Approaches to Working with Children and Families Executive Summary Key findings There are many different formal and informal approaches to working with children and families, resting on a range of concepts and theories. There is little firm evidence that any one approach is more effective or beneficial than another, either from research evidence or local authority practice. Despite this lack of evidence, it appears that local authorities are increasingly opting to adopt one consistent, formal approach across workforces, although this is more prevalent in Children’s Social Care than across the whole workforce. Research suggests that implementing an approach across a whole workforce would be a long-term process requiring agreement, involvement and widespread training over time, yet there appear to be numerous advantages to working in a formalised manner. Recommendations 1. Given the wide range of available approaches in working with children and families, the approach currently taken and possible alternatives should be reviewed. Any consideration of adopting an approach should involve exploring the research evidence and experiences of other local authorities. 2. Adopting one, standardised approach would require exploring and agreeing upon core principles, underlying theories, processes for practice, common interventions and strategies, and a standardised agreement on desired outcomes. Given the costs of adopting and training staff in a specific approach, exploration of and agreement on these principles should be sought before a final decision is made. This would also prevent a situation where a formal approach adopted was at odds with the principles and experiences of the workforce. 3. Any changes to children’s services should be focused on and driven by the needs of children and their families in the local area, and they should be involved in any decision making, implementation and testing processes. 4. Munro suggested that “a local authority wishing to implement a particular evidence-based way of working with children and families’ needs to consider what changes may be needed in the training, supervision, IT support and monitoring to enable this to be carried out 1 Catherine Goodall KTP Design and Implementation Analyst effectively”(Munro 2011:8). 5. If any approach or combination of approaches is to be adopted, this should be implemented with clear, regular and rigorous testing and evaluation which includes measuring the impact on systems and processes; performance management information for practitioners, and; outcomes for children and families. Evaluations should also consider the system as a whole, and how changes will influence other areas in working with children and families. 6. The current pilot of the SAAF in children’s social care presents an opportunity to explore and evaluate the use of this approach in Nottinghamshire, and to measure its effectiveness, appropriateness and implementation within the workforce. It is recommended that the piloting of this approach be monitored and evaluated internally, taking into account both practitioners’ perspectives and effects for service users. Doing so would not only test the SAAF itself, but would also be an opportunity to critically appraise the implementation and practice of an approach, providing valuable evaluative experience for the authority. 2 Catherine Goodall KTP Design and Implementation Analyst Contents Approaches to Working with Children and Families............................................................................... 1 Executive Summary................................................................................................................................. 1 Key findings ......................................................................................................................................... 1 Recommendations .............................................................................................................................. 1 Introduction ............................................................................................................................................ 4 Needs .................................................................................................................................................. 4 Theory and Practice ............................................................................................................................ 5 Theory ................................................................................................................................................. 5 Overview of Findings............................................................................................................................... 8 Core Principles ...................................................................................................................................... 10 Formal approaches ........................................................................................................................... 15 Solely Social Care Approaches........................................................................................................... 19 Structural and strategic issues .............................................................................................................. 23 Whole Workforce Approaches.............................................................................................................. 24 Participation .......................................................................................................................................... 25 Limitations ............................................................................................................................................ 25 Implementation .................................................................................................................................... 