Research Report
No 475
On Track Thematic Report:
Assessment, Referral and
Hard-to-Reach Groups
Paul Doherty, Melanie Hall and Kay Kinder
National Foundation for Educational
Research
with contributions from:
Lesley Noaks and Karen Moreton
Cardiff University
The views expressed in this report are the authors' and do not necessarily reflect those of the Department for Education and Skills.
© Queen’s Printer 2003. Published with the permission of DfES on behalf of the Controller of Her Majesty's Stationery Office.
Applications for reproduction should be made in writing to The Crown Copyright Unit, Her Majesty's Stationery Office, St Clements
House, 2-16 Colegate, Norwich NR3 1BQ.
ISBN 1 84478 089 9
September 2003
Contents
Executive summary
i
Chapter1
1
1
2
2
Introduction
1.1
Background
1.2
About this report
1.3
Methodology
Chapter 2
Chapter 3
Hard-to-reach service users
2.1
Introduction
2.2
Hard-to-reach service users: the
current situation in On Track
areas
2.3
Providing services to hard-toreach groups
2.4
Challenges when working with
hard-to-reach groups
2.5
Access to hard-to-reach services
2.6
Summary
Models of referral to On Track
services
3.1
Introduction
3.2
The role and contribution of the
On Track coordinator
3.3
The roles and contributions of the
broader On Track team
3.4
Routes of referral to On Track
services
3.5
The agency dimension of referral
3.6
Capacity boundaries and sites of
provision
3.7
Summary
5
5
5
9
11
14
16
18
18
18
20
20
29
32
35
Chapter 4
Chapter 5
Models of needs assessment
4.1
Introduction
4.2
Needs assessment at project
level
4.3
Needs assessment: degrees of
structure in different approaches
4.4
The experience of service users
4.5
The roles and contributions of
service providers
4.6
Service users ‘outside’ existing
provision
4.7
Summary
Concluding comments: implications
of the NFER research
5.1
Introduction
5.2
Hard-to-reach service users
5.3
Referral to On Track services
5.4
Needs assessment within the On
Track programme
36
36
36
42
45
46
49
51
53
53
53
55
56
Appendices
58
References
70
Executive Summary
Chapter 1 Introduction

On Track is a research-based, preventative, crime reduction programme involving
children aged between 4 and 12 years and their families. Originally conceived by
the Home office, the programme operates in 24 deprived areas in England and
Wales. It delivers a range of services (or ‘interventions’) which fall within six
main Home Office categories: pre-school education; home visiting; home-school
partnerships; family therapy; parent support and training; and specialist.
Chapter 2 Hard-to-reach service users

Three main types of hard-to-reach groups were identified throughout the NFER’s
evaluation of On Track services (NFER 2002). These were:

Type A definitions: where hard-to-reach was defined as the traditionally
under-represented groups, the marginalised, economically disadvantaged or
socially excluded.

Type B definitions: where hard-to-reach groups were defined as those
currently ‘slipping through the net’, the overlooked, ‘invisible’, or those
unable to articulate their needs.

Type C definitions: where hard-to-reach was defined as the service resistant,
those unwilling to engage with service providers, the suspicious, over-targeted
or those disengaged from social, economic or educational opportunity.

These definitions remained recognised and useful concepts within the current
phase of research, albeit broad. Thus, within these overall definitions, all of the
eight coordinators identified specific subgroups, the most common of which were
families in need; men; and families engaged in criminal activities and or antisocial behaviour.

Few services targeted hard-to-reach groups, although such groups were a feature
of provision since they made up a proportion of all service users.

The key challenges in working with hard-to-reach service users fell into four main
categories: site; staffing; engagement; and safety.

It was also suggested that services themselves were hard-to-reach. For example,
Social Services and specialist mental health agencies were consistently identified
as hard-to-reach services.

The more specialist and/or more threatening or stigmatising the service, the
greater the perceived distance between it and the community.
i
Chapter 3 Models of referral to On Track services

There were three main approaches to referrals:

A decision making approach – this was where the referrals came directly to
the On Track coordinator who would take the decision themselves as to who
should deal with the case and direct the referral to a team member or service.

A collective approach – this was where a referral came into the team and the
team as a whole reviewed the case, identifying the most appropriate team
member or service to allocate the case to.

A joint services approach – this was where referrals came to the coordinator
and/or the service provider themselves and they would jointly decide who
should take the case.

Users were referred to On Track through either formal or informal referrals from
another service/agency, or self referrals. Users became aware of On Track by
being informed by schools or other agencies or professionals, On Track service
providers, friends or family. ‘Formal’ referrals essentially utilised existing
professional providers and relationships between agencies, ‘informal’ involved
new relationships and ongoing dialogue between agencies.

Referrals came from a range of agencies, and the main categories were
educational agencies, health professionals, statutory agencies, voluntary agencies,
police/Youth Offending Service and self. It was possible for On Track to refer on
to other agencies and the main types of agencies referred to were educational
agencies, health professionals, statutory agencies and voluntary agencies. Within
these, there was evidence of clustering. For example, health providers tended to
refer to health services, school providers tended to refer to school-related
specialist services (e.g. speech and language therapy, educational social workers
and the education welfare service). This was related to service providers’ existing
professional links, their knowledge of service providers and to the co-ordination
of services around specific users (e.g. children) and sites (e.g. schools). There was
also some evidence of ‘two-way referral’, that is, where the clustering worked in
reverse, with professionals within the same ‘cluster’ referring cases back to On
Track.

Perceptions of the success of the referral process were generally positive. Key
strengths to the procedures included: flexibility; the scope for multi-agency work;
the open nature of the procedures; informality; clarity; and that the framework
they created and allowed professionals to build upon their knowledge of their
clients. There were challenges identified around the referral process: users could
be uncomfortable being referred to another service; and agencies could make
inappropriate referrals, or not co-operate.
ii

On Track served a specific geographical area, and in most cases, users had to
reside in the area in order to access services. However, there were circumstances
under which those living outside the area could access a service: users attending a
school in the On Track area; flexible interpretation of access criteria; where the
nature of the service itself prevented restrictions being placed on access (such as
universal service); and if the service user moved out of the On Track area whilst
in receipt of a service.
Chapter 4 Models of needs assessment

Needs assessment was either carried out at service level, or they were used across
services. That is, some projects used a common tool across all those services
provided, whereas others did not.

There were three main approaches to needs assessment. These were:



the outcome orientated approach: where the focus of assessment was on
agreed outcomes and structured time scales in which these were to be
achieved.
the needs led approach: where assessing need was the primary feature of the
process and the engagement of the service user was paramount.
the risk and protective approach: where identifying the risk and protective
factors associated with particular behaviours formed an essential part of the
process.

Service users were often unaware of any needs assessment procedures. Only a
minority reported that their needs had been assessed, although two thirds reported
that there had been an ‘informal chat’ with their service provider.

Service providers were central to identifying the needs of service users, although
some had a more prominent role than others.

Key elements of effective needs assessment included: the multi-agency coordinated approach; the involvement of users; and the ability to determine and
meet users’ needs accurately.
Chapter 5 Implications of the NFER research

It is clear that needs assessment approaches should not prevent the identification
of additional needs, for example, by limiting needs assessment to a one-off, entry
level exercise. The evidence of On Track is that service users, specifically hardto-reach service users, have multiple, complex and inter-related needs. Because of
the difficulties of engagement, these needs are often emergent and may not be
immediately evident or expressed.

The model of needs assessment adopted within any one area (or programme)
influences the roles that partners (including service users) play in needs
iii
assessment. Thus, the impact of any one model of needs assessment should be
considered carefully before implementation.

The quality of the relationships between different service providers (at both
strategic and operational levels) appeared to affect needs assessment. Where
some services shared information and engaged in inter-agency (or inter-service)
needs assessment, others did not, or did so reluctantly. Joint assessments are
invariably inhibited by differential strategic and operational commitment to them.
Hence, a focus on needs assessment may require or benefit from joint training.

At policy level the evidence of On Track suggests that needs assessment requires
an agency dimension, but need not be agency specific. That is, where some
providers have skills that are not widely available, the sharing of this expertise
could be encouraged through the provision of resources (or direction) to further
encourage the establishment of inter-agency working groups, or inter-agency
needs assessment panels for children and families.
iv
Chapter 1
Introduction
1.1
Background
On Track is a research-based, preventative, crime reduction programme aimed at
developing multi-agency partnerships and delivers a range of services to children
aged between 4-12 years (and their families). It was established within the Home
Office Crime Reduction Programme (CRP), which sought to both deliver preventative
programmes of crime reduction and through rigorous evaluation, develop existing
knowledge about which of these programmes were more or less effective in reducing
crime. The On Track programme was established in 24 project areas in England and
Wales. (Throughout the report, the terms ‘area’ and ‘project’ are used
interchangeably.) When the On Track programme was proposed, services were
developed under six main service headings (termed Home Office categories): preschool education; home visiting; home-school partnerships; family therapy; parent
support and training; and ‘specialist’ interventions. ‘Specialist’ interventions
appeared to cover pastoral work, (such as transition activity, designed to prepare
children for transfer from primary to secondary school) as well as those run by
specialised professionals such as speech therapists.
The first phase of the evaluation of On Track was led by the University of Sheffield,
where the National Evaluation Team (NET) was established to coordinate and lead
the research. Four Local Evaluation Teams (LETs) were also appointed to support the
national evaluation’s data gathering and to undertake evaluation at a local level in six
areas. In addition, a specialist training and consultancy organisation (Dreyfus UK)
was contracted to act as an Evaluation Advice and Support Team (EAST) and offer
advice and support to On Track personnel in each area, facilitating the evaluation and
feeding back key findings.
The first phase of the evaluation drew to a close in August 2002. To secure transition
to phase two (where a new NET would build on the work already completed) the 24
On Track areas were divided into three groups of eight on a regional basis and three
Local Evaluation Teams (LETs) carried out research in each regional area. The
National Foundation for Educational Research (NFER) was responsible for the local
evaluation of On Track in eight areas.
Each of the three LETs, with responsibility for eight of the 24 areas, was asked to
identify key themes for the research to be conducted between September 2002 and
April 2003. The NFER LET identified three key themes:



the assessment of service users
the referral of service users
issues around the assessment and referral of ‘hard-to-reach’ service users.
1
This thematic focus built on previous research carried out at the local level, which is
in part to be published as a Home Office Development and Practice Report DPR
(Doherty et al Forthcoming) and as a Home Office Research Report (Armstrong et al
Forthcoming) and which remains in unpublished reports for sponsors (for example,
Doherty, Kinder and Stott, The Final Report of the NFER Northern Office Local
Evaluation Team. Slough: NFER).
1.2
About this report
The report is set out in three main parts. The first part examines the current situation
in On Track areas in terms of providing services to groups considered to be ‘hard-toreach’; a theme pursued in previous NFER research (Doherty et al, Forthcoming).
The second examines On Track referral policies and procedures across the eight
programme areas, assessing both programme and service level referral (and the
referral of hard-to-reach groups). The third section examines assessment at
programme and service level in each On Track area, again assessing the experience
and implications of hard-to-reach groups. At the end of each section are summaries
and key points, drawing together data collected at both programme and intervention
level. ‘Programme level’ refers to the On Track programme as a whole, all of the
services implemented within an area under On Track. Intervention level refers to a
specific service (or raft of services) delivered within a particular Home Office
intervention . This could include multiple sites and providers, an intervention does
not necessarily provide a single service (such as Health), at a single site (such as
clinic). The interventions had strands, and these could include, for example, a school
nurse, home visitor, community based health advisor and paediatrician all providing
services under a generic title (such as ‘Healthy Living’) to a range of clients.
Therefore, when findings are reported at programme level, they extend (or have
relevance) across all interventions within a single On Track area and where stated
beyond the single area itself. When findings are reported at intervention level, they
refer (or have relevance) to that intervention and its associated strands, sites and
service providers, etc.
1.3
Methodology
The report is based on data collected on two occasions between October 2002 and
March 2003, in the eight NFER programmes. Each fieldwork visit involved focussing
on one intervention and included:

A structured interview with the On Track coordinator;

Structured interviews with those delivering the selected interventions;

Structured, semi-structured and/or focus group interviews with those receiving
services in the 16 selected interventions; and
Collection of documents associated with assessment and referral (such as
assessment tools, policies, etc).

Interviews were conducted using participant specific interview schedules and lasted
between 20 minutes (service user) and 60 minutes (On Track coordinator). Each
2
interview was recorded, so that analysis could take place from transcribed copies of
each interview. The data from interviews provided a narrative account of assessment,
referral and hard-to-reach from the perspectives of those at different positions and
with different roles in On Track. These accounts were summarised individually (as
individual narrative accounts of experience) and then analysed collectively and
comparatively. The structured schedule allowed cross-case analysis to take place, so
that each unit of discourse (such as a single interview) could be compared to another.
For example, the eight coordinators’ specific perceptions of a single schedule item
(such as service drop-out), could be juxtaposed. Or, a collation and ranking of all
participants’ perceptions, on an issue such as future service needs could be
undertaken. The qualitative data collected thus allowed the experiences and views of
participants to be relayed via a systematic analysis of key research categories. In
order to further assist this analysis, summarising data templates were also produced.
Examples of interview schedules and summary templates are provided in Appendices
2 and 3.
As noted earlier, the report builds on previous research carried out by the NFER LET
and, where relevant, draws on previous research findings from the different stages of
programme. Achieving a spread across the categories of intervention provided one of
the initial criteria for selection for the purposes of this study. In addition, because of
the number and scope of the different services being developed within the
programme, it was decided that 16 of the services (two services in each On Track
area) would form the basis of the research. This reduced the burden on those
delivering and receiving services and also built on previous work at service level.
Those services selected and the respective Home Office categories are set out in Table
1.1. (below).
Table 1.1
On Track interventions studied
On Track area
A
B
C
D
E
F
G
H
Intervention title
Health advisor
Home-school partnership
Family-school coordinator
Home visiting
Family therapy
Fast track
Nursery outreach
Home visiting
Consultation
Pastoral support
Parentline Plus
Family therapy
Home-school links
Supporting families
Webster Stratton
Transition
Source: NFER 2003 Evaluation of On Track
3
Home Office Category
Specialist
Home-school partnership
Home-school partnership
Home visiting
Family therapy
Home-school partnership
Pre-school education
Home visiting
Specialist
Specialist
Parent support and training
Family therapy
Specialist
Parent support and training
Parent support and training
Specialist
Researchers from NFER visited each of the areas twice, examining a different service
on each visit. The research reported here is based on 136 interviews with participants,
set out by their role in Table 1.2. Note that each coordinator was interviewed twice,
once for each of the services (16 interviews).
Table 1.2
On Track
area
A
B
C
D
E
F
G
H
Research participants and role
Intervention title
Health advisor
Home-school partnership
Family-school coordinator
Home visiting
Family therapy
Fast track
Nursery outreach
Home visiting
Consultation
Pastoral support
Parentline Plus
Family therapy
Home-school links
Supporting families
Webster Stratton
Transition
Total interviews
Service
provider
1
1
1
2
1
2
1
2
3
2
1
2
2
2
2
1
26
Service
user
5
7
13
4
1
6
4
3
9
5
5
6
16
2
2
6
94
Coordinator
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
16
Total
7
9
15
7
3
9
6
6
13
8
7
9
19
5
5
8
136
Source: NFER 2003 Evaluation of On Track
One of the issues relating to participation in the research was service type and user
profile. There were difficulties in achieving a target service-level sample of four
users in a quarter of the services studied. Significantly, these were services with a
familial component (though not necessarily those categorised as a family intervention)
and/or services that worked with marginal or difficult to engage users. For example,
in area G it was difficult for researchers to engage families in the research who used
the ‘drop-in’ facility associated with the service. In area C, parents with fragmented
and difficult familial circumstances did not keep appointments for research
interviews. Nonetheless, the sample was boosted wherever possible from other
services within the same Home Office category.
This report sets out the findings of research from each of the On Track areas. It
covers both general, programme wide issues and service specific dimensions.
Included in the report are comments and analysis from the Canterbury and Cardiff
Local Evaluation Teams, giving a national perspective on some of the key issues
addressed. Wherever possible, it suggests the implications of the findings for others,
specifically those who may be coordinating or delivering services in similar contexts.
4
Chapter 2
Hard-to-reach service users
2.1
Introduction
During the implementation of On Track services, the NFER LET carried out research
examining aspects of service delivery that involved those populations that were
considered to be ‘hard-to-reach’ in some way (NFER 2002). Three main definitions
of hard-to-reach groups were evident at ‘programme level’ (i.e. across a whole On
Track area) and at intervention level (i.e. those definitions operating within any single
service). Sometimes the definition of hard-to-reach varied, for example, different
definitions of who was hard-to-reach were used by different service providers within a
single On Track area. However, overall, three main versions were found:
Type A definitions: where hard-to-reach was defined as the traditionally underrepresented groups, the marginalised, disadvantaged or socially excluded.
Type B definitions: where hard-to-reach groups were defined as those currently
‘slipping through the net’, the overlooked, ‘invisible’, or those unable to articulate
their needs.
Type C definitions: where hard-to-reach was defined as the service resistant, those
unwilling to engage with service providers, the suspicious, over-targeted or
disaffected.
The definitions of hard-to-reach were significant, in that they formed the basis for
strategies for targeting service users and informed assessment and referral procedures.
Equally, given the preventative and experimental nature of On Track, hard-to-reach
definitions showed where service providers were experiencing most difficulties, or
expressing most concern around service delivery.
2.2
Hard-to-reach service users: the current situation in On
Track areas
In the current phase of the research, the definitions of hard-to-reach set out above
were again discussed with service coordinators and service providers. The purpose
was threefold: to assess the usefulness of the concept of hard-to-reach, to examine the
validity of the three main definitions and their consistency over time; and to examine
how services were being configured around the needs of hard-to-reach groups.
The research found that the main definitions (or ‘types’) of hard-to-reach remained
recognised and useful concepts, although all of the eight On Track coordinators
interviewed found the original categories very broad and tended to elaborate on
specific sub-groups within them. A number of specific sub-groups within the
population defined as ‘hard-to-reach’ emerged as key clients. These included: men;
families in need; and families engaged in criminal activities and/or anti-social
5
behaviour. The research found that familial issues were associated with the overall
hard-to-reach populations in seven of the eight On Track areas (see Table 2.1 below).
Table 2.1
Hard-to-reach groups: types and sub-groups
Area A
Main type
Type C: the service
resistant
Main type(s)
Type B: those
currently ‘slipping
through the net’
(and)
Type C: the service
resistant
Sub-group
Families who were seen as ‘difficult’ locally and the source of
anti-social behaviour
In this area hard-to-reach was defined as the service resistant, but
specifically those with children with specific needs, who were
often known to other agencies, but who were difficult to engage as
either individuals or in a family context (children with behavioural
problems that were condoned within the home were referenced).
Area B
Sub-group
Some families that were ‘invisible’ locally and families
resistant to intervention
The population of the On Track area (estate based) contained a
number of fragmented families who were reluctant to come
forward or make themselves known to service providers. They
did not resist services, but were passively disengaged from
providers and disengaged from the local community itself. A high
proportion of families on the estate were resistant to intervention,
specifically from Social Services. However, there was also an
issue around awareness of needs, where families did not see that
there was a problem around their own or their child’s behaviour.
Other families had already received a lot of interventions through
other agencies but had not ‘moved on’. They were not hard to
reach initially, but their behaviours were entrenched.
Area C
Main type(s)
Type A: the
traditionally underrepresented
(and)
Type C: the service
resistant
Main type
Type A: the
traditionally underrepresented
Sub-group
Those families not engaging after being targeted, ‘service
resistant’ and ‘high need’ families
Services were focusing on families who didn’t traditionally access
services, whether they were universal or selectively targeted.
These included: travelling families; families seeking asylum;
families who were ‘turned off’ by involvement with some
agencies (such as Social Services) for fear of losing their children
or because of child protection issues. There were also families
within the area identified with mental health needs and families
with drug and alcohol dependent members. There were also
families whose needs were not high enough for statutory
intervention, but who were not motivated enough to access lower
level preventative services.
Area D
Sub-group
Men within minority ethnic groups
Services were focusing on specific families within the broader
ethnic minority populations and the traveller community. More
recent work had identified men as a ‘hard-to-engage’ as opposed
to hard-to-reach. The On Track project were running a men’s
6
Main type
Type C: the service
resistant
Main type(s)
Type A: the
traditionally underrepresented
(and)
Type C: the service
resistant
Main type
Type C: the service
resistant
Main type(s)
Type B: those
currently ‘slipping
through the net’
(and)
Type C: the service
resistant
group for male lone parents and a men’s group for Asian fathers in
order to engage these groups.
Area E
Sub-group
Men resisting services and ‘high need’ families
Service resistant individuals were the main focus. Services
primarily focused on those families who had immediate needs.
This was challenging where male householders in particular were
unwilling to work with providers, specifically resisting Social
Services or other agency involvement around their families,
despite high need (the demographics of the area meant that there
was no significant minority ethnic populations).
Area F
Sub-group
Under-represented groups and ‘high risk’ families
Groups that were not engaging in the service were defined as
hard-to-reach because they were unaware of the On Track service,
though not necessarily resistant to it. The definition also included
those groups lacking the right information to make a choice. There
were also service resistant and ‘problem families’ in the area, who
were the source of a great deal of local difficulties, but this was
difficult to deal with without singling them out and possibly
increasing their resistance and/or the stigma associated with the
service.
Area G
Sub-group
‘High need families and those identified as ’criminally active’
Families within the overall ‘resistant’ group were hard-to-reach
because of specific, but inter-related difficulties: substance
misuse, domestic violence, poverty, poor housing standards or
limited abilities. There were families that stood out locally, ‘didn’t
fit’ and a cluster of factors, such as their physical appearance or
social isolation contributed to make their children vulnerable.
There were also offending behaviours and high risk factors
associated within some of these families.
Area H
Sub-group
‘High need’ families
On Track was trying to target those that resisted intervention with
providers and also trying to facilitate access to services for those
unable to meet the thresholds for entry to a service (often a
threshold set at a higher level than their need). On Track did not
target in terms of population characteristics (such as ethnicity), but
on basis of individual needs. This had identified a number of
‘needy’ families who were not formally know to any agency and
to a number of families who were known to many, but who
refused to cooperate with them.
Source: NFER 2003 Evaluation of On Track
There were two main reasons reported as to why certain families were becoming the
focus of service provision in On Track areas:
7


