“Delivering person-centred support services for children with a disability and their families in times of risk, change and uncertainty”.

Q Exchange Final Report for Southern Health and Social Care Trust pilot project 2021 – 2022;

Project overview/abstract.

At the outbreak of Covid 19, Children’s Disability services worked with over 630 families within the Southern Health and Social Care Trust via a mixture of residential, short breaks fostering and contracted/non-contracted community programmes. The service is primarily focused on family support but also manages child protection and looked after children cases.

The project was primarily designed to support families and stop children with a disability being admitted to the care system when normal support systems are disrupted or withdrawn due to COVID-19 or other system pressures. Traditional services and education cease or are disrupted during these uncertain times which places additional stressors on these individuals. These families already often struggle to manage due to the additional needs of their children and these circumstances can overwhelm their coping abilities without an adequate respite response from statutory services. Bespoke 1:1 and 2:1 packages based in the community were therefore commissioned in conjunction with contracted and non-contracted providers to support families during lock down.

This was an action research qualitative approach designed to target children with a disability on the edge of care via a new social care support service pilot to build upon the model delivered during Covid.

Impact/project journey 

Two band 4 Social Care Support workers have been employed since October 2021 to offer flexible crisis intervention support to families assessed in need. This has involved some child protection cases, discharge from mental health facilities, unforeseen life events and chronic familial dysfunction. There have been 9 referrals to the service with 7 active interventions. The number of care admissions has decreased as detailed below although it is not possible to accredit this entirely to the advent of the service. However, evaluations and feedback from recipients and staff would indicate that the service has stabilised and improved situations were children were at risk of significant harm. Parents/carers have indicated within evaluations that without the service they were unsure what would have happened and they were very concerned for their family’s well-being. Therefore it is reasonable to hypothesise that the service has played a partial role in decreasing these care admissions.

Full-time care admissions
April 2019 – March 2020 – 9
April 2020 – March 2021 – 7
April 2021 – March 2022 – 2

Social work staff who referred families to the service stated during formal evaluations that the input of the service met their expectations with excellent engagement between the worker and family. The service was deemed to be beneficial to families in crisis and social work staff noted that it minimised the risk of family break down. Skilled intervention was referenced that met physical and emotional needs via focused implementation strategies with a reduction in undesired behaviours and an improvement in daily functioning. The consistency of the service provided much needed respite for carers and allowed them to spend time with their other children. The only suggestion to improve the service advocated making it a permanent resource rather than a pilot and staff stated that they would not hesitate to use the service again.

Carers who utilised the service were equally positive about the impact that it had on their family’s lives. Significant behavioural difficulties were common which had led to extreme stress and a negative effect on physical and emotional well-being. Emotional support to the carer and service user were cited as being welcome and essential. Satisfaction levels with sessions, activities, communication, flexibility and staff skills/knowledge were 83% very satisfied and 17% satisfied.

The kindness and support of staff was referenced and the importance of being provided with a break and emotional support during a family crisis. One parent stated “I have nothing but good things to say for the support I have received. I could not have made it this far only for the help and support extended to me – your service has majorly helped save our family!”

Learning

Enablers include a whole service approach that embraced person centred practice and working coherently as a multi-disciplinary team. This was the exact opposite of silo mentality which has been an issue in many Northern Ireland institutions and agencies and the fact that we have an integrated health and social care system was helpful. In practical terms this meant that the social care support workers were provided with information and advice from key stakeholders including clinicians, speech and language therapists, occupational therapists, community children’s nursing, autism specialists and social workers.

One of the main challenges encountered was a regional recruitment process which delayed the commencement of the workers. Another challenge was the potential for workers to be in environments where behavioural issues were extreme. This was countered by comprehensive risk assessments, recruiting highly qualified and skilled staff and providing a whole service support approach to the workers.

We have learnt that keeping the family at the centre is key and being able to respond quickly is essential. Relationship building and trust is possible within these parameters if you take the correct approach and silo mentality should be challenged and collaboration celebrated. Other Q Exchange members should remember that a simple aim/message that is effectively communicated to relevant stakeholders will definitely enhance the potential success of any project. We simply told people that we wanted to keep children out of the care system if this was appropriate and could be done safely.

Communications

The project has been disseminated via regional Head of Service meetings for children with a disability and also through a regional lunchtime presentation organised by the Northern Ireland Social Care Council (NISCC).  A further presentation during March 2022 at the Health and Social Care Annual Research Conference was positively received and transferable learning noted. The service was also highly commended by the HSJ Value Awards under the Specialist Service Redesign Initiative 2021. A journal publication under the open access process is a possibility with the publication “Childcare in Practice” and interest has been noted. Engagement with senior management within the Trust has been ongoing to look at funding streams and it is hoped to keep the service running beyond the end of the pilot period.

Next steps/sustainability

The potential to publish within Childcare in Practice would be a significant opportunity to highlight the project on a wider scale. Ongoing evaluations will be shared with senior management to secure recurring funding to keep the service running. Feedback and support from Q Exchange members would be useful in supporting this funding request. If any Q Exchange members have used any of the ideas or approaches detailed within the project this would also be beneficial to learn about with regard to transferable learning.

What have you learned that you will share with the community?