26 A Framework ......................................................................................................................................... 26 Evaluation ............................................................................................................................................. 27 Conclusions ........................................................................................................................................... 28 Glossary ................................................................................................................................................. 30 Bibliography .......................................................................................................................................... 31 3 Catherine Goodall KTP Design and Implementation Analyst Introduction The lives of children and families are diverse, changing and complicated, and as a result the variety and complexity of children’s service provisions, both in the UK and beyond, is significant. Distinctions between children’s social care staff and other practitioners, between theory and practice, as well as in differing levels of skills in staff, and styles of leadership and management, complicate matters further. This is compounded by the range of organisations involved in providing services, the tensions between central and local government, and the major reductions on resources forecast for coming years. This review will consider a range of possible approaches to working with children and families, using research, practice examples and evidence. Within this range there are formal models, general approaches, theories and concepts, any of which could be adopted. It is important to note that, despite some evidence of positive effects “all of these methods have limitations” (Barlow et al. 2012:21). Limitations and difficulties in implementation do not necessarily rule out an approach as an option, but would need to be considered and mitigated against if any such approach were to be adopted. Children’s services are driven by the principles of making children and families’ lives safer and happier, yet whilst “safety, permanency and well-being are worthy practice goals…they are not sufficient as a theoretical framework for child welfare policy and practice”(Lawler et al. 2011:473). Indeed, it has been argued that “too often, the assumption in our field is that good intentions lead to better outcomes”(Axford and Morpeth 2013). However, the principles and determination to do right by families does not in itself necessarily lead to the best outcomes. The wide range of methods for working with children and families demonstrates that there are many possible approaches to take. So, whilst a commitment to protecting children and families and ensuring that they prosper is important and necessary, it may not be sufficient on its own to guarantee success, and there may be far more effective alternative methods. Needs Any changes to children’s services should be focused on and driven by the needs of children and their families in the local area (Sloper 2004). The diagram on the right illustrates the ideal scenario for designing and developing children’s services. A planning, action, critical reflection, development cycle such as this is vital in ensuring that services are appropriate, targeted and 4 Catherine Goodall KTP Design and Implementation Analyst relevant to service users1. Such a cycle would also help to ensure that services are effective and cost efficient, as well as providing clear, local evidence for commissioning. This form of cycle is also in line with the Working Together To Safeguard Children (2013) guidance (Department for Education 2013). A cyclical process like this needs to be an intrinsic and ongoing part of any approach taken, and a commitment to be prepared to change and adapt services which are shown to be ineffectual or costinefficient is necessary. Theory and Practice There are numerous difficulties for local authorities in managing the links between theory, practice and outcomes (Connolly 2007:826). Discussion, debate and agreement on the way the local authority views children and families, and the theories and concepts supporting this would be beneficial, and would inform any decision on adopting a standardised approach. For any one approach to be implemented and to be effective, the ideals and principles underlying this must be made clear, and should be relevant and agreeable to all involved, including service users (D'Cruz and Stagnitti 2008). Also, both the interventions used with families and the theories which support these should be evaluated separately on their own merits (Sheldon and Macdonald 2009). Theory A theory can be understood to be “a generalised set of ideas that describes and explains our knowledge of the world around us in an organised way” (Payne 2014:5). Theories and concepts therefore shape how we understand children and families, and can provide guidance on how best to support them. Approaches often involve several theories or elements of theories, and they are often complementary or interrelated. There is no one theory which entirely encompasses what a family is, or how best to work with them, due to the variety and diversity of different families, and of practitioners. Also, no singular, agreed upon definition of what actually constitutes a family exists, and those that do cannot “always capture the diversity of family forms, traditions and histories”, especially when the structures of families in the UK are changing (Morris et al. 2008:3). This has meant that ‘family’ has become a “taken-for-granted and narrowly defined concept within policy documentation…often used interchangeably with ‘parents’” (Murray and Barnes 2010:533). As policy and legislation could therefore be insufficient in its guidance on how best to understand and work with families, it is important to review existing theories and establish a common understanding locally. Often an approach, particularly in the case of social work, will be based upon a specific theory and set of concepts. These theories include attachment, psychosocial, cognitive behavioural, social pedagogy, systems, and these will be described here. Each theory will have a different focus, which will dictate and guide any approach based on it, and how it is deemed best to work with children and their families. 