the incidence of family factors in any immediate problems identified or
expressed elsewhere (e.g. a child’s behaviour in school)
the development of truly ‘preventative’ services (e.g. services that required the
users’ cooperation and commitment in order to address and reduce the impact of
longer term problems, such as criminal behaviours).
The incidence of family factors could be directly causal (e.g. drug use at home
leading to erratic attendance at school), or could prevent progress during or after
intervention (e.g. parentally condoned behaviours could undermine work done in the
school). There were also social issues around the excluded family, those who were
victimised locally due to physical or mental traits, or who were not locally grounded,
known or included in community life. In some cases, the issue was around the needs
within the family and the family’s ability to express or articulate needs and access
services. In other instances, the issue was around the negative impact the family itself
played, preventing the needs being met. In some cases, the family unit was divided,
into those willing or able to engage (females and children) and those unwilling or
unable to engage (men). Moreover, once a user was in receipt of a service, some of
the ongoing behaviours (e.g. criminal and/or anti-social behaviours) within the home
environment were seen as contributing to his/her needs or preventing those needs
being met.
The development of truly ‘preventative’ services also required a greater focus on
those risk factors underpinning, or adding to needs expressed by children or parents.
For example, it was reported in three areas that specific families were identified with
a disproportionate amount of criminal and/or anti-social behaviour. Not only were
children of these families engaged because they were exposed to multiple risk factors,
but the families themselves represented a risk factor to others in the locality (either
victimising others or supporting their anti-social or criminal behaviours).
Preventative services, seeking to protect children and families, ultimately encountered
such families and needed to engage them in provision. Building trust with and
securing the commitment of these families to intervention was a major challenge for
service providers.
The definitions of hard-to-reach (Types A-C) that were evident were underpinned and
informed by an awareness by providers of current ‘gaps’, overlap or inappropriately
targeted services. Given the preventative nature of On Track, this offered an
opportunity to engage in work that was outside usual practice or sphere of influence.
Therefore, hard-to-reach was a concept that service providers used to rationalise their
decisions to extend into new areas of work. The increased familial dimensions to the
concept reflected its greater use in practice. ‘Hard-to-reach’, in moving from broad
types to specific user groups, was becoming more useful in defining practice and
informing decisions around which service users should receive services.
8
2.3
Providing services to hard-to-reach groups
Earlier research by the NFER LET suggested that very few services (interventions)
were explicitly targeting hard-to-reach groups: only one of those 12 studied in July
2002. During the most recent research, when the data from the project level was
compared to that collected at intervention level, it was clear that providing services
for hard-to-reach groups was becoming more of a focus of On Track activity, but
hard-to-reach groups were still not the main target of interventions. Of the 16
interventions examined in more detail, three were specifically targeting hard-to-reach
groups: Home Visiting in area D, and both the Consultation and the Pastoral Support
interventions in area E. Of the remainder, 12 interventions were not specifically
targeting hard-to-reach groups, but such groups were a feature of provision, making
up a varying proportion of all service users. Only one intervention (Home-school
links in area G) was not working with groups considered hard-to-reach (see Table
2.2).
The research found no discernible link between the type of service (by Home Office
category) and whether or not it targeted hard-to-reach groups. This suggests that
targeting was area or agency specific. The decision to target hard-to-reach groups was
taken at strategic level in area E, whereas in other areas it was a decision delegated to
service level, to greater or lesser degrees. So, a service which fell under the ‘Family
Therapy’ Home Office category was no more and no less likely to target hard-toreach users than one under the Parent support and training category. This may
account, to some extent, for the diversity at service level overall where targeting
depended on local criteria and need. Perhaps in the case of area E, where hard-toreach was defined as the ‘service resistant’ in a relatively homogenous and
geographically defined area, strategic direction was easier.
Given the lack of strategic steerage evident in the majority (seven of eight) On Track
areas, the extent to which hard-to-reach groups could be targeted was linked to the
focus, interest and capacity of service providers. This was in turn influenced by other
factors. Site of delivery and the configuration of the delivery team affected the extent
to which hard-to-reach service users could be engaged, or would come forward. For
example, in school-based service delivery, hard-to-reach groups may be reluctant to
engage with providers. As one service provider mentioned:
“I think schools can be very, very intimidating places for parents. I think
teachers can patronise you and I think more so in secondary schools than
primary school. And I think [if] parents felt patronised by their child’s
primary teacher well they’re not going to make any attempt to see their
secondary school teacher [of that child] either” (service provider).
9
Table 2.2
Area
A
B
C
D
E
Services targeting hard-to-reach groups
Intervention
Health advisor
Home-school partnership
Family-school coordinator
Home visiting
Family therapy
Fast track
Nursery outreach
Home visiting
Consultation
Pastoral support
F
G
H
Parentline Plus
Family therapy
Home-school links
Supporting families
Webster Stratton
Transition
Targeting hard-to-reach groups
Not specifically, delivering on a needs basis only
Not specifically
Not specifically, but working with some families
experiencing drug use and domestic violence
Not specifically
Not specifically
Not specifically
Not specifically
Yes, mothers experiencing domestic violence,
single parents, carers, drug users, those resistant to
intervention and Asian women, all of whom were
considered hard-to-reach
Yes, parents who were service resistant, who may
have been involved in crime or have other
problems, such as drug abuse
Yes, those reluctant to engage with statutory
providers
Not specifically, but attempting to target hard-toreach parents
Not specifically
No, not directly working with hard-to-reach groups
Not specifically, but starting to target fathers
Not specifically, but attempting to target families
reluctant to engage with statutory providers
Not specifically, hard-to-reach groups have such a
range of needs they are often unable to address the
issue of transition at all
Source: NFER 2003 Evaluation of On Track
10
Home Office category
Specialist
Home-school partnership
Home-school partnership
Home visiting
Family therapy
Home-school partnership
Pre-school education
Home visiting
Specialist
Specialist
Parent support and training
Family therapy
Specialist
Parent support and training
Parent support and training
Specialist
Hence, areas where school-based services were an integral feature of delivery (such as
area H, area C and area B) reported difficulties in engaging hard-to-reach service
users. The findings at this stage of implementation suggest that strategies were being
developed to compensate for any negative effect of site-service-team factors that
reduced engagement. For example, in area C, the Fast Track intervention was schoolbased, but engagement of parents, many of whom were hard-to-reach because of
fragmented family circumstances, was enhanced through the strand that supported
parents in their home. This increased pupils’ attendance, reduced drop-out and
provided the school-based staff with important family information (such as children’s
degree of exposure to risk factors in the home). It also brokered the relationship
between providers and parents, with social work staff modelling strategies of
assessment and engagement for the benefit of other professionals, such as teachers,
which they could then adopt to reduce any tensions between the school and parents
around children’s needs. This accommodation between site, provider and hard-toreach service user was evidence that hard-to-reach groups were engaged after
services were established (in most cases). They were not, for the most part,
specifically targeted from the outset.
2.4
Challenges when working with hard-to-reach groups
There were various challenges identified when working with hard-to-reach groups and
these were reported across all eight of the On Track areas:

Keeping service users engaged for the life of the intervention,
specifically those with difficult or fragmented home circumstances

Limiting the perceived distance between the service provider and user,
if the user felt culturally or socially comfortable with the provider

The lack of suitable local venues for service provision, particularly
venues that were non-stigmatising or threatening to potential users

The geographical proximity of the service to the service user, where
users lacked mobility, willingness and/or the resources to travel even
what may be perceived by providers as quite short distances

The lack of points of contact with hard-to-reach groups, their
existence on the margins of society and their anti-social values and/or
behaviour

The multiple and extensive needs of the ‘hardest-to-reach’ and the
extent to which preventative services were appropriate given the level
of crisis within their lives

The tensions of working across professional or agency boundaries,
within the team (such as between police officers and social workers)
and between teams (such as voluntary and statutory providers)
11

The lack of information about hard-to-reach groups, their visibility
and transience or their engagement in criminal behaviours that made
contact difficult

The lack of appropriately experienced staff with the skills required to
recruit and engage hard-to-reach groups

‘Initiative overload’, where families were weary of any intervention
and suspicious of new services being offered

The risk involved in working with the target group for the service
providers, including threats to their safety and fear of assault.
Overall, these challenges fell into four main categories:




safety
staffing
engagement
site
Of the four main categories, safety was specifically identified with the service
resistant, and sub-groups involved in criminal activity and associated anti-social
behaviour in the area. It was reported that threats to the safety of On Track workers
had been made and that these posed significant barriers to working with children.
Challenges around staffing were associated with inter-agency teams more than single
agency delivery. These challenges could include: levels of remuneration; attracting
staff; retaining staff; tensions between agencies; and the appropriate skills-mix
required to deliver services. Such a list features in many other studies of multiagency activity (see Atkinson et al, 2002, Makins 1997, Normington and Kyriacou
1994).
The challenges around engagement were predominantly associated with the service
resistant and the ‘traditionally’ hard-to-reach groups (such as members of minority
ethnic groups). One aspect here was contact or routes to engagement. It was
possible, for example, for On Track community outreach workers to identify routes to
a group that trusted them, or to establish contact with groups who were unwilling to
engage with the other services as they were currently delivered, or with staffing as
currently configured. Where hard-to-reach was defined as, or derived from those
‘slipping through the net’, the overlooked, ‘invisible’, or those unable to articulate
their needs (Type B), then the challenge of engagement was also about awareness, of
the potential user and their needs.
The challenges of site varied across areas and these will be examined in greater detail
in Chapter 3. Nonetheless, it was evident that the lack of suitable space for service
delivery, both in terms of its suitability of purpose and its suitability to potential users,
was a major issue in areas such as area H, where adequate space was difficult to find.
In area A, the issue was less of space than the extent to which potential users
identified that space with a particular service and, on occasion with the stigma
associated with that service.
12
Overall, the On Track provider’s configuration of services, the make up of delivery
teams and the sites in which services were provided, suggested that providers were
already aware of the challenges associated with engaging hard-to-reach groups.
However, despite any awareness, it was also suggested that existing practice did not
always provide the services that were required, the places where they were required,
by staff who were trusted by service users.
On Track was an opportunity to continue to try innovative work with those groups
whose needs were not, for one reason or another, being met. While refining and
redefining which potential users were in fact hard-to-reach, service providers faced
these issues of site, staffing, engagement and safety. The research conducted by the
NFER in eight of the 24 On Track areas was examined by other LETs, in order to
address the generalisability of any findings. For example, from the Cardiff LET it
was reported that a similar move towards family definitions of hard-to-reach, with a
focus on men was taking place. Indeed, many of the strategies of identification and
engagement evident in NFER project areas were evident in the Cardiff sample also.
An example is provided below.
Cardiff University Cameo
Hard-to-reach: Parent Factor 85
The Parent Factor course existed pre-On Track (but not specifically in the On Track area) and was run
to the same 6 session format as part of On Track. Each session covered different parenting issues and
gave the participants the opportunity to discuss and share problems. The parent training was only
attended by mothers although efforts to engage fathers were made. The course and support sessions
were delivered through group work. Participants were able to self-refer or other agencies referred them.
Attempts were made by the intervention co-ordinator and On Track senior practice development officer
to attract fathers to the course, for example, a course was attempted in a pub setting in order to offer an
attractive venue for fathers. This was not successful as attendance fell dramatically after the first week.
Parents who had themselves undergone the parent training acted as facilitators of the course to decrease
the stigmatisation for those thinking about going along to groups.
The self-esteem of parents had been raised as a result of the course. Parents also reported feeling more
in control of their children’s behaviour in the home and that they felt more confident about their
parenting skills. They had also established new sustainable friendships and found the courses fun. This
lay behind setting up the ongoing support group.
Volunteer facilitators reported satisfaction in knowing that other parents could learn from their
experiences. One volunteer described this as a life changing experience. Since volunteering, she had
spoken at conferences and had written an article on her experiences. Subsequently, she felt she had the
confidence to enter the labour market.
The course providers planned to develop the intervention further. This included further involvement of
parents as volunteer facilitators; further strategies to attempt to engage fathers and generally more
targeting of parents who would benefit from the service. They were also thinking about to how they
would explore the views of children whose mothers were taking part in the programme and also those
of partners who did not attend the programme. This latter point particularly applied to some working
fathers.
13
2.5
Access to hard-to-reach services
The concept of services themselves being hard-to-reach was raised in previous
research (NFER 2002) and in subsequent dissemination of findings to On Track
coordinators and service providers. A number of these professionals pointed out that
identification of individuals or groups as ‘hard-to-reach’ risks, albeit unintentionally,
linking the problems around take up with that individual or group, not with the service
provider and/or the way the service was delivered. There was a danger therefore, that
any programme-wide or service-level solutions to the problem of hard-to-reach
service users risked ignoring the ways in which the services themselves could isolate
or alienate potential users. In order to examine this further, On Track coordinators
were asked about the extent to which services in their area were hard-to-reach and if
they were, how access might be improved.
Two services were consistently identified as hard-to-reach: Social Services; and
specialist mental health services (specifically CAMHS - Child and Adolescent Mental
Health Services).
During this phase of the research, across all eight On Track areas, Social Services was
most frequently identified by providers and coordinators as the hardest-to-reach
service for children and families. However, explanations for the cause of this varied.
In one area, it was suggested that service users did not really worry about who
provided the service, as long as their needs were met. However, local Social Services
were perceived as quite ‘precious’ about working with other providers and tended to
protect their role. In other areas, the difficulty was linked to resources and the
staffing difficulties. It was reported that, within Social Services, numerous posts
remained unfilled and there were problems attracting staff. In addition, initiatives
such as Connexions and YOTs (Youth Offending Teams) had taken staff out of social
work, thus reducing capacity. The stigma associated with Social Services was cited
as making the service hard-to-reach in two other areas: in both cases this related to
historical mistrust around major investigations into child sexual abuse. It was
reported that the hostility to Social Services had led to their withdrawal and/or
reluctance to work on the estates.
The high threshold of need which governed access to a service was associated with
the more negative perceptions of Social Services in two city-based programme areas.
Here, it was felt that Social Services simply could not meet the existing level of need,
it was simply too great for them to deal with. However, in another area (where Social
Services were reported as ‘invisible’ locally), this inability to cope with high demand
was seen as a convenient screen behind which their withdrawal from responsibility
was taking place. Here, there was a perception among users that some of the
interventions offered by Social Services were ‘clumsy’ and contained within them an
embedded ‘lack of respect for children and families’.
The problematic nature of the relationship between user and provider was also
associated with Child and Adolescent Mental Health services (CAMHS), identified as
hard-to-reach in six of the eight areas. The ‘medical model’ was seen as unhelpful
when working with vulnerable groups, where the intended recipients of services were
not always engaged in finding solutions to their own difficulties. A commonly
reported problem was the removal of children from the CAMHS waiting list if they
missed scheduled appointments (usually two or more). Providers and users felt that
14
this failed to take account of the fragmented nature of life in disadvantaged
communities, the lack of transport, social isolation, etc. In addition, the specialist
nature of the service and site of provision made CAMHS appear distant compared to
other providers: it was reported that users felt alienated and lacked confidence in
contacts. However, while CAMHS was singled out for criticism, in many cases this
extended to other health-related services. The ‘clinical’ health services were
identified with difficulties of engagement, whereas community-based health services
(such as School Nursing and Health Visitors) were not. This suggested that the issue
was of specialism and site of provision, rather than to service as a whole.
Beyond the two most frequently cited hard-to-reach services, there were a range of
others: schools were least cited (although were referenced), followed by voluntary
providers. One of the issues relating to statutory and voluntary providers was
‘culture’: the cultural distance or proximity between provider and user (or potential
user). Voluntary providers were reported as less ‘distant’ and more ‘in tune’ with
local populations and their needs. There was a perception that, the more specialised
the service, the greater the distance. However, some voluntary providers were also
identified as hard-to-reach. In two areas, this was linked to the values or ‘mission’
underpinning the organisation. If this was expressed to users in ways that were
perceived to be a little too ‘explicit’ then it was perceived to be unhelpful or even
alienating. Alternatively, if they were closely identified with issues around child
protection, then their services were not necessarily seen as any easier to reach than
those of statutory providers.
Overall, the research suggests that the more specialist, threatening or stigmatising the
service, the greater the perceived distance between it and the community: some
providers (including non-specialist) inevitably faced problems of engagement,
whatever the need for their intervention. Nevertheless, there was also evidence of
ways in which services that were deemed hard-to-reach (whether perceived or actual)
sought to diminish any negative effect. Five main strategies by which service
providers attempted to improve access were identified:





Blurring any agency identity and/or any agency specific roles
Reducing the ‘distance’ (perceived or actual) between the service user and
the service provider
Shifting the site of provision towards the community
Providing a broader range of services, including engaging in more
preventative work, increasing visibility
Learning from those strategies developed by any voluntary groups active
locally.
These strategies varied by site and service, they were not necessarily all evident
within any one service, but collectively used to increase access. For example, social
workers joined multi-agency teams offering support in the home and community. In
some cases, they did not explicitly stress their role as social workers, but in other
cases they did, making it clear that they had a certain role within the service. A social
worker in one area helped to run the youth club so parents could pick up their children
and see her there and talk to her and she could support them. This reduced stigma and
increased contact, so led to the earlier identification of need and greater willingness to
express that need to the agency. In other cases, services ‘moved out’ into the
15
community. In another area, specialist services were made available through schoolbased intervention. Specialist health and mental health services were offered to
children and families by the team siting themselves in local primary schools.
According to the head of one of these schools, prior to this the credibility of the
service was ‘close to zero’. The teachers did not understand the assessment criteria
and felt that they could not influence the service. In some cases children had needs
that were too severe to be dealt with, leading to feelings of frustration. Parents were
unwilling to engage in services that were provided at a central site, feeling stigmatised
by any assessment the school made about the needs of their child. Reducing the
distance was achieved in some cases by ‘fronting’ the service with local community
development or outreach workers. The credibility of local workers lent authority and
trust to the inter-agency team of which social workers were members. However, even
where this was successful, a balance was sought between the appropriate skills
required to engage and the skills required to deliver, ‘fronting’ or screening a service
could not compensate for inappropriate content or poor delivery.
Local voluntary agencies were perceived by users and potential users to be more
likely to engage with those families who were alienated from other providers because
of a lack of capacity, cumbersome or time consuming entry requirements. These were
‘skilled engagers’ and could work with other providers to share good practice. In
area D, quite simple, but effective ‘bridging’ strategies were developed, such as
visiting families in their homes, or calling by telephone to remind them of Child and
Adolescent Mental Health Service (CAMHS) appointments. Working out-of-hours,
in tune with parents’ lives and replacing any organisational needs with a focus on
children and families (and their needs) was identified as a good way of gaining their
trust and respect. Models of engagement were based on the local practices developed
by voluntary providers. As such, they were perceived to be more sensitive to local
context than those used by statutory providers. Where the statutory providers adopted
or copied these models, engagement increased (for example, fewer appointments were
missed). Across all of the eight On Track areas, there were examples of ‘hard-toreach’ being a concept applied to both user and provider, and evidence of a range of
strategies being required to meet the needs of these potential users.
2.6
Summary

It was clear from the research undertaken that the concept of hard-to-reach
remains useful for service managers and providers.

The ways in which service users were identified as ‘hard-to-reach’ had undergone
a degree of refinement at both programme and service level. Definitions were
linked to the very broad typology developed from previous research but which no
longer fully captured the complexity of approaches within the On Track
programme.
Despite this, the three broad types: the traditionally
underrepresented; those currently slipping through the net; and the service
resistant remained useful concepts around which to start to target specific
populations within the area.

A significant feature of the conceptual developments of ‘hard-to-reach’ had been
the consistency with which families within the various categories, or types of
hard-to-reach groups had become seen as hard-to-reach. This was also linked to
divisions within families, the reluctance of men to come forward, the engagement
16
of family members in crime or anti-social behaviour. Where only a minority of
those services studied were explicitly (and solely providing) services for hard-toreach groups, the challenges of attempting to extend services to such groups were
commonly experienced and associated with site, staffing, engagement and safety.

Examining the concept of services as hard-to-reach identified some key challenges
for service providers in the statutory and voluntary sector. Although some
agencies were associated more frequently with difficulties of access, the problems
were not agency specific and affected a range of providers. Engagement was
increased when providers: ‘blurred’ their agency identities (while retaining their
agency’s integrity); reduced the distances (geographical, physical, cultural and/or
professional) between themselves and the users; became community focused
providing a broader range of services (over differing timescales); and learnt from
successful strategies already in place – often developed by voluntary providers.

Work with those receiving services highlighted that their needs were multiple and
often complex, occasionally resistant to single solutions and ‘quick fixes’.
Therefore, agencies needed to make a longer-term commitment to the
communities and work collectively to meet their needs.
17
Chapter 3
Models of referral to On Track services
3.1
Introduction
This section focuses upon the referral of children and families to On Track services.
It will consider the role and contribution of the coordinators in referral, that of service
providers and examine the routes of referral. The section is based upon face-to-face
interviews conducted with the coordinators and service providers in each of the eight
NFER LET On Track areas. Two of the coordinators were ‘acting’ and so it is
possible that some of the participants were more ‘immersed’ in On Track than others.
3.2
The role and contribution of the On Track coordinator to
the referral process
The interviews carried out with the On Track coordinators highlighted three main
approaches to their management of referrals. These were:



Directing referrals, i.e. where the coordinators directly allocated users to a service
Team referrals, i.e. where the team as a whole took responsibility for allocating
users to a service
Taking no direct role, i.e. where the referral process took place at intervention
level.
Table 3.1 (below) shows these main variations, a more detailed summary, along with
the time commitment, can be found in Appendix 4.
Table 3.1:
On Track
Area
A
B
C
D
E
F
G
H
A Summary of the involvement of coordinators across On
Track
Coordinator’s
involvement
Team referrals
Team referrals
No direct role
Directing referrals
Directing referrals
No direct role
Team referrals
No direct role
Source: 2003 Evaluation of On Track
Those coordinators directly allocating users to a service was evident in two projects,
area D and area E. In area E, referrals came directly to the coordinator, who then took
18
the responsibility for allocation to interventions, whereas in area D the coordinator
additionally carried out the assessments and then allocated the user to an intervention.
The distinction was, while both received referrals directly, only one also took direct
responsibility for needs assessment. In the majority of cases, these were individuals
who had not already been assessed elsewhere.
The use of team referrals (where the team as a whole took responsibility for allocating
users to a service) was evident in area A, area B and area G. Here, the coordinator
involved the whole On Track team in the process. In area A, referrals were logged
onto a central case management system that constituted a referral to On Track as a
whole, and not a specified intervention. The case management system was looked at
on a weekly basis during a team meeting. At this point, referrals were directed to the
relevant intervention on the basis of their needs. The main presenting need shaped
allocation, for example, if the main presenting needs were educational based, the
home school link worker may be identified as the relevant team member to deal with
the referral. This team member would carry out a needs assessment and bring the
case back into the management system where the whole team checked the assessment
to identify the relevant worker. In some instances, the worker originally allocated the
case would continue to work with the user. In other cases, another team member was
brought in who specialised in a different area, such as health if additional needs were
identified. In area B, weekly referrals meetings were held and these were facilitated
by the coordinator, although she did not play a key role at referral level since referrals
were brought in by On Track staff (for example, school based team members).
Within these meetings, the team as a whole discussed each referral and the work
appropriate to the case. In area G a ‘hybrid’ approach existed, where the team as a
whole took responsibility for allocation, but the coordinator took little active roll
within the team, delegating most decisions to service providers and adopting a
coordinating role. It was a team referral system, but while the coordinator was in the
team, she played a relatively passive role. However, decisions were not delegated to
intervention level; the process remained within the team.
Coordinators were taking no direct role in the referral process in three areas; area C,
area H, and area F. In these cases, referral was delegated to the On Track team.
Referrals also took place at intervention level. In area F for example, referrals were
made to the individual interventions rather than the On Track coordinator or On Track
team.
The extent of the coordinator’s involvement in the referral process had implications
for workload, i.e. the amount of their time it required. For those who had direct
involvement in referral, the time spent on the task was from one hour per week to
over half a day per week. This suggested that direct involvement did not necessarily
correspond with a high time commitment. Where coordinators did not direct referrals,
this was reflected in the demands made upon their time. One of the coordinators said
that the time taken was ‘practically none’, while another said that referral might
merely involve an occasional telephone conversation.
Six out of the eight area coordinators interviewed indicated that they were satisfied
with the degree of their involvement in the referral process. Nonetheless, these
coordinators acknowledged that this might change in the future. For example, one
coordinator felt that implementing services corresponded with their increased
19
involvement in the referral of service users, while another suggested that involvement
would increase as information sharing protocols and systems were developed. None
of the coordinators felt that the demand which referral procedures made on their time
was unreasonable, despite the variation in the level of involvement in the process.
Only one of the eight coordinators reported dissatisfaction with the level of
involvement in referrals and this was attributed to feeling ‘over involved’ in referral
(here, referral required over half a day each week of the coordinator’s time).
3.3
The roles and contributions of the broader On Track
team to the referral process
Just as the roles and contributions of coordinators were contrasting, the degree of coordination with providers in referring users to On Track also varied. This depended
on how the coordinator managed the referral system and upon the service on offer.
Three potential approaches were identified:



A decision making approach – this was where the referrals came directly to the On
Track coordinator who would take the decision themselves as to who should deal
with the case and delegate it accordingly to a team member or service
A collective approach – this was where a referral came into the team and the team
as a whole looked at the referral. They identified the need and subsequently the
most appropriate team member or service to allocate the case
A joint services approach – this occurred where On Track was run in conjunction
with another agency, e.g. Social Services. Referrals could come in to the
coordinator and/or the service and they would jointly decide who should take the
case.
As may have been expected, the contribution of the wider On Track team mirrored the
role of the coordinator to a greater or lesser degree. However, this in itself suggests
that, although the coordinator role is primary in referrals, others may shape or limit
that role, and are in turn shaped in relation to it. Thus, where the coordinator directed
referrals, a joint service approach within the team was not only less evident, but less
possible. The coordinator’s role determined, to some extent, the role that others could
take.
3.4
Routes of referral to On Track services
The means by which users were referred to On Track ranged from informal to
structured processes. The three main routes of referral were:



Formal referrals from another service or agency
Informal referrals
Self referrals.
Formal referral of users to On Track services could come from one agency making an
explicit referral to On Track where they had identified a specific need. For example,
a GP(General Practitioner) or a senior teacher might have filled in a referral form for
a user with a particular need and then passed this on to the On Track team. Parents
whose children were participating in the Webster Stratton dinosaur curriculum in
20
school could be referred to a parenting programme running in a community venue by
their child’s teacher. In other areas, referrals could come from Social Services, school
nurses, health visitors or from voluntary agencies. The main feature of the route was
its formality, from one professional to another, often drawing on existing procedures
or professional relationships.
Informal referrals occurred when a professional ‘suggested’ a user to On Track, but
stopped short of making a formal referral. For example, the provider of Consultation
in area E reported that referrals were made through ‘a process of ongoing dialogue’
with schools or parents. Teachers and other professionals met and informally
discussed referring cases within and across agencies. The main feature of this
approach was the informality of the process and the new professional relationships
that were developed between providers.
Across On Track areas, but not across all services, users were able to refer themselves
to a particular service. This could occur by the intervention of a third party (like the
informal approach above), but also where awareness of a service had been raised. For
example, a user may have heard about the service through a friend or a poster. They
may then have gone on to request the service directly from the provider. The main
feature of this route was the proactive role played by the service user in coming
forward for the service.
As would be expected, the research found that, regardless of whether services were
universal or selective, eight key selection criteria were evident across On Track areas:









The user lived within the On Track area
The user attended a school within the On Track area
Parents who were receiving a service had at least one child between the ages of
four and 12 (not necessarily in receipt of an On Track service)
The child/parent/family had behaviour problems
The child had problems at home
The child had problems at school
The user (child/parent/family) had needs that were not being met by statutory
providers
The user was exposed to a range of risk factors, e.g. poverty, poor housing,
truancy, involvement in crime, etc
The child was aged between 4-12.
These were obligatory factors, that is, they formed the basis of entitlement across the
services provided. Because of the high level of need within the local population, they
also acted as filters to services, with providers and/or coordinators excluding those
who did not meet the key selection criteria.
The most common criteria in place were that the user should have lived in the On
Track area, attended a school in the On Track area and been (or had) a child aged
between four and 12. However, there were also cases where very specific criteria
were established. For home visiting in area D and area B, and for family therapy in
area C, the child had to be thought to have problems at school, at home or with
behaviour. To access Parentline Plus in area F, it was necessary to have access to a
21
telephone. For transition work in area H, only pupils transferring from Year 6 to Year
7 were able to be involved.
3.4.1 The referral of users from outside the On Track area
In order to assess the relative adherence to access criteria (above), service providers
were asked whether or not there were any circumstances under which these could be
waived. In the majority of areas (seven of the eight), this was possible, but only for
specific reasons:
Attendance of a school within the On Track area
Though individuals might not live in the On Track area, if they were a pupil in
a school in the area, this would enable them to access On Track services. This
was the most commonly used method of allowing someone not residing in the
area to access a service, evident in seven of the eight areas in this study.
Furthermore, attendance at school did not just grant entitlement to schoolbased services, but to any other On Track provision available to pupils or
parents.
Professional judgement
The flexibility within any one individual service allowed a coordinator or
service provider to exercise differing degrees of professional judgement. For
example, ‘an exception to the rule’ in one area was where the On Track
catchment area divided a street in two, so that one side was able to access On
Track services but the other was not, so the whole street was included. This
was more common at service level and reported at programme level in only
three areas.
Spare capacity and/or poor service take-up
Where there was spare capacity, for example where a parenting course was
under-subscribed, it was seen as cost-efficient to open it up to those who did
not fully meet On Track criteria. Providers often reported that it was better
that places on a course were filled by someone from outside than remain under
used. This raised two interesting points. Firstly, if people were not coming
forward for the service this might highlight a lack of awareness, or
engagement issues. Secondly, if a course was running under capacity this
might raise the question as to whether or not the intervention was indeed
necessary. However, at the opposite end of the spectrum, there were also
cases where demand for an intervention exceeded the capacity available.
Here, a decision was made regarding who was able to access the service:
requiring a definition of the most needy.
Service specific restrictions
For services such as drop-in centres, it was not possible for the clientele to be
restricted to those living in the designated On Track area. For example, if a
service had an ‘open door’ policy, it would not be possible to stop people from
22
attending. This was also the case for any interventions that were run in
conjunction with another agency, where their own criteria for access were less
restrictive than those used by On Track.
Where a user moved out of the On Track area
Where work with a family or service user had begun and they then moved out
of the area, they would continue to access On Track services if it was feasible
to do so. An example was given of a child who was taken into foster care and
placed outside the area. The relationship with the service providers was
maintained. However, there were different interpretations of ‘continued work’.
For example, in one area when a family moved out of the area, even by a short
distance, the service had to stop within 4-6 weeks.
A number of the interviewees reported that broadening the geographical scope of On
Track would be an improvement. However, staffing levels and current capacity
would have to be increased. Not all providers shared the view that the services should
be opened up to those outside the area. Broadening the geographical remit of On
Track risked increasing workload and diluting impact.
3.4.2 Universal and selective service
On Track services were a mixture of universal and selective. Universal services were
those services that were open to a universal population, such as children aged between
five and eight attending the same school. Selective services had set criteria which
users needed to meet in order to access a service. For example, children aged between
five and eight attending the same school whose reading levels were at or below a
certain point. The key factors in determining which category each service fell into
was the type of service offered and/or the individual approach to service provision.
Of the 16 services studied at intervention level, ten were described as selective, four
were described as universal and two were described as a mixture of both. For
example, In area E, Consultation was run as a universal intervention but certain
individuals were targeted (a measure put in place to minimise the stigma attached to
involvement). In four of eight NFER On Track areas, there was a mixture of universal
and selective services. In three areas (A, B and F) the interventions were all selective.
The site of service provision was found to influence whether an intervention was
universal or selective. For instance, in area B a large number of interventions were
school based and these tended to be provided to a class as a whole.
Universally provided services included nursery outreach (area D), Fast Track (area
C), Webster Stratton (area H) and supporting families (area G). The types of services
that were a mixture of universal and selective were consultation in area E and
transition work in area H.
The routes of referral (formal, informal or self-referral) were also varied, in terms of
service, area and selective or universal access (see Table 3.2)
23
Table 3.2
Area
A
B
C
D
E
F
G
H
Referral routes to On Track services
Service
Home Office category
Access
Referral route
U/S/B*
Health Advisor
Specialist
S
Formal
Home School Partnerships
Home-school partnership
S
Formal
Family School Co-ordinator
Home-school partnership
S
Formal/Informal/Self
Home Visiting
Home visiting
S
Formal/Self
Family Therapy
Family therapy
S
Formal
Fast Track
Home-school partnership
U
Formal
Nursery Outreach
Pre-school education
U
Formal
Home Visiting
Home visiting
S
Formal
Consultation
Specialist
B
Informal/Formal
Pastoral Support
Specialist
S
Formal/Informal/ Self
Parentline Plus
Parent support and training
S
Formal/Informal
Family Therapy
Family therapy
S
Formal/Informal
Home School Links
Specialist
S
Formal
Supporting Families
Parent support and training
U
Formal/Informal/Self
Webster Stratton
Parent support and training
U
Informal/Self
Transition
Specialist
B
Informal/Self
* U = universal
S = selective
B = both universal and selective
Source: NFER 2003 Evaluation of On Track
24
Within universally provided services, it was possible for self-referrals to be made
since it was possible for them to be accessed by the population of On Track.
However, it is interesting that referrals for Nursery Outreach and Fast Track came
from formal sources, despite them being described as ‘universal’. There were no
obvious links between Home Office categories and either routes of referral or access
(universal or selective). That is, services under the same category (such as parent
support and training) had different routes of referral and access criteria in different On
Track areas.
3.4.3 Participants’ views on the referral process
Coordinators and providers identified the main strengths of the referral process which
included:







flexibility
the scope for multi-agency work
the open nature of the procedures
informality
clarity
the framework they created
they allowed professionals to build on their knowledge of clients.
In particular, flexibility seemed to be valued at service level. Professionals in four
areas reported that such flexibility allowed referrals to be made that were
multidisciplinary while ‘leaving space’ for self-referrals. In one area, the informal
aspect of referral allowed the provider to reduce any stigma associated with seeking
and receiving help. Providers of a telephone support service for parents valued the
informality of the referral procedures because it was useful in engaging users and
keeping them engaged over the initial period, when commitment could waver.
Informality and flexibility were particularly useful when there were problems of
engagement: where the service users may be hard-to-reach or hard to engage. A
provider in area D highlighted how this allowed them to work around the needs of the
users:
‘You’ve got to be prepared to go and meet the needs and start [from] where
people are at. Not be too inflexible’ (service provider).
Starting from where ‘people are at’ meant accepting that existing referral procedures
could be cumbersome, inflexible and had the potential to exclude or alienate service
users. However, it did not mean that existing procedures were dispensed with, or that
corners were cut. For example, flexibility could mean accepting a referral for a
family who lived outside the On Track area, but whose child attended a school in it,
even though the unit of referral was the family and not the child. Alternatively, it
could mean that service users were referred directly to a specialist family therapy
programme, without waiting the usual six weeks or twelve weeks, or that failure to
attend appointments did not end the referral process.
On Track referral procedures also brought clarity and consistency to the process of
referring users, across agency ‘boundaries’ and areas of usual involvement. The
25
borders of the On Track area, while forming a barrier to some service providers, also
gave a very clear focus for others. The borders of the area, or other criteria created a
degree of ‘entitlement’ to services, and where this was present before On Track, it
was now more pronounced. Despite some concerns around those unable to access
services, On Track coordinators found this broadly helpful in providing clarity around
access to services. On Track also encouraged clarity by focusing on specific age
groups and, importantly, on specific risk or protective factors. The focus of the
referral was therefore guided by the focus of the programme, to a lesser or greater
extent, reducing some of the tension associated with resource allocation where
boundaries are less clear.
The majority of those service providers interviewed reported that referral procedures
allowed the team to build up a more detailed knowledge of the service user and their
needs. Another expressed viewpoint valued the capacity for multi-disciplinary
involvement. The extent to which referral acted as a form of community engagement
was unclear, but where populations were ‘overloaded’ by initiatives and/or resistant to
intervention, referrals allowed providers to work together in targeting services. In two
of the eight areas the referral procedures were used to ensure an immediate service
response. That is, referrals were never left without an agreed action within a specific
time scale. Service users were always offered a service that could go some, if not all
the way to meeting their needs. This mean that immediate contact was made with the
users and this was received positively, especially by those who had been disappointed
by previous experience.
Four key challenges were associated with referral procedures:




users could be uncomfortable with the procedures
agencies could make inappropriate referrals or not co-operate
inadequate or out-of-date procedures
inappropriate referral tools.
Working with some teachers proved challenging for some service providers. For
example, some teachers were reluctant to let children out of lessons to receive any
additional service. In one area, the provider found that teachers exaggerated
behavioural problems in order to access the service, whereas others expected
immediate results:
‘If they get sick of a kid, or if they’ve got issues. They want you to wave a
magic wand, do one visit and then they won’t misbehave’ (service provider).
Most providers and coordinators thought that the procedures were both appropriate
and effective. However, there were also those who identified problems, for example
that the procedures were too intrusive and representative of a professional’s
perception of need, ‘the needs of the family aren’t recorded as the family see them’
(service provider). It was reported in three of the eight areas that there were problems
with inappropriate referrals, for example, where referrers were unclear with regard to
the criteria, or where the referrers were inexperienced, or if they had a problem with a
client and did not know where else to refer them (a form of ‘dumping’).
Alternatively, providers might simply not use the procedures, or not cooperate with
26
those aspects of it that they felt did not include them (and their professional views).
However, such examples of ‘inappropriateness’ were not area specific.
Service providers also suggested ways of improving current inadequate and/or out-ofdate procedures: such as tailoring the referral procedures to individual services (as
opposed to being agency wide); tailoring referral to individual service user’s needs (as
opposed to general procedures); increasing awareness of the referral process and
referral criteria among those likely to use it; and where appropriate, providing greater
clarity and coordination across all referrals, reducing confusion and possible overlap.
Another challenge was that referral systems instruments were perceived as quite
daunting and could alienate both provider and potential user, there was a need to
ensure that tools were:
‘Getting a balance between needing enough information and overwhelming
whoever referred the family or the family themselves’ (service provider).
It was interesting that the appropriateness of tools was seen to alienate both provider
and potential user. For providers, simply the lack of time was an issue in referring
potential users. Procedures that were very demanding were not valued as highly as
need-specific and flexible procedures. Clearly, there was a balance between ensuring
appropriate referrals and developing systems that engaged both users and providers
and willing, informed and engaged partners. The evidence of On Track was that
participants wanted more responsive and appropriate procedures than had been used
in the past.
3.4.4 Raising awareness of On Track services
Service users were asked about how they found out about the service they were using,
and several means of raising awareness about the service emerged. In addition,
providers offered insight into strategies employed.
Contact through schools
The majority of service users said schools had made them aware of On Track: either
by sending letters home with their child or by approaching them and speaking to them
directly. Some users said individual ‘trusted’ teachers had recommended that they go
to On Track, for example, one mother was having problems with her son and she went
to see the class teacher who suggested seeking help from On Track. Schools were
seen as ideal sites for awareness raising and for contacting parents. However, it was
pointed out that some parents and some children did not attend schools. Thus,
strategies that sought to engage service users solely through schools may miss
opportunities to contact potential clients and raise awareness of services available.
Drawing on professionals or agencies other than schools
A number of users said that they became aware of the intervention they were using
through other professionals or services. Where these were often school-based (such
as a school nurse), they also included health visitors, Sure Start and the Traveller
Education Service. Other users had mentioned problems to professionals such as
social workers, doctors or health visitors and these professionals had alerted them to
27
On Track. For example, one woman went to see her GP because she was feeling
depressed and isolated and he suggested she go to On Track who could provide family
therapy. The key to using other professionals was in building relationships across
agencies. For example, it was common to place leaflets in health centres, but this did
not always raise awareness among potential users or other professionals. More
effective strategies were to make presentations to groups of professionals and/or meet
with other professionals to set out exactly what On Track services were available,
who could access them and what needs they sought to address.
Drawing on other On Track providers
Quite often the users found out about the service from the On Track providers
themselves. This may have taken the form of home visits to users, where a range of
additional or complementary services were offered. The key strength of this approach
was in that it rested on existing relationships, the providers had already engaged the
service user. Its weakness was that it was useful for those already engaged, but less
so for those reluctant to come forward, and redundant for those unknown to the
service providers.
Using friends or family
The most significant and valued means of awareness raising was through word of
mouth. This was consistently cited across areas and across services as the most
effective method, where parents found out about services through friends or family
that had experience of the service and children hearing from their peers. The strength
of this method was that potential users, particularly those suspicious of involvement,
trusted their friends, family and neighbours more than they did the service providers.
The weaknesses were that it took some time to establish a good reputation locally and
it was very easy to lose a good reputation because an individual unhappy with the
service could be vociferous in their criticism of it in the local area. This made the
providers somewhat hostage to fortune, if they upset any service users it could
undermine their work, when in fact their work often upset service users by
confronting them with some of their problems and working with them to find
solutions. Another issue was that ‘cliques’ could develop, where the service found it
difficult to extend beyond a relatively small ‘clique’, or sub-group of the population,
whose initial willingness to engage was seen as wider community or user
engagement. In addition, some services were highly confidential and relied on that
for engagement. Some services went to great lengths to hide user involvement from
their neighbours and some users were unwilling to reveal the extent of their
involvement in a service with friends or family. Nonetheless, word of mouth and a
good local reputation in delivery was highly valued by service providers and users.
Marketing or advertising the service
A small minority of the 16 services examined in detail were using more commercial
awareness raising strategies such as advertising on local radio, in local publications,
on buses, in shops and cafes. Leaflet campaigns were also used, but were less
common, although some services did go ‘door-to-door’ to inform potential service
users of what was available, engaging them in face-to-face conversation about On
Track services (and in some cases also leaving literature or publicity material).
28
Linking with other programmes or initiatives
An interesting development in one area was the extent of the cooperation between On
Track and other initiatives (such as Sure Start and New Deal). Not only did this bring
economies of scale in awareness raising (through joint advertising or presentations), it
also led to a reduction in service-specific or ad hoc methods, which were seen as
potentially disruptive. For example, all contact with the community was coordinated
so that the various providers were not touring the area in an uncoordinated way, with
different providers contacting people in their homes repeatedly. Because of the size
of the small On Track area, the challenges facing residents and the extent to which
multiple initiatives were evident, this ‘protected’ the community from over-targeting
and ‘initiative overload’. The success of this strategy was difficult to gauge from
interview data, but it was reported that (in addition to reducing duplication and
overload), it raised the awareness of the services available (evidenced by increased
take-up) but was even more effective with targeted groups. That is, coordinating
strategies not only increased awareness and subsequent take up among the general
population, but also increased awareness and take up more significantly among
targeted hard-to-reach groups.
One of the more general challenges in awareness raising was to manage the
expectations of both users and providers. Coordinators in particular, many of whom
had experience of other initiatives, were careful to make sure that service providers
were in a position to meet any additional demand resulting from their strategies.
Moreover, some providers were not keen to raise attention to their work, either for
reasons of confidentiality (as above), or, more commonly, because they did not have
the capacity to meet existing demand. Therefore, awareness raising was associated
with service development and/or expansion, evident where a new service was being
offered, or additional resources had allowed an existing (successful) service to
increase its capacity. For the majority of services, the focus was on meeting existing
needs. Awareness raising that led to an increase in referrals was problematic,
especially if these referrals were self-referrals (the most valued form), because unlike
using schools, other professionals, other On Track service providers or advertising, it
was difficult to ‘turn off’ word-of-mouth, and this could undermine their local
reputation if they were then unable to meet any increased demand.
3.5
The agency dimension of referral
On Track was established as an inter-agency preventative programme for children
aged between 4 and 12 years and their families. As such, the range of agencies
providing services reflected (to some extent) existing work with this target population,
but On Track was not necessarily restricted to those agencies ‘traditionally’ associated
with such a population. For example, the police provided services in areas such as
area A, voluntary groups with extensive experience of children and families (such as
Barnardos) provided services in area F. These were ‘new’ services and research
found that new configurations of providers were formed as statutory and voluntary
agencies came together (though not necessarily only in areas where new services were
developed). Across all of the On Track areas, there was evidence that the programme
was used, as was intended, as a ‘test bed’ for new services, new ways of delivering
services and new ways of working within and between agencies.
29
The research found quite clear links between the agency providing On Track services
and referral, both in terms of referrals from others to the 16 services set out above and
then on to other service providers. For example, the referrals from other agencies (or
sources) to the 16 On Track services came from a wide range of sources, up to 30
agencies or organisations were cited (see Table 3.4).
Table 3.3
Other agencies referring to On Track services
Education
Schools (general)
Teachers
Head Teachers
SENCOs *
Educational Welfare Officers
Traveller Education Service
Non-attendance Team
Health
Health (general)
Educational Psychologists
Health Visitors
School Nurses
CAMHS***
Hospital Tuition Service
Child Health Team
GPs
Midwifery Service
Pediatricians
Child and Family Services
Voluntary/other programme Other services offering
referrals
Sure Start
Police
Home Start
Youth Offending Team
Children’s Society
On Track services
NSPCC**
Social
Social Services
Educational Social Workers
Family Support Team
Users
Self-referral
Parents
* Special Education Needs Coordinators
**National Society for the Prevention of Cruelty to Children
*** Child and Adolescent Mental Health Service
Source: NFER 2003 Evaluation of On Track
Health, or health-related service providers were well represented among referring
agencies or organisations, making up a third of the total. School and school-based or
linked providers were also referring users, linked to the site of provision and access to
service users. Voluntary providers were represented, but few agencies linked
explicitly to crime prevention or reduction (such as the Police and Youth Offending
Service).
Service users were referred to 26 other agencies or providers from these On Track
services, either after receipt of a service or because the service available was not seen
as appropriate. Health and health-related services again made up over half of these,
with schools and school-based providers less reported. There were additional
providers cited, such as housing the Fire Service, the Citizens Advice Bureau and a
range of pre-school providers (private and voluntary) (see Table 3.5).
30
Table 3.4
Other agencies referred to by On Track services
Education
Educational Welfare Officers
Educational
Early Years Service
Traveller Education Service
Adult Education
Health
Health (general)
Health Visitors
School Nurses
GPs
CAMHS
Child and Family Services
Home-school Tuition Service
Speech and Language Services
Drug and Alcohol Unit
Voluntary/other programme
Sure Start
Home Start
NSPCC
On Track services
Parent and Toddler Groups
Citizen’s Advice Bureau
Other services
Youth Offending Service
Fire Service
Housing
Social
Social Services
Social Workers
Family Support Team
Source: NFER 2003 Evaluation of On Track
One of the key features of referral between agencies was some evidence of
‘clustering’ of services where services tended to refer to those where existing practice
or existing relationships were good. For instance, health providers referred
predominantly to other health services. An example was in area G, where the service
Supporting Families was only open to those referred by a health professional
(although others could refer potential users to this professional for referral). Service
users were predominantly referred on to other specialist health providers, but also to
other On Track providers, Social Services and the NSPCC (see table 3.6 below).
Table 3.5
Example of referral to and from an On Track service
Service
Supporting families
Taking referrals from
Diagnostic service, only those
seen by a GP, Paediatrician,
Health Visitor, Midwife and/or
School Nurse could access
provision.
Referring on to
Referred on to other On
Track providers, Speech
and Language Therapy,
CAHMS, GPs, Housing,
Specialist Health (drug and
alcohol unit), Social
Services and the NSPCC
Source: NFER 2003 Evaluation of On Track
The clustering of referrals was clearly linked to existing practice, knowledge of
additional services and, in those cases where referrals were extending beyond these
clusters, to the overall coordination of On Track services. However, there was less
evidence of a ‘true’ inter-agency system, other than where all referrals were
coordinated within an inter-agency team (such as in area A). While there was
31
stronger evidence of limitations based on the current structure of that team (i.e. fewer
referrals were made to the agencies not represented on the team).
A significant feature of provision was the evidence and encouragement of selfreferral, where either a parent or young person came forward themselves to seek
provision. Potential service users were able to refer themselves to the majority of
those services examined in detail (14 of the 16). In the two cases where they could
not, this was because of diagnostic or screening processes of entry. For example, the
Fast Track service in area C used a screening process that was applied universally to
the cohort of children entering the primary school where the service was provided.
The results of the screening governed access to the service, which included numerous
strands involving children and parents. Access to one or more strand was not possible
outside this screening process; parents and children could not self-refer. In other
services, the extent of self-referral varied. Six of the 16 reported that self-referral was
the most ‘significant’ source of referral, importantly, these services were
predominantly provided solely by, or provided in association with voluntary
providers.
One of the issues facing those providers taking and making referrals in such an
experimental and inter-agency context was appropriateness of service. There were
two related facets; dealing with inappropriate referrals to the service; and finding
appropriate providers post-service. In the case of the Family Therapy service offered
in area C, the first facet was dealt with by operating a ‘24 hour’ provision, that is,
where the referral was inappropriate (the user did not require the service or had other
needs that prevented them accessing it at that time), the user was passed onto a
relevant and appropriate provider within 24 hours of initial contact. This meant that
potential service users were not left with needs that were expressed and then not met.
The second facet was reported (by under a third of those interviewed) as more
difficult to deal with, because of the lack of specialist service available locally, or the
inability of users to access more ‘mainstream’ provision. However, finding
appropriate further provision was assisted by keeping working within On Track to
locate and contact appropriate services and by retaining a point of contact for the user
post-service.
The main source of inappropriate referrals were Social Services, with a minority of
providers (five) reporting ‘dumping’ by Social Services staff, who were working to
such a high needs threshold that On Track provided an attractive provider for families
or children who could not access their services, sometimes with little regard with
matching user need to service content. However, the majority of providers did not
feel that inappropriate referrals were agency specific, but were linked to a more
general lack of information about On Track services. Services provided by voluntary
providers were particularly vulnerable to this, whereas health-related services tended
to have existing information sharing protocols and/or routes of access that filtered
referrals.
3.6
Capacity boundaries and sites of provision
One of the main issues affecting referrals was capacity, linked predominantly to the
boundaries of agency involvement and to the site of provision. These boundaries
were determined by responsibility, but also by current or previous practices. Services
32
were provided in a number of sites, single and multiple, including the user’s own
home. Examining the 16 selected services showed that the majority (15 of the 16)
were multi-site (see Table 3.4 below).
Table 3.6
Area
A
Site of service provision
Intervention
Health advisor
Home-school partnership
B
Family-school coordinator
Home visiting
C
Family therapy
Fast track
D
Nursery outreach
Home visiting
E
Consultation
Pastoral support
F
Parentline Plus
Family therapy
G
Home-school links
Supporting families
H
Webster Stratton
Transition
Site(s) of service delivery
Home
On Track centre
Schools
Home
On Track centre
Primary schools
Home
Home
Community venue
Family Centre (specialist site)
Home
School
Home
Off-site (crèche facility)
Primary schools
Home
Outreach (travellers)
On Track centre
Home
On Track centre
Primary schools
Home
On Track centre
Primary/secondary schools
Home
Off-site (trips and outings)
Home
Community venues
Schools
Primary schools
Agency centre (specialist)
Home
Schools
Home
On Track centre
Agency centre (specialist)
Home
Centre (specialist)
Secondary schools
Primary schools (limited)
Source: NFER 2003 Evaluation of On Track
The most common site of delivery was the home (12 services), followed by schools
(ten services). Six services used space within the On Track centre and four used an
33
‘off-site’ centre, ranging from outreach work with traveller families, to the use of
specialist off-site resources, such as a crèche.
These sites influenced referrals in a number of ways. Firstly, sites set boundaries to
intervention and these could limit the number of users referred, or restrict referral to
those on site. For example, in locating a service on a school site, it could be difficult
to refer children not attending, or engage their parents in an aspect of provision.
Correspondingly, no school-based service only provided a service on a single site, all
of those examined extended beyond the school, predominantly into the home.
However, sometimes the site was used to restrict the number of referrals, because the
agency lacked capacity to extend services beyond its boundary. In area F, Family
therapy was protected from high unmet demand within the area by being location
specific within school sites and the restriction of all referrals to professionals within
those sites: ‘There are only two of us and we cover six schools I think to offer to
deliver good quality services, we can’t spread it too thin’. Schools provided good
boundaries for services, allowing providers to focus quite carefully on a specific
target group.
In a small number of cases (two) community centres were used and these often served
to ‘screen’ referrals, reducing stigma and overcoming any resistance to intervention.
In area B, for example, the community venue was a ‘trusted’ site on the estate and did
not carry some of the negative connotations associated with other sites. The Home
Visiting service based their engagement strategies there, bringing parents in to discuss
their needs and then referring them on to their own and other services as appropriate.
These parents would not necessarily engage with providers in agency locations and in
many cases (based on interviews with parents) were not fully aware of the complexity
of the process of screening taking place. This service provided an example of how
statutory providers were learning from the more sensitive engagement strategies of
the voluntary sector and using their skills in making referrals. Whereas these methods
came closest to being appropriate to hard-to-reach groups, they were not developed
specifically for a single hard-to-reach group, but for the overall population. However,
the majority population was perceived to be hard-to-reach and the successful referral
strategies developed by voluntary providers were seen as those most effective. Where
they were not reported as being for hard-to-reach groups, they serviced hard-to-reach
communities. Thus, where there was a lack of reporting of strategies that were
established specifically for hard-to-reach groups, there was evidence that practice was
fixed on this purpose on the ground.
Where sites included multiple similar venues, such as multiple schools, referrals were
not handled in the same way at each site. In area H, for example, the Transition
service was provided at two secondary schools in the On Track area (and their
associated feeder primaries) but routes of referral were different. At one site teachers,
learning mentors and support staff worked much more closely and towards shared
ends than at another, where there was evidence of less cohesion between the various
professionals. Multiple sites therefore presented providers with different challenges,
but also with the ability to test different approaches and be flexible in delivery. So
that in area H, strategies that were successful at one school were applied in another,
and solutions to challenges that emerged in one site were used to pre-empt difficulties
as the service extended.
34
3.7
Summary