The key learning in this project is that sometimes by necessity we have to try something new and that this should be built upon and nurtured. Person centred approaches underpinned by evidenced based skilled and informed practice are welcomed by real people with real problems in the real world. “Lifesaver” is a term that many parents/carers used when describing the service. Collaboration and mutual respect between stakeholders including professionals, parents/carers and social care and voluntary workers should be embraced, promoted and celebrated. Project outcomes and any new learning will be shared via updates with the Q community.

What have you learned so far, either from the successes you have had or from where things haven’t gone to plan?

Significant issues with centralised recruitment system beyond our control has delayed the recruitment and start of social care support staff by about 3 months. However, past experience of these systems meant that we decided to proceed with induction training for these individuals prior to their official commencement date so we did not miss key training opportunities.

What could others learn from your experience of working with a range of stakeholders and collaborating across boundaries (geographical, professional, sector) – including what is working well and any challenges you have faced?

The big learning from this has been that silo mentality can be tackled when there is a clear simple message that is articulated and communicated clearly. This has meant that we have buy in from parents/carers, the voluntary sector, statutory sector including social care, clinical colleagues and AHP’s. The wide range of stakeholders has also touched the project with credibility as any potential issues would be addressed and highlighted from different perspectives. An open and honest learning culture has meant that different people understand the concept of using an existing evidence base to do something new and innovative. Challenges have been in engaging more parents/carers as their caring roles are intensive and their time precious. We have engaged with the Children and Young People’s Strategic Partnership (CYPSP) – the families, multi-disciplinary team, and the children. Used emerging and existing PPI groups to help inform and influence the development of the project) – Job roles on what the support workers would be doing have been based on what parents told us via questionnaires and working groups. Professionals within the multi-disciplinary process have also informed the development of the service in addition to the views of children captured via summer schemes and 1:1 bespoke packages evaluation.  For example we learned that children liked it being 1 to 1 as they were  able to get loads of interaction done on a one to one basis and it has worked. We were advised by some professionals that children with a disability would not be able to tolerate person wearing ppe – there were very little problems with this – lanyard with worker photos was one solution – they were happy with them wearing the mask .  some of the families who were managing  quite well prior to Covid and not on the edge of care list were the ones who required this service during covid – this was unexpected but important learning about what can happen in a crisis.

What are the next steps for your project over the coming months?

Commence workers and complete their induction and specialised training. Begin screening referrals and allocate cases based on priority need. Link with specialist services including IDCAMHS and Autism services to provide advice and resources to intervene effectively. We anticipate that out of 16 hours per week (per worker) 10-12 hours will be spent face-to-face with families including travel as Northern Ireland is a rural community; 4-6 hours will be spent at admin and attending multi-disciplinary meetings. The outcome measures will be captured utilising existing recording proforma’ s provided by the therapeutic team and contact sheets uploaded onto the PARIS information system. Baseline  presentation will be agreed at initial multi-disciplinary meeting and desired outcomes will be highlighted and any changes ascertained. We will use a simple scaling questionnaire to reduce the demands on the parents/carers providing feedback which will focus on areas such as stress/fatigue levels, mental health and has this service helped them – much of the evaluative material will be qualitative supplemented with some quantitative information around the number of challenging incidents etc. Intervention will normally take place and be measured over 6 weeks.

How can the community get involved in your project?

We are sure that there have been similar early/crisis intervention family support models completed before that can be used to inform practice. We need to add the therapeutic dimension and input to build on this within the context of harmonious and coordinated multi-disciplinary working. Therefore any advice from the Q community on how to do this effectively would be greatly appreciated.

September 2021: Q Report against milestones

Our Q Exchange project continues to progress positively. We have been providing updates on the Q Exchange website. This month we are providing a short update on the progress made against the original project timeline and how the outline plan for Q resources.

QI methodology has informed our project. we have applied this to our project, ensuring all risks and lessons learnt are logged at each monthly managers meeting.

Project Plan Timeline

Date/Planned action/Update

4th April 2021 – Scoping of providers and stakeholders for additional views, perceptions and information.

12th April 2021 – Liaison with psychology and Trust therapeutic Scaffold service to agree key training needs and staff qualities and qualifications. Agree appropriate supervision arrangements. Agree practical resources/equipment required for workers and source funding for same within existing Operational Manager for Short Breaks budget.

30th April 2021 – Finalise job description and personnel criteria.

14th May 2021 – Submit recruitment E-requisition and commence recruitment process.

6th June 2021 – Completion of Good Practice Guide.

14th June 2021 – Scoping of high priority children within children with disability caseloads. Agree referral criteria for service and identify appropriate decision making forum to process potential applications for service.

15th June 2021 – Interviews for 2 x band 4 social care support workers – this was delayed until 21st July 2021 by central recruitment issues.

26th July 2021 – Complete induction, mandatory and role specific training for social care support workers which will be sourced “in house”. –  this was commenced 23 – 24th August prior to the workers official start date due to delays with recruitment with further training to follow.

28th September 2021 – Commence social care support worker (x1) role second social care support worker following within the next 2 weeks.

22nd October 2021 – Induction and specialist training for social care support workers complete.

1st November 2021 – commencement of Role of Social Care Support Worker x 2 (16hrs per week)

8th November 2021 – Local Launch Event for new service.

17th January 2022 – Interim Progress Evaluation of Project Report

31 March 2022 – Final Evaluation of Service and Wider Regional Dissemination.