1 The term ‘service user’ will be used in this review to include any child or family member who receives any form of support from the local authority and its partners, not just those who receive children’s social care involvement. 5 Catherine Goodall KTP Design and Implementation Analyst The table below groups the main forms of theories in social work, their objectives and contributions to practice. This table is useful in visualising the general groupings and purposes of theories, and how they may be applied in practice. There are a vast number of different theories, both within social work and beyond, and any or several of these may be relevant and appropriate for the authority to use as a basis for its work with children and families. The table demonstrates one method for grouping theories to aid understanding, and is not the only way in which these theories can be arranged and understood. 6 Catherine Goodall KTP Design and Implementation Analyst Table 1 - Payne, 2014 Modern Social Work Theory p33 As such, there is a need to consider and collectively understand the theories and concepts which define our practice, and this is important for ensuring that an approach is grounded in research evidence, is relevant to, and accepted and used by all staff. 7 Catherine Goodall KTP Design and Implementation Analyst Overview of Findings Approach Psychosocial Psychodynamic Attachment theory Cognitivebehavioural Systemic theories Social democratic theories Context Based in psychology and psychiatry. Person focused on individuals’ capacity to overcome problems Based in psychology and psychiatry. Person focused, yet the practitioner is in position of power Suggests that infants bond to primary carers, and that the bond is crucial for a range of developmental processes Based in psychology and psychiatry. Person focused on individuals’ capacity to overcome problems. Looks at current problems within the family only. Often used in MH and crime based settings Covers range of theories and approaches. Views families as systems connected to wider societal systems. Supported in government guidance and policy Person focused, emphasis on empowering service users to overcome issues Pros Long history in social work; focus on individual’s and families’ capacity to change; relationship focused which is agreeable to service users; complementary with a range of interventions Long history in range of settings; focus on individual’s and families’ capacity to change; relationship focused which is agreeable to service users; evidence supporting use in specific clinical contexts Supported by extensive research in a range of disciplines; provides clear supporting guidance for practice decisions Cons Limited evidence of effectiveness in this context; can overlook wider influences or causes of a family’s problems; if problems persist this perspective can lead to allocation of blame; a personal and emotional focus can be difficult to apply in statutory settings Resource intensive and costly Evidence supports use in clinical settings and in specific interventions, rather than as a general approach CB approaches and theories are supported by a rigorous evidence base and can have significant positive effects on some families CB practice focuses on manipulating behaviour making it ethically precarious and difficult to obtain true consent for these practices; CB approaches require extensive training and faithfulness to formal theories and processes, which is resource heavy; CB approaches can overlook wider influences or causes of a family’s problems; if problems persist this perspective can lead to blame being placed on a family or individual Systemic approaches can be complex and difficult to employ through a lack of clear practice guidance; these approaches can overlook an individual’s personal problems and lack of commitment to change Useful for practitioners locating family problems within wider systems; positive for service users as it acknowledges wider influences on their needs and problems; can help families connect to and gain support from their wider networks; systemic theory is currently used in certain existing services Can be positive for service users who’s perspectives, experiences, strengths and opinions are taken into account; a focus on A desire to preserve secure attachments over safeguarding could increase risks; a sole focus on attachment could overlook other systemic/family functioning issues Can be overly optimistic of service users’ potential to change their situations; this can damage relationships with service users over time; these principles can be difficult to apply, particularly in statutory settings 8 Catherine Goodall KTP Design and Implementation Analyst Social Pedagogy Whole family Signs of Safety Systemic Unit Safeguarding Assessment and Analysis Framework (SAAF) A general approach or set of principle which views education as informative. Situations are viewed as learning experiences Approaches here take focus on the whole family. Characterised by a whole family assessment (beyond simply a child/children and parent/s or carers) Formal model which assesses the signs of safety for a family. Provides clear guidance on assessment tools and practices with children and families. Primarily safeguarding focus. A structure solely for social work teams. Designed to handle cases in a team environment rather than linear structure. A