In terms of referral, the role and the contribution of both the coordinators of On
Track and service providers appears to have been varied. Some coordinators
operated in a direct manner, while others delegated the role to the team as a whole
or to individual providers. The level of involvement of the coordinators was
affected by the approach taken, and this ranged from no time for those who had a
light involvement in referrals to half a day or more for a coordinator who was
more heavily involved. In terms of providers, some had a high level of
involvement and some did not.

Users of services were referred to On Track via various routes. These could be
formal, involving a meeting that used a structured tool in a structured meeting or
they could be informal involving a casual discussion.

Agencies outside of On Track were able to refer into the projects, and by the same
token, On Track could refer to other agencies. Schools were the most likely to
refer into On Track and CAHMS and Social Services were most likely to receive
referrals from On Track.

Generally, referral procedures were seen as appropriate and effective, although
there were drawbacks associated with them. Users had become aware of On
Track through several means, such as finding out from schools, other
professionals, friends and family or On Track themselves. Those users living
outside the On Track area could receive services in some areas, but only if they
met certain criteria. None of the areas reported specific procedures for hard-toreach groups, but evidence on the ground was of the development of strategies
appropriate for this purpose.
35
Chapter 4
Models of needs assessment
4.1
Introduction
The purpose of this chapter is to explore the issue of needs assessment within the On
Track programme; at both programme and service level. In particular, it will examine
the different models of needs assessment and the roles of those individuals (both
professionals and users) in the assessment process. It will also consider the
contribution of assessment tools, examining whether providers have received training
in their use and their perceptions of the tools usefulness in an inter-agency
preventative programme. Finally, the section will consider how the needs of hard-toreach groups were assessed and what implications for practice this raised.
4.2
Needs assessment at project level
One of the aims of the research was to examine whether, how and by whom the needs
of the On Track service users were assessed. While it was clear that some form of
needs assessment took place in each of the On Track areas, it was not clear to what
extent this assessment was coordinated, or to what extent it was agency or programme
specific. Because the On Track programme was preventative in nature, it was also of
interest to examine the extent to which assessment took account of known risk factors,
sought to address particular needs and/or focused on outcomes. In addition, the
timing of assessment was of interest, whether it was a one-off assessment at the
‘front-end’ of provision (on or immediately after the first contact), or an informal
assessment involving review, reflection and possible re-assessment.
The research found two main distinctions in the procedures used to assess need across
the eight NFER On Track areas: assessment procedures were either delegated to
service level, or programme-wide procedures were used across services. A typical
programme-wide procedure began with the potential service user being visited by a
member of the On Track team at home, or at the site where the need was identified
(such as the school), where an initial assessment took place before their needs were
presented to the whole On Track team. This initial visit could involve a basic
assessment of their need and eligibility checks, to ensure that they could receive the
service(s) being offered. The service user was then presented to the On Track team as
a case and a second and fuller assessment took place. A service provider may have
been identified and be present during this second assessment, as may other service
providers, the referring professional, the service user and/or the parent. In a
programme-wide model, all service users followed the same or a very similar
procedure, regardless of their needs and the site of eventual service delivery. For
example, a family identified with mental health needs would have those presented to
the team, as would a pupil identified with educational needs, even when meeting the
need may require very different solutions and different agency involvement.
36
In the programme-wide model, the On Track coordinator, to a greater or lesser degree
coordinated the whole process. The research found that programme-wide needs
assessment took place in four On Track areas (A, D, E and G). One other area (area
B) was moving towards a programme-wide model, but had not yet developed the
procedures. In the other three areas (C, H and F) there was no common procedure and
assessment was delegated to service level, see Table 4.1 (below).
Table 4.1
Models of needs assessment across On Track areas
On Track area
A
B
C
D
E
F
G
H
Assessment procedure
Programme-wide
Programme-wide (developing)
Delegated to service-level
Programme-wide
Programme-wide
Delegated to service-level
Programme-wide
Delegated to service-level
Led by
Coordinator
Coordinator/services
Service providers
On Track team
Coordinator
Service providers
On Track team
Service providers
Source: NFER 2003 Evaluation of On Track
The delegated model of needs assessment was one in which the On Track team and
the coordinator in particular played a less active role in needs assessment, at least on a
case-by-case basis. The procedure would typically be a child or family referral to an
On Track service, responsibility for needs assessment being delegated to the provider.
As was the case with the programme wide model, there may be an initial eligibility
check, but this too was commonly carried out at service level.
The involvement of the coordinator varied within each model. For example, in areas
A and G, where the procedure was programme-wide, the coordinators took different
roles, with higher direct involvement in area A. Similarly, where the procedure was
delegated, coordinators were more and less engaged. The coordinator in area C took a
more proactive role in monitoring and seeking information about assessment
procedures than the coordinator in area F. The major distinction between the models
was the extent to which the procedure was coordinated within the On Track
programme and the extent to which it drew on existing, service specific or interagency procedures. These differences can be presented schematically (see Figure 1
and 2) to point to the effect each had in terms of the involvement of the coordinator
and the wider On Track team.
37
Figure 1
Programme-wide model of needs assessment
On Track team
Coordinator
Site of need/concern
Service user
2nd and/or 3rd agency representatives
3rd agency
2nd agency
Parent
Programme-wide needs assessment
In this model the coordinator sits at the centre of an inter-agency ‘in-house’ team. The
service user comes to the team for assessment, along with their parent (where appropriate)
and another professional from a second or even third agency.
A feature of the model is that the assessment takes place outside the site at which the need
was first identified (e.g. the school or home). The broken arrows between the site and 2nd
agency denote that the On Track needs assessment model does not necessarily interfere with,
or disrupt existing practice. For example, where the site is a school and the 2nd agency is
speech and language therapy, the relationships remain intact. On occasion, the team, or a
member of it may make assessments or collect data to assist assessment off site, in the service
user’s home, or at the site where the need was expressed.
In this model the relationship between the 2nd and 3rd agency (for example, Speech and
Language Therapy and Educational Welfare Service) are maintained. Representatives of
each, if appropriate are involved in the needs assessment and the assessment need not
supersede or replace any agency-specific procedures.
The membership of the On Track team includes professionals able to assess the needs of the
service user. These professionals may use agency-specific tools, such as the DoH Strengths
and Difficulties questionnaire, or general On Track tools, specifically designed for the
programme. The assessment itself is led by the coordinator, drawing on the appropriate
expertise inside the On Track team and inviting contributions and participation from those
outside it (including parents and/or children)
38
Figure 2
Delegated model of needs assessment
On Track team
Site of need/concern
Service user
Coordinator
3rd agency
2nd agency
Parent
Service provider
Delegated model of needs assessment
One of the major distinctions between the delegated and programme-wide models is the
movement of the assessment away from the On Track base and the limited role played by the
On Track coordinator.
The greater role taken by others can be seen in the solid arrows between the site of need and
the 2nd agency. These denote a much more active role of the 2nd agency, with the needs
assessment taking place at their base, or at the site where the need was expressed (for
example, a pupil being (initially) assessed at school by a speech and language therapist and
then being assessed again at the agency base).
An On Track professional may be involved in the assessment off-site, but they may equally
delegate the procedure entirely to the 2nd or 3rd agency.
Another feature of the model is the extent of the contact between On Track and other
interested parties (for example, a 3rd agency and/or a parent). These parties would both be
primarily involved at the agency base, or at the site at which the need was expressed, not at
the On Track team base.
The broken arrows between On Track team, the 2nd and 3rd agency and the parent denotes that
the delegated model does not necessarily interfere with, or disrupt existing practice. For
example, where the site is a school and the 2nd agency is speech and language therapy, the
relationships between these and On Track remain intact, regardless of On Track’s lack of
involvement in assessment.
The major difference between models were the limitations placed on coordinator and
On Track team involvement in the delegated model and the extent to which the On
Track team brokered assessments across sites and between agencies, bringing together
the inter-agency team within it and drawing on other partners outside.
39
The model links to previous research carried out by the NFER LET in that it relates to
the ways in which On Track areas developed and delivered services. Previous
research showed that different models of service delivery were evident across the On
Track programme. Where services were coordinated and delivered ‘in-house’ by the
On Track team (in two areas), a multi-agency team delivered a range of services to the
On Track population, working together from the same premises, sharing information
and strategic direction, this was termed the in house model of service delivery.
Where service delivery was bought-in from a range of providers (in one area), where
the On Track team played no direct role in service delivery and coordinated those
provided by other agencies, this was termed the contracted out model of service
delivery. Where a mix of the two was evident (in five areas), where some service
were delivered by the On Track team and others were bought in, a mixed economy
model of service delivery was identified.
These models of service delivery had implications for the programme-wide or
delegated assessment procedures evident during more recent research. For example,
adopting a common needs assessment procedure was less problematic where services
were delivered in-house, than where they were contracted out. The coordinator in
particular, played a more active role in the in-house model and this lent itself to
programme-wide procedures for needs assessment. Coordinators and team members
were closely involved in assessments and in two of those four cases where the
programme-wide procedures were evident, directing assessment. It was clear that
coordination was greater when the On Track team members and/or the On Track
coordinator conducted ‘in-house’ assessments, drawing in other agencies and/or
parents when required or appropriate. Moreover, the programme-wide model offered
a form of ‘brokerage’ between agencies, so that any needs outside those dealt with by
one agency (such as health) were assessed by the On Track inter-agency team. Where
needs assessment was delegated, the On Track coordinator or team member had some
involvement, but this tended to be agency specific, contingent on an individual’s links
to an agency. For example, an On Track team member with responsibility for health
could sit in on assessments taking place in schools or at a second or third agency base,
but only where there was a clear link to their health-related role.
Where assessment was delegated to service level, the influence of the On Track
coordinator and the On Track team on the procedure was reduced, resulting in agency
specific procedures taking precedence. However, this did not imply an absence of
coordination on the part of the On Track coordinator. Ensuring that services targeted
specific groups on the basis of specific needs allowed the coordinators to exercise
control over which groups’ needs were met. In area C, for example, three of the
services had explicit assessment or screening procedures of their own, ensuring that
only children and families with an assessed need in a specific area (such as emotional
development or conduct disorder) could receive a service. This meant that despite the
lack of direct involvement in assessment, the On Track coordinator orchestrated
assessment procedures by implementing a range of services, or even a specific
service, that directly met particular needs.
The delegated model of needs assessment and the more common programme–wide
assessment procedures had a number of strengths and weaknesses, identified by those
involved (see Table 4.2).
40
Table 4.2
Models of needs assessment across On Track areas
Programme-wide assessment procedures
Strengths





Weaknesses
It offered a form of ‘brokerage’, reducing and resolving conflicts between
service providers and service users
It was inclusive, bringing in parents and contacting other service
providers where necessary and appropriate
It had broad expertise, drawing on the abilities and experience of a range
of professionals
It identified additional needs, not necessarily those presenting at the point
of referral
It provided structure to existing (agency specific) assessment procedures,
setting time limits and initiating actions;







It risked replicating existing procedures (if there was poor coordination
between agencies) and overburdening staff and/or service users
Its procedures were only as good as its current membership
Some services were absent, specifically voluntary providers
The links between the members of the team and other service providers
were variable, sometimes contingent on key personnel
It was cumbersome and could impose a model of assessment that was
‘culturally’ specific (i.e. the medical model)
Targets and time scales could not be imposed on other providers, but
participants could assume good practice in their work
Professionals within the team did not always share information or work
collectively towards the same goals.
Delegated assessment procedure
Strengths



Weaknesses
It allowed flexibility in needs assessment, taking account of the
procedures used by different service providers (such as self-assessment of
need)
It allowed freedom for providers to change focus and/or direct services
towards a different target population, with different needs
It utilised existing sites and staff in the assessment procedure, avoiding
duplication.




