence (SCIE) collaborated with Department for Education (DfE) on a project to improve mental health for looked after children. We asked a group of 30 children with this background what would most help them. They told us: ‘We want services which are joined up around our whole lives, not just parts of it.’
Troubled Families Programme
The Troubled Families Programme, which is seeking to transform the lives of up to 400,000 families, has a similar objective: to provide families with coordinated, holistic services and support which can help them overcome complex and persistent problems. In the areas featured below, Multidisciplinary teams (MDTs) are a key part of their local Troubled Families programmes and are enhancing the local offer provided to families in these locations.
MDTs are teams of professionals from different disciplines in health, community, social care, mental-health, employment, education, criminal justice and community services who work together to plan services and support for people and families.
Individuals and families facing multiple hardships often tell us that they are passed from pillar to post when they contact services. Information about them is not shared properly, proposed solutions are single agency ones, and when services are provided they don’t always feel coordinated.
MDTs seek to resolve these problems. MDTs, as we argue in a joint SCIE and Birmingham University paper, enable professionals and practitioners from different backgrounds and services to communicate better about each other’s roles and responsibilities, share information and design services which better meet people’s needs. If they are well organised, research shows they improve not only outcomes but also staff satisfaction.
MDTs that are working well have the following four features:
- an identified manager and/or practice leader who oversees and facilitates the work of the whole team
- a single process to access the workers in the team, with joint meetings to share ideas, insights and concerns
- electronic records of all contacts, assessments and interventions of team members with an individual and their family
- a ‘key worker’ system through which care for those with complex support packages is coordinated by a named team member
MDTs at the heart of the Troubled Families offer
In many parts of the country MDTs are at the heart of successful initiatives aimed at improving experiences and outcomes for individuals and families, with care and support needs that cross traditional professional and organisational boundaries. They are at the heart of many local Troubled Families offers.
In Liverpool, as part of the Troubled Families Progamme, we have seen the development of locality based, early help hubs, underpinned by MDTs, which provide coordinated early help to families, consequently reducing the demand for higher cost services. In the Hubs, staff have been skilled up to complete whole family assessments and measure outcomes for the whole family.
North Yorkshire, when a new Prevention Service was established in 2015, the Troubled Families approach and whole-family model of working was fully mainstreamed into casework activity delivered by the service. A key element of frontline practice is that the Prevention Service keyworker will work with all relevant partner agencies to ensure a co-ordinated multi-agency response is put in place to best meet the needs of children, young people and families.
Four years ago, Hertfordshire was concerned about the number of children at risk of neglect living in families facing multiple challenges. Developed by the Family Safeguarding Service and funded by the DfE Innovation Programme, Hertfordshire establish the Family Safety initiative, which involved setting up 22 co-located MDTs combining social workers and specialist staff to provide direct help to families on child safety issues, such as domestic violence, parental mental health and substance misuse.
The initiative provides a different approach to child protection using multi-agency workers and motivational interviewing. An independent evaluation found there to be indications of better outcomes for families and estimated cost savings to Children’s Services from reduced care and child protection allocations in the first 12 months of £2.6 million. The Innovation Grant has also enabled Hertfordshire to support 4 other local authorities to introduce this model.
The Stockport family model, also funded by the Innovation Programme, has MDTs at its heart, focusing on how different professionals can better support vulnerable families. Developed initially in relation to those who had experienced crime, this approach seeks to help families to deal with challenges and build relationships.
Mainstream services such as social care, health visiting, school nursing, early years and early help are organised into three localities within their traditional disciplinary teams. Specialist teams such as youth offending and ‘Mosaic’ (drug and alcohol) working across the borough and being ‘called in’ as required to reduce ‘hand-offs’ for families.
There has been as strong emphasis on openness and engagement in the service, with regular communication between colleagues, partners and families. This includes weekly sharing of good practice via email, informal coffee and conversation sessions with senior managers and very recently a focus on serious success reviews that examine why support for a given family went well capturing the family voice. Social media provides further opportunities for networking across organisations, roles and management levels.
Whilst it is too early to determine the success of the initiative, the signs are that it has become a crucial part of the success of the children’s service. Stockport was graded as ‘Good with outstanding features’ at the Ofsted inspection in July 2017.
In North Yorkshire the No Wrong Door initiative, also funded through the Innovation Programme, supports the local Troubled Families programme by seeking to improve the life chances for teenagers entering care by addressing their needs through a single MDT and one management structure which ensures that the young people have access to a range of complementary services and outreach support.
An evaluation of the 12 month pilot project revealed that 86% of adolescents remained at home through this successful out-of-care support, with reductions in remands and crisis presentations.
The evidence points to the potential for MDTs to bring about better outcomes, but they don’t happen simply by bringing professionals together. They require committed and collaborative leadership, a clear purpose, culture and defined role that requires team members to interact across professional and disciplinary boundaries, strong investment in integrated IT systems, joint training and where possible co-location. In short, MDTs help enable the properly joined up focus on what needs to happen to help young people and families achieve their potential in safe, comfortable and fulfilling lives.
Ewan King, Director of Business Development and Delivery
Social Care Institute for Excellence