systematic assessment process for social work teams in the safeguarding environment. empowerment and change can be beneficial for service users As a set of principles, social pedagogy can underpin all work with children and families; highlights the positive effects of communication, listening and critical reflection as important Wide focus can address a range of issues, rather than focusing on one individual who may not be the most at risk or in need. Can be positive and empowering experience for families This is a diverse and ambiguous approach; it does not provide clear practice guidance; as it has not been adopted widely in the UK there is little evidence available to support its use here Costly to train entire workforce in approach; difficult to implement when adult’s and children’s services are separate and numerous agencies are involved; whole family approaches may not be appropriate for every case Very simple and well-defined; the strong principle of ensuring safety provides a clear motive and standpoint; high level of involvement of service users and children in particular is positive; it is supported in the Munro reviews and increasingly being adopted in local authority practice Supported by policy developments; increasing in popularity across local authorities; cases are dealt with in teams providing a more robust and supportive environment Limited in the range of issues it assesses; limited guidance and support for practice; the simplicity of the model may overlook wider issues faced by families; focusing on strengths and signs of safety could lead to increased risks A clear and systematic approach provides consistency and standardisation across workforce; currently being piloted across the UK (and in Nottinghamshire) by the DfE Very little evidence of effects or success of the framework; particularly focused on safeguarding context which possibly limits its wider applicability and relevance Little evidence to support approach; supporting evidence cannot be attributed only to this model as positive effects could be due to a range of factors; costly and resource heavy approach 9 Catherine Goodall KTP Design and Implementation Analyst Theories and Principles The following are examples of theories and their core principles which are or support some of the main standardised approaches to working with children and families. Many of these theories provide general guidance on an approach, rather than specific instructions or patterns for interventions in the form of a formalised theory or model (Vickery 1974). There appears to be stronger evidence for the use of theories in a social work context, than more general in local authority children’s services, and evidence for both is considered here. It is important to note that these theories and concepts are often contested and are not necessarily simple to employ. Child protection and safeguarding are also of key importance, and will shape the way these approaches are read, understood and used in practice (Gorin and Jobe 2013). Establishing a common theory or model can be useful as a starting point to explore and guide service design and practice, and in choosing or creating an approach. Psychosocial theory Positives: Long history in social work; focus on individual’s and families’ capacity to change; relationship focused which is agreeable to service users; complementary with a range of interventions Negatives: Limited evidence of effectiveness in this context; can overlook wider influences or causes of a family’s problems; if problems persist this perspective can lead to allocation of blame; a personal and emotional focus can be difficult to apply in statutory settings Psychosocial theories are influenced heavily by psychology and Freudian psychoanalysis, and can be traced in social work practice to the 1920s (Healy 2005). Focusing on locating problems, and the capacity to overcome these, within the individuals and the family itself (Sheldon and Macdonald 2009), “goals to restore, maintain, and enhance the personal and social functioning of individuals” are central (Goldstein 2008). These theories “emphasize the importance of people’s feelings…in creating and resolving the problems that they face”, and have historically been more prominent in the US and other countries, than in UK based social work practice (Payne 2014:95). Overall, the evidence for the use of psychosocial theories is strong, the principles of psychosocial theories are influential and embedded within social work practice, and could have potential benefits as part of a formal approach (Payne 2014). However, psychosocial theory is unlikely to be sufficient on its own to drive a single approach for the whole workforce in working with children and families due to a lack of associated practice guidance and tools. Psychodynamic theory Positives: Long history in range of settings; focus on individual’s and families’ capacity to change; relationship focused which is agreeable to service users; evidence supporting use in specific clinical contexts Negatives: Resource intensive and costly; evidence supports use in clinical settings and in specific interventions, rather than as a general approach A key distinction between this set of theories and relationship/person-centred practice is that psychodynamic practice places the practitioner in a position of power, with expertise and control, 10 Catherine Goodall KTP Design and Implementation Analyst compared to involving or collaborating with service users in a different balance of power (Murphy et al. 2013:705). There is a range of evidence suggesting that psychodynamic practices are varyingly effective in different contexts. One of the causes of the conflicting evidence on psychodynamic approaches is due to the range of contexts for and applications. Whilst focusing on service users’ abilities to overcome their problems could be seen as a simple practical focus, some