Source: NFER 2003 Evaluation of On Track
41
It restricted needs assessment to existing structures and relationships
It limited and/or reduced the involvement of other agencies where links
were not already established
It could limit the needs assessment procedure to a an expressed need,
rather than total needs
It risked excluding partners, particularly children and families, where
there was no culture of inclusion in the assessment procedures used at
service-level.
Needs assessment procedures at programme-level required the On Track coordinator
to balance the strengths and weaknesses of the respective approaches. However, for
the majority of coordinators, the procedures were ‘inherited’ from the Delivery Plan,
or had been developed ad hoc during implementation. So, for example, where a
coordinator worked with a programme-wide model of needs assessment, there was
evidence of strategies to address some of its weaknesses; such as drawing on expertise
that resided outside the immediate ‘in-house’ team. Where the coordinator worked
with a delegated model, they sought to retain or gain steerage by directing resources
at services that had clear internal (or agency specific) needs assessment procedures.
In doing this they took advantage of the flexibility of the delegated model, while
mitigating against some of its weaknesses.
4.3
Needs assessment: degrees of structure in different
approaches
Whether needs assessment procedures were delegated or programme-wide, the
specific approaches to needs assessment varied. Across On Track areas there were
three main approaches:



The outcome orientated approach (i.e. where the focus of the approach was
on reaching an agreed outcome for the service user, linked to milestones and
measurable progress)
The needs led approach (i.e. where the focus of the approach was primarily
on identifying and addressing the needs of the user)
The risk and protective approach (where the approach was informed by a
focus on risk and protective factors).
Any one approach could include all three, for example, an outcome orientated
approach did not ignore need or take no account of risk or protective factors.
However, the NFER research identified there was a primary focus within each
approach and it was this primary focus that had implications for practice.
Outcome orientated
This approach was more common where needs assessment procedures were programme wide. For
example, in area D, the initial assessment of need was done within six weeks of a referral, using an
adapted Department of Health Strengths and Difficulties assessment tool. However, in more complex
cases, assessment took place after the service user was in receipt of a service, with other providers
taking part (using other tools). The On Track coordinator chaired what were termed ‘springboard’
meetings, where the agencies (and where appropriate the service users) came together to determine
provision. The whole approach was structured around timescales and agreed outcomes. Assessment
had to take place within six weeks and within that period needs that could be met were addressed, or
the user was referred on to another provider. The approach rested on targets and milestones relating to
need. For example, a target of improved attendance at school would see attendance rising from the
point of intervention, passing specified targets at specified times.
42
The needs led approach
This approach was more common where needs assessment procedures were delegated. For example, in
area H the approach to assessment was needs led, that is the basis of the process was the needs of
service users and meeting their needs (in an appropriate way). Assessing need took precedence over
assessing risk and protective factors and outcomes were addressed, but not given primacy in the way of
an outcome approach. Moreover, the focus on outcome could be explicitly avoided so that parents
would come forward without feeling under any pressure to meet targets or being ‘set up to fail’.
Assessing risk and/or protective factors around the family was avoided, particularly early in the
assessment, because it had proved to negatively impact a) engagement; and b) retention on the course.
Providers did not want to be perceived as ‘prying’ into family life.
Risk and protective approach
This approach was evident where needs assessment procedures were both delegated and programme
wide, but was more evident in those areas where programme wide procedures appeared to be
established. For example, in area G, where the approach rested on a single assessment tool at
programme level, the procedure was split into two stages. This had been developed from a tool used in
the voluntary sector that was seen to lack focus in terms of identifying risk and protective factors. The
initial assessment sought to obtain a variety of information around need: details of family members and
‘significant others’, ‘description of family composition’; those other professionals involved with the
family; a description of the home and financial situation; information regarding referrals (such as
reasons from the referrer, parent and child); and an outcome of the assessment which includes an
agreed action. However, once successfully engaged, detailed data of risks and protective factors in the
home and wider experiences of the service user were sought, developing a profile of which areas
required intervention (such as school or social behaviour) and drawing on data from a range of
agencies (such as Police, Social Services, etc.) to check for involvement with other services. In this
respect the approach was more risk and protective orientated.
There was evidence that the needs led and outcome orientated approaches were
changing to become more like the risk and protective approach, or at least taking
more account of risk and protective factors within their approach. For example, in
area A, the Social Services national assessment framework was adapted for the team’s
use. However, it was adapted because it was only appropriate for Social Services (the
lead agency), rather than the entire On Track team (inter-agency). It had since been
revised again, and a risk factor check list had been added to make assessment specific
to the needs of service users and the focus of the programme. These included issues
such as: risk of exclusion from school; neglect issues; evidence of offending
behaviour; and familial composition. Moreover, service users were visited in the
home (sometimes twice) during the assessment to ensure that an holistic needs-led
approach was retained, to identify any unmet needs associated with risk factors not
evident in those concerns that led to referral.
In On Track areas H, C and F, all three areas where needs assessment procedures
were delegated to service level, the approach to assessment was less structured and
described as informal. A key feature of less structured approaches was user
engagement. For example, in area H, professionals were encouraged to communicate
with each other and with the potential service user outside any structured or formal
assessment procedures. This was to avoid the structure and ‘inevitability’ that was
perceived to accompany such procedures. Because the process was informal,
unstructured and not outcome orientated, it was possible to engage users without
alienating them with a more structured, outcome orientated approach. There were
also issues about the terms on which participation was secured. For example, where a
high number of voluntary providers were involved, the nature of their relationship to
users was reported as different to statutory providers. As a consequence, highly
43
structured approaches to needs assessment was seen as potentially damaging to the
service provider/service user relationship.
There was also evidence of mixed assessment approaches, between the more or less
structured, depending on the service user, their needs, their relationship to the
provider and the service content. For example, in area C the approach was based on
continual needs assessment delegated to service level, using less structured methods.
However, this did not preclude the use of highly structured approaches for some
services in that area (for example, the Fast Track model of screening cited earlier).
This ‘mix’ of approaches was due to the need to calibrate the approach to client
groups, i.e. to implement different services for very different users. The balance
between structured approaches and flexible procedures was linked to the coordinator
retaining a degree of coordination over needs assessment within service delivery.
Where the needs assessment procedures were delegated to service level (referred to
above), there was a desire to ‘protect’ the integrity of services one the one hand, and
ensure that the needs of the target population were met:
‘Pyramid is a very specific model for children who are emotionally vulnerable
not for children with behavioural difficulties at all. It’s therefore important to
be very clear about the criteria and they [teachers] are not short of children
with those difficulties so we have got enough. It’s not as if it’s just because
they get more - I mean children who are emotionally vulnerable are often the
invisible children in the class and understandably if a teacher has got 25, 30
children [they] will want to help the children who are causing them most
difficulties’ (On Track coordinator).
A very structured assessment approach was aimed at meeting the specific needs (in
this case emotional vulnerability) of a specific population. This allowed an element
of strategic coordination in addressing the needs of the target population; by reducing
flexibility at service level. Highly structured screening or assessment approaches
were also evident at service level, whatever the procedure adopted at programme
level.
In the case of some interventions, needs assessment was combined with referral;
needs were assumed, rather than assessed. For services that sought to target
particularly vulnerable groups, such as drop-in services, service was accessed at the
point of need and open to everyone presenting. In these cases, the programme-wide
procedure did not influence the approach (other than by permitting it).
Overall, needs assessment approaches at programme level illustrated the complexity
of delivering a range of preventative services that were both universal and targeted.
The data suggests that coordinators could achieve greater coordination of needs
assessment (ensuring the needs of target populations were met) by establishing a
programme-wide needs assessment procedure.
Where this was flexibly
implemented, calibrated to service, so that staged assessments allowed different
providers to use individual (agency specific) approaches or tools, the procedure was
able to engage users, retain the integrity of the service and target the required
population.
44
4.4
The experience of service users
Examining needs assessment at programme level also involved examining the
experience of service users. However, the majority of those interviewed reported that
they had not had an assessment of their need as part of the service. Out of 94 users
interviewed, only four reported that their needs had been assessed. The difficulty,
therefore, was that where needs assessments had taken place (evident from data
collected from coordinators and service providers), the majority of service users were
unaware of them. Two thirds of interviewees reported an ‘informal chat’ with a
service provider, suggesting that users, while not aware of the assessment itself, knew
that some kind of process was taking place, albeit perceived as informal. For some
service users, the assessment process was purposefully hidden from them. For
example, in Area E, the Consultation service identified two class members to
represent the class on the pupil council. The route to the council was by popular vote,
in a class election. However, there were two lists, one based on pupils identified as in
need of support and the opportunity for pro-social activities provided by the council,
the other list was of the general class population. The purpose of hiding the
assessment was to reduce stigma, to make the child elected from the needs assessed
list (and his or her peers) believe that they had been truly elected. This meant that
those pupils in receipt of the service had no idea that they were actually assessed as
needing one.
A similar example was provided by the Fast Track service in Area C. Here, users
were assessed on entry to primary school, but the assessment was not presented to
them or their parents as leading to a specific service. Those children identified with a
conduct disorder went forward to the service and their parents were invited to school,
to discuss the needs of their child, but were also invited to take part in the service
themselves, leading to some concerns on their part:
‘I felt like I was some really, bad parent who couldn’t bring the kid up
properly’ (service user).
‘I was worried. I didn’t know what it was about and that. And I just thought
does somebody know what I have been doing or has Carl been doing
something that he shouldn’t have been doing, I felt a bit worked up about it’
(service user).
In the case of this service, only the outcome of the assessment was reported to the
parents. The majority of the six service users interviewed expressed discomfort at not
being involved in and/or aware of the original assessment process. Furthermore, it
was also reported that in a small number of cases, parents had subsequently refused to
cooperate with the service providers and the impact of the service was reported as
reduced in cases where children were sole recipients. Hiding the process can increase
tensions between provider and user, resolved in the majority of cases, but with
implications for impact in others. One parent reported that she had felt ‘paranoid’
about her child’s needs and felt it reflected badly upon her.
Where hiding needs assessment from the service user, even when they were young
children, could increase tension between the provider and families, the evidence also
showed that this need not be the case and carefully planned, could reduce stigma and
increase engagement. For example, in one case, the use of workers trained and
45
experienced in family engagement allowed the outcome of the assessment to serve as
a starting point in addressing wider family needs. Discussing the outcome of the
initial assessment allowed the worker to gain the confidence of the family and
working in group or one-to-one situation, encourage parents to examine the broader
needs of their children (such as their physical and emotional needs). Thus, where
there was tension around the initial identification of need, this dissipated and was
replaced by close contact with the family that identified (and in some cases was able
to meet) other needs, previously not revealed. Carefully following up the outcome of
the assessment served as a useful tool to engage families who may be reluctant to
discuss their multiple needs with professionals such as teachers.
Where only a small number of users were fully aware of the formal assessments made
prior to intervention, this was reported positively. In area A , for example, one parent
reported that her son’s behaviour had been observed in the playground by a
professional in order to establish his behaviour and assess the work that needed to be
done. Attendees of the Webster Stratton course in area H also reported that their
needs had been assessed. This assessment was carried out at a one-to-one meeting
with the provider. They were asked about their problems, how they rated their
problems and what they wanted from the service. This involvement was reported as
empowering service users by bringing them into discussions about their children or
family. However, the practice of service providers did not always permit such
strategies to take place, fuller involvement being time consuming and potentially
costly.
4.5
The roles and contributions of service providers
In all eight of the NFER On Track areas, service providers were identified as central
to identifying and assessing the needs of service users; regardless of whether the
assessment procedure was programme-wide or delegated to service level. However,
in those three areas where the procedure was delegated, they had a more prominent
role, leading and directing assessment procedures. Delegation also took a number of
forms and assessment was not necessarily delegated solely to the service provider, it
could also involve other professionals such as teachers. An example is provided by
the Fast Track service, offered to children and their families attending a single
primary school.
Fast Track: Home-school partnership
The On Track coordinator and On Track team had no role in assessment, needs assessment was
delegated to service level. Assessment took place on entry to Year One of Primary School, when the
children were aged five. However, the service providers did not assess the children, this was done by
two teachers familiar with them, using an inventory for conduct disorder. A professional assessment
took place at the end of their reception year (aged four) and validated by their Year One teacher, a
month into their first term.
Once the needs of the pupils had been identified, their parents were invited into school to discuss the
service. The service had a number of strands, only parents of those pupils targeted for intensive
support, including home visits, were invited into school. The reported strength of the assessment was
its simplicity and the fact that those carrying it out knew the child: “One of the strengths is it is
extremely easy to think about and does not to take very long. It is done by the class teacher who sees
the children all the time” (service provider).
46
The needs of the parents were assessed less formally, by a co-worker during school-based engagement
and home visits. The main difficulty in assessment was in engaging reluctant parents and service
capacity. There were only six places available and the tool identified more than six pupils with
conduct disorders and associated needs. The service providers were responsible for selecting the most
serious cases. Additionally, the assessment could not deal with emergent needs, once the places had
been filled there was no more capacity. Those pupils absent on the day of assessment, or who joined
the school during Year One could not be assessed.
Where assessment was delegated to the service provider, it was governed by agency
specific approaches. These procedures could isolate service users, or as one provider
remarked: ‘It’s no good having brilliant assessments if they don’t come back’. In
order to overcome this, providers ‘screened’ or ‘fronted’ their service and assessment
of needs that led to it (see also Section 3 on referral). Agency-specific needs
assessment could be broken down into stages, an initial engagement, followed by
assessment over a period of time. Social workers in particular used their experience
of engagement to assess needs. An example is provided by the Family Therapy
service offered to children across a number of primary and secondary schools.
Family therapy
The On Track coordinator and team had no role in assessment, needs assessment was delegated to
service level. Assessment of need was based on ‘self-assessment’ techniques associated with the De
Shazer model of brief solution focused family therapy and with social work principles of including the
service user at all stages of provision. Assessment was linked to the non-curative model of
intervention, that service users could solve their own problems and the role of the provider was to
facilitate that process: ‘We can’t solve the problems, but we can help deal with them’.
One of the challenges of this form of needs assessment was when additional needs were identified
through self-assessment. The providers were not always in a position to deal with these needs and
despite a ‘24 hour principle’ (where any service users seeking assistance was either given assistance or
directed to another provider within 24 hours of contact), there were difficulties over the acute needs
expressed. For example, disclosures of needs that concerned issues of child protection meant that the
user had to be referred back to Social Services. The self-assessment had limits that were not always
evident to the user. In addition, their needs being met relied on an element of cooperation that
excluded non-co-operative groups and those outside the service (non attendees).
The main difficulties in needs assessment were the duration of the service and the different levels of
confidence of the service users. Service providers reported that it took some time to create the
conditions under which service users would identify their own needs, and that some service users were
less articulate and/or lacked the confidence to do this.
One of the common features of areas where assessment procedures were programmewide was that an initial assessment was by the worker thought to be most appropriate.
For example, if the reason for referral was health-related, or by a health worker, the
health professional would make the initial contact. As a consequence, some of the
workers were in much more demand than others, making more assessments than their
colleagues.
In some cases service providers drew on other agencies’ assessment of need. For
example, if a child had been involved with CAMHS and they had carried out an
assessment, On Track would draw on that. As a consequence, assessment extended
beyond the ‘problem’ as identified by the service user and/or the referring agency.
However, almost a third of those services examined in more detail reported concerns
or difficulties around accessing data from, or sharing data with other agencies. Health
providers were cited most frequently as those least willing to share data, although
47
schools and Social Services were also reported as ‘difficult’ on occasion. An example
of successful sharing of information is provided by the Health Advisor service,
offered to children and families across the whole On Track area.
Health Advisor: Specialist
The On Track coordinator and On Track team played a role in assessment, needs assessment included
the use of the programme-wide tool. The On Track team member who had been allocated the case
visited the family at home on at least two occasions in order to carry out the assessment
Assessment of need was carried out through the use of a common assessment tool which was based
upon Social Services National Framework of Assessment. One service provider described this as an
‘excellent tool’. All agencies involved with the family contributed to the assessment, for example,
medical notes and school attendance data were used, as were data from other agency assessments, such
as CAMHS. The provider sought advice and support from other professionals, such as teachers, GP’s,
social workers and schools; any professional with an involvement in the case.
The assessment was described as highly appropriate in that it identified issues in a systemic context,
rather than isolated. Without this from of inter-agency, holistic assessment, certain issues would not
have been identified.
The main strength was that the assessment framework enabled providers to have comprehensive
knowledge of the services that are available: ‘We’re all together, we’re all seen to be working together
as a team, we’ve got a nice flow of information backwards and forwards. Because we give out
information to other people, it tends to get reciprocated’. This reduced the likelihood of
disengagement by providing additional or ‘wrap-around’ support for children and families.
An approach adopted in another area where programme-wide procedures were in
place was to calibrate assessment with engagement, so that some form of service
could be provided before a full assessment took place. An example is provided by
Supporting Families (parent support and training), offered to children and families
across an On Track area.
Supporting Families: Parent support and training
The On Track team played a role in assessing the needs of users who had been referred to Supporting
Families. Once a referral was completed by the referring agency, it was taken to an allocation meeting
and then allocated to the appropriate member of the On Track team. The coordinator was present
throughout these meetings, but was not involved in assessing the needs of service users.
There was a standard assessment tool and the designated worker carried out the assessment. The initial
assessment entailed obtaining family details, the reasons for referral, views of the child and parent and
details of any previous help. The tool for this was called ‘Stage 1’. If the professional who assessed the
users need thought that there was a need for a more in-depth assessment to be carried out, this would
be completed using a ‘Stage 2’ pro forma which requested more detailed information such as details on
peer relationships and social presentation of children. However, this was rarely used.
Initial assessment provided the opportunity to follow a strand, while the second assessment facilitated
an in depth look. This was not based on family perceptions, but through a professional assessment from
people who work with the family or the children. ‘You get a more balanced view’.
The main challenges reported were that families could be reluctant to complete the forms and that the
‘Stage 2’ form was not used frequently enough. If the family disagreed with the content, they could be
lost. However, this was combated by carrying out the assessment carefully, allowing space, giving
dignity and respect.
48
Overall, a number of challenges relating to needs assessment were reported:






Securing the consent and active involvement of service users
The use of inappropriate assessment tools, specifically diagnostic tools
applied across service contexts
The lack of standardisation - different tools collecting similar data
Cumbersome or detailed assessment tools that required disclosure of
personal details
A lack of continual assessment, or the over-reliance on ‘front-end’ and
‘clinical’ approaches
Raising the expectations of service users.
A number of strengths relating to needs assessment were also reported:



The multi-agency co-ordinated approach adopted in most areas
The involvement of the users
The ability to determine and meet users’ needs more accurately.
While service providers were actively involved in needs assessment, the inter-agency
and experimental nature of the On Track programme had led to some tensions and
conflicts between providers. On Track coordinators had to manage and resolve these
conflicts and were increasingly drawn to adopting a common, programme-wide needs
assessment procedure, within which a range of different (agency-specific) approaches
could operate. The staged model (of area G) presents itself as useful in this respect.
The first stage (where minimal data was collected and the focus of assessment was on
providing a route to a service and meeting immediate needs) was simple and easy to
apply across contexts and facilitated engagement and (where appropriate) early
intervention. The second stage focused on needs, outcomes and risk and protective
factors, collecting more detailed information and permitting a fuller, inter-agency
assessment of need. Importantly, providers who had existing needs assessment tools
or approaches were able to opt out of this stage if they felt it unnecessary, if it risked
replication or did not match the content of the service and/or culture of the provider.
4.6
Service users with needs unmet by existing assessment
The research sought to examine the existence of groups that, in the views of the
service providers and On Track coordinators, required a service, but who were not
currently provided with one. These potential service users were not necessarily the
same as the hard-to-reach groups as identified earlier (Types A-C), but those who, for
a range of reasons, fell or remained outside existing assessment procedures. These
included:





Children and young people with behavioural and/or mental health problems
Minority ethnic groups
Service resistant
Families with needs beneath the thresholds required to trigger intervention
Isolated parents (specifically those with mental health problems).
49
4.6.1 Children and young people with behavioural and/or mental health
problems
The group of individuals within the On Track area that were perceived to be the most
likely to have needs that were not being assessed and/or met were children and young
people with behavioural and/or mental health problems. These were often problems
that were evident in a context such as school, such as in withdrawn behaviour or
violence towards other pupils or staff, but had not always led to support or service
intervention. This was related to a lack of capacity among specialist providers; gaps
in provision, for example where young people had been excluded from school with
mental health problems and had not received a proper assessment prior to exclusion;
aggressive and violent behaviour towards service providers; fear of working with such
groups; inadequate screening in schools; a lack of training in the early identification
of mental health problems across service contexts (including health); and the erosion
of preventative services for this group.
A concern across all eight On Track areas in the sample was the lack of early
intervention around young people, leading to the amplification of ‘minor’ mental
health problems over time. For example, the general lack of nursery and crèche
provision in area C meant that diagnostic tests were not always carried out on
children. Added to this was the high annual turnover of population in the On Track
area, meaning that some children could arrive at primary school with unmet and quite
severe mental health needs. The assessment procedures, for those outside the SEN
system, did not always pick up on these difficulties, or they were interpreted as
behavioural difficulties (leading to exclusion).
4.6.2 Minority ethnic groups
Minority ethnic groups were identified as groups who may not be having their needs
assessed and/or met. Four of the eight On Track areas mentioned that Black British
populations, specifically young men, were outside provision. In two of the areas this
was attributed to the fact that these groups tended to be based predominantly outside
the On Track area and therefore out of their remit. However, in terms of their
exposure to risk factors and the perceived lack of protective factors in the peer
community, these young men were the cause of professional concern across agencies.
For example, street gang culture was identified in one area as a growing influence on
the ability to assess and meet needs within specific communities. However, concerns
with ethnicity did not rest solely on anti-social values and behaviour, there were also
concerns that some populations (such as asylum seekers) were dispersed into On
Track areas without support systems that would encourage them to come forward and
express their needs. Linguistic and cultural barriers made assessing the needs of some
populations difficult. In addition, there were variations within any single population.
For example, the ability of Asian women (specifically Bangladeshi mothers) to
engage in needs assessment was limited by cultural concerns about disclosure to men
and by fear of service providers.
4.6.3 Those resisting intervention
The ‘service resistant’ were also identified as groups who may not be having their
needs assessed and/or met. This group linked closely to issues of hard-to-reach (see
Section 2) and were also differentiated into ‘problem’ families and service resistant
50
men who refused to engage in needs assessment, or withheld consent for their child’s
participation. It was acknowledged that some families might not want to engage as
the stigma attached to the service might be off-putting, or that the family might value
privacy. However, reluctance to engage might also be increased by On Track’s
connection to schools, since for most families, the only route in was through schools,
and some families are not keen on working with eductional professionals.
4.6.4 Families with needs beneath the thresholds required to trigger
intervention
Families with needs beneath the thresholds required to trigger intervention were
identified as groups who may not be having their needs assessed and/or met. Families
might have a threshold of need that was too high for On Track preventative work, but
too low for statutory intervention from an agency such as Social Services. This could
mean that the families with the highest level of need were unable to gain any form of
preventative provision for family members, for example, for younger siblings of older
offenders, but it also meant that families who may benefit from early intervention (to
arrest or reduce the risks of offending) could not gain access as their needs were not
considered to be so great. There was reported concern that assessment of families
tended to focus on the ‘higher end’ of need and not on early intervention.
4.6.5 Isolated parents (those with mental health problems)
Incidences of ‘isolated’ parents, those suffering from mental health problems such as
depression or agrophobia emerged during the study, and it was apparent that this type
of parent might constitute another category of potential On Track users with unmet or
undiagnosed needs. These cases could have needs severe enough to trigger
intervention, but be ‘hidden’ from view, for instance because the child helped to
manage the home. In one example, an agrophobic mother was eventually given
support for her condition due to the referral of her sons to an On Track intervention
because of their behavioural problems in school. Thus, identification, referral and
assessment of this user-type may remain a particular challenge because of the very
symptoms they exhibit.
4.7
Summary

There was evidence of two main assessment procedures in the eight of the On
Track areas: the delegated and the programme-wide. Both procedures allowed
service providers to continue with their own service-specific approaches to
assessment, using agency-specific or On Track assessment tools, but there was
evidence that the programme-wide model allowed greater steerage by the On
Track team and the On Track coordinator. Three approaches to assessment were
evident at service level:



the outcome-orientated approach
the needs-led approach
the risk and protective approach.
51

Often assessment approaches could combine all three, but as On Track moved
further into implementation, greater emphasis was being placed on the risk and
protective factors during assessment within both outcome orientated and needs-led
approaches.

A number of service providers were committed to less structured forms of needs
assessment and within these approaches were concerns around user engagement.
Some of the more structured approaches were perceived to risk disengagement
among vulnerable service users. However, the experience of users suggests that
even quite structured needs assessment was often ‘screened’ from them. A key
feature in both structured and unstructured forms of assessment was the use of
strategies to reduce disengagement, especially early in the intervention. However,
there was some evidence that assessment of children without the participation of
parents and/or families, could lead to some tensions, although these were
relatively minor and dealt with by service providers.

A key feature of needs assessment within On Track was the diversity of strategies
evident within any single approach, even where there were programme-wide
procedures. The challenge for On Track coordinators, service providers and their
strategic managers, remains that of taking forward the evidence of good practice
within each area and bringing the benefits and the lessons learned thus far, to the
programme and those delivering and using its services.
52
Chapter 5
Concluding comments: implications
of the NFER research
5.1
Introduction
This final chapter brings together the main findings of the research conducted by the
NFER LET and suggests a number of implications for both policy and practice. The
experimental nature of the On Track programme has led to the implementation of
almost 200 services for children and families in the project areas studied. Many of
these are preventative in nature and work with some of the most vulnerable groups, in
some of the most economically disadvantaged areas of Britain. This work has
potential implications for those working in similar circumstances, for those planning
or delivering services in similar areas, and for policy and strategic direction across a
range of statutory and non-statutory services.
5.2
Hard-to-reach service users
It was clear that definitions of hard-to-reach had been refined and that family factors
were becoming the focus of efforts to target hard-to-reach groups. The research
identified two main reasons for this:


The identification of family factors in any immediate problems identified or
expressed elsewhere (i. e. a child’s behaviour in school)
The development of ‘truly preventative’ services (e.g. services that required the
users’ cooperation and commitment in order to address and reduce the impact of
longer-term problems, such as criminal behaviours).
It was also clear that the risk factors associated with the family (such as criminal
activity, drug use, anti-social behaviour, etc.) were emerging as barriers to
engagement. It was less clear that protective factors associated with the family (such
as pro-social behaviour, positive attitudes to schooling, family stability, etc.) were
facilitating engagement, but there was evidence that service users were being
approached as a family unit in many areas, rather than as individuals.
Within families, men were being identified as one of the key barriers to engagement,
either because they were resisting intervention, or because they were the source of
many of the risk factors impacting on children in other contexts. This would suggest
that engaging families and engaging men was one of the key priorities for On Track
service providers. For some areas, the issue of engagement was around providing
information and building trust, such as those attempts to engage Asian men. In other
areas, where men were hostile to intervention and/or a significant number of men
were involved in criminal and/or antisocial behaviour, there were concerns about the
staffing of services, safety and where services were sited.
53
Where there was evidence of strategies that successfully engaged hard-to-reach
groups, these were not necessarily appropriate to all services within an On Track area,
or appropriate for all users of a single service. For example, relocating a service from
a specialist centre to a school might reduce the stigma associated with attending, but
not all services users could do this and when they did, some service uses were
reluctant to attend a school site, while others were excluded from it. However, the
research would suggest that existing strategies could be shared more effectively,
where similar populations were targeted, or where similar services were implemented.
At the time of the research there was evidence of good practice in engaging and
providing services to hard-to-reach groups at the operational level, specifically
drawing on the skills and experience of the voluntary sector. There was little
evidence of any strategic involvement in any inter-agency or inter-area sharing of
good practice.
The research found that some services were themselves deemed hard-to-reach. On
Track provided examples of successful inter-agency working that addressed some of
the ‘distance’ between service providers and service users. Where effective joint
working took place, there was increased understanding of the professional cultures
within agencies and an agency’s aims and objectives. Co-location of services, where
agencies provided different services on the same site, was found to improve
operational relationships. Relocation of services, where agencies provided a service
at an alternative site (not necessarily working with others) was found to increase
engagement, specifically with hard-to-reach service users. Nonetheless, there was
less evidence of strategic commitment to the changing practices evident within On
Track. For example, commitment to extending the hours during which a service was
available, or for removing restrictions to a service based on attendance (or failure to
meet appointments). The links between operational developments and future strategic
direction were not clear. This does not suggest that future strategies will not be
informed by operational developments, but that these developments pose complex
strategic challenges to providers.
5.2.1 Implications: policy and practice

Given the progress in engaging hard-to-reach service users, the successful
work taking place with these families in On Track areas could be more
widely disseminated to service providers within those areas.

There has been a clear identification of risk factors within families and
increased recognition of the positive and negative influence family factors
have on engagement. Hence the role of families (and particularly men) in
facilitating or impeding service delivery could be addressed more directly by
other On Track providers.

At policy level, the role of the voluntary sector, specifically its experience in
engaging hard-to-reach service users, might be better utilised in the strategic
planning of services. The training it could provide in areas such as
community engagement and in safety when working with the hard-to-reach,
could also be useful for other providers seeking to extend provision.
However, the costs of this training would require additional funding, to make
54
it more widely available and so that it could be structured more
appropriately to the needs of other providers.

At strategic level, the linkages between voluntary and statutory providers
remain variable; often poor and only occasionally effective. The engagement
of hard-to-reach groups and the provision of services to them could be more
of a strategic priority for all services. Addressing the needs of hard-to-reach
service users could be tied more explicitly to the strategic targets of service
providers.
5.3
Referral to On Track services
The research found that the role of the On Track coordinator in the referral process
varied. It identified patterns of referral to and from On Track services that rested on
existing practice and identified four key challenges associated with existing referral
procedures:




Users could find the process uncomfortable and/or alienating
Agencies could make inappropriate referrals to On Track services
Some of the referral procedures were inadequate or out-of-date
The referral tools and instruments could be inappropriate for the uses to which
they were put.
The research also found that the most valued referrals were often self-referrals.
Strategies that sought to raise the awareness of On Track services within the local
community and increase the number of self-referrals were evident.
The site of service provision was found to influence referrals by setting limits or
‘boundaries’ to engagement. The majority of services were multi-site, that is,
implemented in more than one place (frequently the home and school). There was
some evidence of an increased use of community venues to facilitate the referral
process, if another site (such as a specialist centre) was associated with stigma.
Referral between agencies was affected by a form of exclusive ‘clustering’ that rested
on existing relationships and/or existing practices, for example, health professionals
referring service users only to other health professionals. Some other professionals
(such as teachers) considered these referral networks difficult to access and/or to
understand.
5.3.1 Implications: policy and practice

The use of community venues and sites not associated with a specific agency
for referral appeared to increase engagement and reduce any stigma
associated with referral. Using these sites has proved effective and could be
adopted more widely where there was evidence of a reluctance to engage.
55

Noting the exclusive ‘clustering’ of referrals within and between agencies,
some service providers might seek ways to strengthen their links with their
‘non traditional’ partners and with the voluntary sector.

Given that some referrals were deemed inappropriate and that existing tools
and procedures were difficult to apply across services and sites, common
tools and procedures could be adopted and information sharing between
agencies improved.
More effective referral could be secured by a
coordinated approach, through a single group or panel.

There could be more recognition that common referral procedures still need
to allow service-level flexibility. The evidence of On Track points to a need to
avoid replicating or overriding effective systems when seeking to replace
ineffective systems.

In particular, the capacity for referral between agencies should not be
overestimated. Encouraging cross-agency referral without addressing its
resource implications could undermine strategic commitment to any single
group or panel.
5.4
Needs assessment within the On Track programme
The research identified two main models of needs assessment:


Where needs assessment procedures were programme wide
Where needs assessment procedures were delegated to service level.
These models were linked to the ways in which services were being delivered within
the programme (i.e. the ‘in-house’, ‘contracted out’ and ‘mixed economy’ models of
service delivery), although the programme wide procedures (linked to the ‘in-house’
model of delivery) was the more common of the two.
There were more and less structured approaches to assessing need within these two
main models and evidence of three main approaches:



The outcome orientated approach (i.e. where the focus of the approach was on
reaching an agreed outcome for the service user, linked to milestones and
measurable progress)
The needs led approach (i.e. where the focus of the approach was primarily on
identifying and addressing the needs of the user)
The risk and protective approach (where the approach was informed by a focus on
risk and protective factors).
These approaches made different demands on service users, and by allowing
providers to focus primarily on one or more approach, the two models of needs
assessment allowed flexibility at the service level.
The more structured approaches to needs assessment reduced the influence of the
coordinator. For example, where access to a service was assessed within a structure
56
that excluded all needs except the targeted need, it was difficult for the coordinator to
extend the service to other users, with similar or additional needs. However, this
clarity was valued by some service providers, setting boundaries to the service. The
coordinator achieved influence by commissioning (or not replicating) services using
such an approach, or by establishing complementary services around them.
The needs led approaches were more effective in identifying additional needs, over
and above those met by the service. Such approaches were able to assess need at
multiple points, using a range of tools (as opposed to an entry level screening
process). This meant that service users could access them in a more flexible manner
and that they were more effective in collecting additional, often complementary data
around issues such as risk and protective factors in the home and community.
The risk and protective approaches were emerging where agencies worked together,
often in a single site. This approach required greater sharing of data and inter-agency
co-operation and thus was contingent (to some extent) on the quality of operational or
strategic relationships.
5.4.1 Implications: policy and practice

It is clear that needs assessment approaches should not prevent the
identification of additional needs, for example, by limiting needs assessment
to a one-off, entry level exercise. The evidence of On Track is that service
users, specifically hard-to-reach service users, have multiple, complex and
inter-related needs. Because of the difficulties of engagement, these needs are
often emergent and may not be immediately evident or expressed.