psychodynamic theories, are used for complex, clinical practices which require high levels of clinical expertise and resources, making them difficult to apply in practice with children and families (Healy 2005). Recently some “evidence that psychodynamic treatment has a longer, sustaining effect than other models (e.g. systemic family therapy and cognitive behaviour therapy)” with children has emerged (Mishna et al. 2013:297). However, much of this evidence relates specifically to individual treatments which employ psychodynamic theories, rather than a general approach. There is evidence, therefore, to support the use of psychodynamic practice in a variety of settings and applications. However, there is little exploration of how psychodynamic theory may inform a general approach to working with children and families. Considering that these individual treatments are resource intensive and costly, it is problematic to attempt to use this research evidence to support the use of a psychodynamic approach in general. Attachment theory Positives: supported by extensive research in a range of disciplines; provides supporting evidence for practice decisions; Negatives: a desire to preserve secure attachments over safeguarding could increase risks; a sole focus on attachment could overlook other systemic/family functioning issues; Originating in the 1930s with the work of John Bowlby, attachment theory proposes that a child’s early attachment to its mother or primary care giver is crucial for various stages of development (Mennen and O'Keefe 2005:578). It holds that attachment is “a persistent affective tie that binds one person to another…Attachments initially develop through interactions with primary caretakers and continue to stabilise as the child ages” (Johnson and Fein 1991:406). Bowlby’s work cites attachment as a genetic, cognitive and behavioural imperative, and this assertion has been supported in recent neuro-scientific research (Haight et al. 2008:197). Whilst attachment theory is in popular use across a number of disciplines, it has received criticism, and can lead to negative outcomes if overlooked or misunderstood in practice (Johnson and Fein 1991:397). There are also competing understandings of the application of attachment theory to specific practice, such as in foster care (Lewis 2001). It has been noted, that despite the popularity of and reliance upon attachment theory, there is a lack of evaluation and testing of its application to practice, which is disconcerting (Tucker and MacKenzie 2012). An overreliance on attachment theory alone, could lead an increase in risks for children and families, if preserving attachment is allowed to take priority over safeguarding concerns. However, an understanding that a child’s bonds to its primary care givers are crucial for its development, and that secure attachment can be a protective factor against negative influences on its life, is important for practice with children and families. “The nature of the attachment between parent and child should be a major factor in the decision of what kinds of services to provide the 11 Catherine Goodall KTP Design and Implementation Analyst family” (Mennen and O'Keefe 2005:578). As an example, in terms of attachment with regards to fostering, a child who enters foster care in early infancy could well develop a primary attachment to foster carers rather than the birth parent/s, but that by understanding the role attachment plays, birth parents can be supported in this process rather than blamed or ostracised (Haight et al. 2008). Overall, attachment theory can be extremely beneficial in understanding children and families and should factor into considerations, however focusing solely on attachment can increase risks and problems in working with families. Attachment theory alone would not be a sufficient base for an approach to working with children and families, but understanding of attachment should form part of any established approach. Cognitive Behavioural Theory Positives: CB approaches and theories are supported by a rigorous evidence base and can have significant positive effects on some families; Negatives: CB practice focuses on manipulating behaviour making it ethically precarious and difficult to obtain true consent for these practices: CB approaches require extensive training and faithfulness to formal theories and processes, which is resource heavy; CB approaches can overlook wider influences or causes of a family’s problems; if problems persist this perspective can lead to blame being placed on a family or individual Originating in psychology and psychiatry, cognitive behavioural approaches focus “on how to manage and change people’s behaviour to resolve social problems that affect them”, and this is often used in mental health and criminal justice settings (Payne 2014:150). CB approaches therefore look at current behaviours of individuals and how to change these in order to improve their lives. They do not examine wider causes of problems or attempt to explore past experiences in any depth. Across disciplines CB approaches are regarded as rigorous and effective, but only if they are employed following substantial training and adherence to models and guidelines (Sheldon and Macdonald 2009:154). A difficulty in establishing an evidence base for cognitive behavioural approaches is that often this is considered and tested as Cognitive Behaviour Therapy (CBT) , rather than as a general approach to working with families. CBT as an individual treatment has substantial evidence of effectiveness in a range of specific and clinical settings, but it is more difficult to establish evidentiary support for a general CB approach (Scott and Stradling 1991:544). CB approaches have been criticised in social work for obscuring or overlooking the importance of cultural and structural effects on families (Healy 2005). Person-centred approaches and