The model of needs assessment adopted within any one area (or programme)
influences the roles that partners (including service users) play in needs
assessment. Thus, the impact of any one model of needs assessment should be
considered carefully before implementation.

The quality of the relationships between different service providers (at both
strategic and operational levels) appeared to affect needs assessment. Where
some services shared information and engaged in inter-agency (or interservice) needs assessment, others did not, or did so reluctantly. Joint
assessments are invariably inhibited by differential strategic and operational
commitment to them. Hence, a focus on needs assessment may require or
benefit from joint training.

At policy level the evidence of On Track suggests that needs assessment
requires an agency dimension, but need not be agency specific. That is,
where some providers have skills that are not widely available, the sharing of
this expertise could be encouraged through the provision of resources (or
direction) to further encourage the establishment of inter-agency working
groups, or inter-agency needs assessment panels for children and families.
57
Appendices
Appendix 1:
Interview schedules with coordinators and
service providers
Appendix 2 :
Summary Templates
Appendix 3:
Factors in informing priorities identifying
hard-to-reach groups or individuals
Appendix 4:
A Summary of the involvement in referral of
coordinators across On Track
58
Appendix 1
Interview schedules with coordinators and
service providers
The research team used interview schedules which contained sections on Referral
Procedures, Assessment and Hard-to-Reach groups. The schedules were used during
fieldwork which took place in Autumn 2002 and Spring 2003.
These sections are reproduced below.
59
A
Referral procedures
A5
In this section we are looking in more detail at referral procedures – how service
users come to receive the intervention.
A1
At a general level, what is your role in the referral of service users?
A2
Is this a universal service, open to all, or is it selective in some way?
Probe: What are the key criteria for access?
A3
Can other agencies, or other On Track service providers, refer service
users to you?
IF YES
A3.1 Which ones?
A3.2 Do some agencies/On Track service providers refer more than
others?
(Probe for details/examples/reasons)
IF NO
A3.3 Why not? (Probe for details/examples/reasons)
A3.4 Would you prefer it if they could?
(Probe for details/examples/reasons)
A4
Do you ever refer those you work with to other agencies or providers,
including those offering another service within the On Track project?
IF YES
A4.1 Which agencies?
A4.2 Do you refer to some agencies or services more than others?
(Probe for details/examples/reasons)
On Track covers a specific area. Can people who live outside the On
Track area be referred to the service?
IF YES
A5.1 Who can be referred?
A5.2 On what grounds can they be referred?
IF NO
A5.3 In your view, would it be better if they could be referred?
(Probe for details/examples/reasons)
A6
What are your general views of the referral process for the service?
Probe: The key challenges relating to the referral procedures?
The particular strengths of the procedures in place?
A7
How effective and/or appropriate do you feel the process is?
Probe: Does it work? Is it appropriate for all of the users, or potential
users?
A8
Could the referral process be improved?
IF YES
A8.1 How could it be improved? (Probe for details/examples/reasons)
A9
Focusing on a specific intervention in your On Track area which you
consider to be an example of good practice in terms of referral, could
you go through the referral process?
Probe: Which/intervention?
What are the referral criteria for this intervention?
Where do referrals come from?
Describe the referral process?
Who does what?
What are the particularly effective/successful aspects of the
process?
Are there any particularly effective/successful aspects in relation to
hard to reach groups?
IF NO
A4.3 Why not? (Probe for details/examples/reasons)
60
B
Needs Assessment
This section looks at how service-users’ needs are identified. A general discussion
of the issues around need and needs assessment, is followed by your own work in
this area.
B4
What are the main strengths of the current assessment procedures in
diagnosing the needs of service users?
B5
What are the main challenges?
B1
B6
Do you offer, or have you received any training or support in the use of
assessment tools?
IF YES
B6.1 What is this, who offers or provides it and who has delivered or
received it?
B7
In your view, which groups or individuals, if any, within the On Track
area locally have needs that are not being met within current provision?
(probe for details/examples/reasons)
B8
Focusing on a specific intervention in your On Track area which you
consider to be an example of good practice in terms of assessment, could
you go through the assessment process?
Probe: Which intervention? Pastoral support
Describe the assessment process
Which assessment tools, if any, are used?
Who carries out the assessment?
What are the particularly effective/successful aspects of the
process?
Are there any particularly effective/successful aspects in relation to
hard to reach groups?
Are the users of your service assessed before accessing the service?
IF YES
B1.1 What is the process?
B1.2 What does it involve?
IF NO
B1.3 Is there a reason for this?
B1.4 Do you use any other methods of determining users’ needs?
B2
Is there a common assessment tool, used by all of the On Track service
providers, and for all service users?
IF YES
B2.1 Can we see it (if we don’t have a copy, can we take one)?
B2.2 What are the reasons for using the tool (what are its origins)?
B2.3 Who carries out the assessment?
B2.4 In your view, is this assessment tool appropriate for all service
users?
IF NO
B2.5 What are the reasons for not using one?
B3
Do you use any other assessment tools?
IF YES
B3.1 Can we see it (if we don’t have a copy, can we take one)?
B3.2 What are the reasons for using the tool (what are its origins)?
B3.3 Who carries out the assessment?
B3.4 Is this tool used by any other On Track services, or for any other
service users?
B3.5 In your view, is this assessment tool appropriate for all service users?
IF NO
B3.6 What are the reasons for this?
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C
Hard to reach groups
This section focuses on issues around service provision and accessibility as it may
relate to particular populations or hard to reach groups and their referral and
assessment.
C1
In terms of providing services to children and families, are there any
groups locally that you consider to be hard to reach?
Probe: Which groups are considered hard to reach?
(Probe for details/examples/reasons)
C2
Does your service specifically target hard to reach groups?
(Probe for details/examples/reasons)
C3
Do you intend to target any hard to reach groups locally in the future?
IF YES
C3.1 Which groups?
(Probe for details/examples/reasons)
C3.2 What service will you offer? (Probe for details/ examples/reasons)
C4
Have you encountered any difficulties locally in terms of providing
services across the whole area, or to the whole population?
(Probe for details/examples/reasons)
C5
Do you have any difficulties with ‘needy’ service users, those who will
engage, but who are difficult to move forward?
C6
Looking at what you do, are there any issues around non-attendance,
where some people may not turn up for sessions?
(Probe for details/examples/reasons)
C7
Are there any issues relating to drop out, where services users may stop
coming? (Probe for details/examples/reasons)
C8
At a more general level, what are the main challenges you face in
providing services here? (Probe for details/examples/reasons)
C9
What is the most satisfying part of your role?
C10
Focusing again on effective/successful practice, can you describe any
examples of successful strategies with hard to reach groups in relation to
the following areas:
a)
Referral/recruitment?
Probe How is referral of hard to reach groups encouraged/ensured?
Are the referral criteria adapted for hard to reach groups?
What makes this strategy particularly successful?
b)
Assessment?
Probe How is the assessment of hard to reach groups conducted? In the
same way as all assessments. She mentioned that you can over
input into a family and that you need to work to their agenda.
Where does assessment of hard to reach groups take place?
What makes this strategy particularly successful?
c)
Ongoing work?
Probe How do providers best ensure sustained support for these groups?
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Appendix 2
Summary Templates
Hard to reach data summary
A
Groups considered hard to reach
B
Specific targeting of hard to reach groups
C
Strategies to engage hard to reach groups
D
Future targeting of hard to reach groups
E
Difficulties in providing services locally
F
Main challenges associated with providing services generally
G
Difficulties with needy service users
H
Issues around non-attendance
User views on missed sessions
I
Issues relating to drop out
J
Most satisfying part of your role
K
Summary/analytical notes
63
Assessment data summary
A
The assessment process
B
User involvement in the assessment process
C
Who carries out the assessment?
D
Common assessment tools
E
Other assessment tools
F
Main strengths of the current assessment procedures
G
Main challenges of the current assessment procedures
H
Training in the use of assessment tools
I
Groups or individuals whose needs are not being met within
current provision
J
Summary/analytical notes
64
Referral data summary
A
Selective or universal intervention
B
Referral criteria
C
Intended recipients
Key characteristics
D
Actual recipients
E
Grounds for referral of those outside the On Track area
F
Agencies/services that can refer
Those that refer more than others
Reasons
G
On Track providers that refer
H
How service users knew about the service
I
Agencies/services to which service users are referred
Those to which refer more than others
J
On Track providers to which service users are referred
K
Referral/recruitment process
Provider’s and coordinator’s role-
L
Views on the referral process
Service users’ views
Provider and coordinator views
 Strengths
M

Weaknesses/challenges

Appropriateness

Improvements
Summary/analytical notes
65
Appendix 3
Factors in informing priorities identifying hardto-reach groups or individuals
It was apparent in recent research that across all eight NFER On Track areas, the
differing definitions of hard-to-reach were still placing greater or lesser emphasis on
some key features of the service user and hence shaping provision:
Population characteristics The population (its presence in the area and absence
from service) was a key factor in provision. This was where specific characteristics
within the population (such as its ethnic composition) defined all that population as
hard-to-reach. Providers were either resting their services on such characteristics, or
using such characteristics to press for, or to develop new services. For example, in
one area by drawing on census and population data to develop services for children of
Vietnamese origin, whose presence was evident, but who did not come forward for
services, or engage with providers in any meaningful way.
Perception of need The needs of service users (and the feeling that they were not
being either fully expressed or met) was a key factor in provision. This was where
there was a desire on the part of providers to focus in on the needs of a particular
group. There could be both a projection of need onto a group (as above), but also this
was evident where individuals or groups were unaware of their needs, or unable to
express them. For example, one area provided female outreach workers to assess the
parenting needs of Asian women, because their needs were often (but not exclusively)
expressed by, or articulated through men.
Prior experience of service The impact of the previous experience of the service
user on engagement was a key factor in provision. This was where there was
evidence that negative or positive experiences of services had impacted the future
participation of service users. For example, in one area there was difficulty of both
engagement and ‘movement’, where some potential service users, with clear needs,
would not engage, yet others who had come forward were reluctant to move through
services and were becoming service dependent.
Behavioural issues The past, current or anticipated behaviour of service users was a
key factor in provision. This was where certain behaviours defined a group as hardto-reach or outside the main population. For example, research has identified
exclusion from school as increasing the risk of future offending. In one area, children
excluded for violence were seen as particularly hard-to-reach because service
providers were reluctant to work with them, citing issues of their own personal safety
and the children’s reluctance to engage with them. The key feature of providing
services to these children was to establish a context where their behaviour could be
managed, but did not preclude access, meaning that children could escape their
‘difficult’ identities and providers could feel secure when working with them. The
66
key feature of provision was in addressing the influence of behaviours on creating
socially isolated groups, or addressing how behavioural problems in one context (such
as a school) might exclude some individuals from subsequent provision in another
(such as a youth centre).
Physical or social isolation or exclusion A key factor in provision was the need to
provide for those outside services as currently located, configured or delivered. This
was where service users were unable to access provision that was available. For
example, where whole communities or individual service users were cut off from
provision, possibly by poor transport links, an inability to afford the costs of transport,
or a reluctance to access any services provided in a centralised setting or in a distant
location.
Information provision A key factor in provision was the accuracy and availability
of information about service users. Providers often lacked information about potential
service users and potential service users lacked information about the services
available. Some services contained within them an awareness raising exercise,
directing users to it, or to other services and informing potential service users of what
was available. A key feature in the provision of these services was their ‘educational’
role. In some cases the desire to raise awareness of a service was perceived by
providers to be of equal significance to its actual content. Thus, awareness raising
became a service in itself.
Targeting strategies A key feature in provision was the strategies used to target
specific individuals or groups. This included the explicit under or over-targeting of
some populations. For example, where service providers examined the demographic
profile of users and compared this to local or nationally available data. As was the
case with population characteristics, this was driven by a range of factors, but in
stressing targeting strategies providers were displaying a recognition that current
provision was out of kilter with need, or that it was unable to respond to changes. As
a consequence, some groups were over-targeted, leading to reluctance to participate,
replication and/or misdirected resource allocation. Others were not targeted, due to a
lack of awareness, current practice, local politics, or a lack of information. Where
targeting strategies was a key feature within provision, it tended to be linked to other
issues.
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Appendix 4
A Summary of the involvement in referral of coordinators across On Track
On Track Area
A
B
C
D
Role
All the referrals were taken by the coordinator. She then checked
each referral to ensure that the eligibility criteria were met. A
representative of the agency making the referral was then invited to
attend a weekly interagency referral meeting. At this meeting the
appropriate service within On Track was identified. If services
outside On Track were seen as more appropriate, a referral visit to the
user will follow before contact with that agency was made and the
referral progressed.
All referrals came through to the pastoral support team, which
consisted of the On Track team members providing services within
the On Track. The role of the coordinator was to manage referrals, if
a referral was made to an individual intervention, this would be
passed through the coordinator, not move forward directly to the
service via the provider.
The coordinator had no direct role. Referrals came into the On Track
team. Each one was different, in fact, only three of the services had
specific referral forms. The programme manager checked the criteria
and checked the target group for eligibility. All providers always
referred on to another agency if they were unable to provide a
service, either directly or via the On track team, informing the
coordinator of destination.
Referrals came onto a central case management system. This entailed
looking at the referral form to check whether the referral was
appropriate and matched referral criteria. The coordinator would also
check whether the referral was an ‘emergency’ and if it was, she
would refer on to an agency such as Social Services. Referrals would
Time Demand
Referrals occupied two to three hours of
the coordinator’s time. The weekly
meeting itself took around an hour, but
this depended on how many referrals
there were.
View of involvement
The coordinator felt that her level of involvement was
about right and reported that the demand made on her time
was appropriate.
Referrals for services came through to
pastoral support workers who spent
around an hour a week on this. The
coordinator monitored referrals but was
unable to say how much time this
required.
None as she had no direct role, other than
receiving referrals and maintaining a
strategic overview.
The coordinator was involved as much as she wished to
be. She felt that demands upon her time were fairly
reasonable.
The coordinator was unable to indicate
the time demand of this.
The coordinator was satisfied with her role in referrals.
She reported that the case management system was easily
managed, straightforward and required a team approach.
68
She stated that at the moment, she was satisfied with her
level of involvement. However, over the next few months,
this would change as the team was trying to increase
information sharing.
E
F
G
H
be brought to the referral management meetings which were held
twice a week in order to be allocated. The cases were allocated
according to the main presenting need. The coordinator’s role was to
maintain the system and to keep an overview of referrals. She also
managed the allocation of cases to the team.
The coordinator did not have a direct role in referral. There was a
specific panel to deal with referrals. Members of the panel included
representatives from Home Start, Family Support, the Children’s
Society and link representatives from schools. The panel met
monthly and the coordinator delegated attendance of this to the
practice development manager.
The coordinator reported that her role was limited. Referrals were
brought to the weekly meeting where referrals were allocated to On
Track staff. The referrals came to the coordinator if she came across
the agencies that refer during her day to day work but most came
through the central referral system. The coordinator attended and
facilitated the meetings of the team, but was able to exert limited
steerage on referrals that were not presented at these meetings (i.e.
taking place outside it, but within On Track). She added that
agencies have referred directly to her and in these cases, she took the
referrals to the meeting for discussion.
The coordinator had no direct role in referral.
The coordinator didn’t have a particular role in referrals. These were
made to individual interventions.
The role demanded very little time as it
only involved an occasional conversation
with schools.
The coordinator didn’t feel that the role was time
demanding.
The coordinator spent over half a day on
referrals. This was taken up by the
meeting and issues arising from it.
She reported feeling too involved and that she would like
to step back more, although interestingly, she felt that the
role wasn’t too time consuming.
She said it required ‘practically no time’.
She was satisfied with her involvement, as she didn’t think
the coordinator should be too involved in service delivery.
She felt that she could be more involved so that she had a
better idea of the whole of On Track and how far services
were utilised.
The coordinator was not involved in
referrals and so it didn't require any of
her time.
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References
ARMSTRONG, D., DOHERTY, P., FRANCE, A., HINE, J., KINDER, MORETON,
K., NOAKS, L., PARSONS, C. STOTT, A. (Forthcoming). On Track: Process and
implementation. Home Office Research Report. HMSO: London.
ATKINSON, M., WILKIN, A., STOTT, A., DOHERTY, P. and KINDER, K. (2001).
Multi-agency Working: A Detailed Study (LGA Research Report 26). Slough: NFER.
DOHERTY, P., HARRADINE, S. and STOTT, A. (Forthcoming). Hard-to-reach:
definitions, consultation and service delivery. Home Office Development and Practice
Report. London: HMSO
DOHERTY, P., KINDER, K. and STOTT, A. (Unpublished). The Final Report of the
NFER Northern Office Local Evaluation Team (LET). Slough: NFER.
MAKINS, V. (1997). Not Just a Nursery: Multi-Agency Early Years Centres in
Action. London: National Children’s Bureau.
NORMINGTON, J. and KYRIACOU, C. (1994). ‘Exclusion from high schools and
the work of the outside agencies involved’, Pastoral Care in Education, 12, 4, 12-15.
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