concepts are positive in focusing on individuals’ and their capacity to improve their own lives, but can be negative if this ignores or misses the wider influences and causes of problems for children and families. This is especially problematic when socioeconomic deprivation and social exclusion are a key issue for families (Axford and Morpeth 2013). Overall, specific cognitive behavioural approaches and interventions are proven to be effective in a number of (mainly clinical based) settings. But the approach requires significant training and resources to employ correctly, making it unlikely to be useful on its own as an approach for the whole workforce. An understanding of the principles of cognitive behavioural approaches could be a useful addition to any formal model or approach which is developed. Systemic Theories 12 Catherine Goodall KTP Design and Implementation Analyst Positives: Useful for practitioners locating family problems within wider systems; service users can find this positive as it acknowledges wider influences on their needs and problems; can help families connect to and gain support from their wider networks; systemic theory is currently used in certain existing services Negatives: systemic approaches can be complex and difficult to employ through a lack of clear practice guidance; these approaches can overlook an individual’s personal problems and lack of commitment to change There are a number of different approaches under the general label of ‘systemic’. Systemic family practices work on the premise that the family must be understood to be a system, related to wider systems in the community and society (Forrester et al. 2013). “Systems focus on the connections between, and the resources of, families and groups, and on helping those to connect well” (Payne 2014:185). As such, interventions should be used for the entire family system. A system is understood here to be “a collection of parts (or subsystems) that interact to accomplish an overall goal”(Munro and Hubbard 2011:728). These types of approaches have grown in significance and popularity in recent years, particularly in the light of the Munro reviews (Munro 2011). “A major advantage of the systems model is its broad scope” (Hepworth et al. 2010:14). Yet whilst some research acknowledges the theory behind systemic approaches to families is positive, they are extremely complex and often provide limited practice guidance, making these approaches difficult for workforces to employ effectively (Payne 2014:184). A variety of problems are encountered by professionals employing systemic approaches in particular practice situations, for example how the way in which a family is perceived determines the type, and sometimes appropriateness, of the service they receive (Morris 2012:10). Generally, systemic theory can form a model for practice, by providing a deeper insight into the effects and influences of systems on children and families. There are also several prominent specific methods of working with a family based on systemic approaches, such as Multisystemic Therapy (MST) and family systems therapy, which have been shown to have positive effects (Sheldon and Macdonald 2009). MST in particular has a very strong evidence base, however it is also very costly, used in limited specific settings and requires a range of resources and systems to be effective (Littell 2008:1302). These are specific interventions guided by systems theory which can be used by practitioners in particular cases. Much research has been conducted in recent years into systems theory alongside systemic theory, which considers the structural and organisational factors of systems such as children’s services. Munro argued that adopting a “systems approach will help to understand how and why previous reforms have had both beneficial and adverse consequences and how the review might improve how the system supports social workers and other professionals”(Munro 2010:10). An understanding of the range of effects that changes to aspects or services within an organisation can have, could be beneficial in considering approaches to working with children and families. Overall, systemic theories are supported by research evidence and policy drivers, and are increasing in popularity. General systemic theory can be beneficial in working with children and families, and specific interventions such as MST can be effective in certain settings. It would be entirely possible to train the entire workforce in systemic theory and practice, but due to the lack of clear and consistent practice guidance evident in research, this would have to be established locally. Social Democratic Theory 13 Catherine Goodall KTP Design and Implementation Analyst Positives: Can be positive for service users who’s perspectives, experiences, strengths and opinions are taken into account; a focus on empowerment and change can be beneficial for service users Negatives: Can be overly optimistic of service users’ potential to change their situations; this can damage relationships with service users over time; these principles can be difficult to apply, particularly in statutory settings Broadly speaking, social democratic theory focuses on children and families’ rights, strengths and potential to change. A range of different approaches fall within this category, including feminist, critical, empowerment, advocacy and strengths-based approaches. Within these models, all assessments and interventions “should place the service user at the centre of the process, valuing their perspective as a contributing partner” (Baldwin and Walker 2009:227). In these approaches, “the social worker-service user relationship is viewed as a central and key component of bringing about change”(Murphy et al. 2013). These approaches focus on helping service users to develop greater control over their lives, and to be involved in their service provision (Payne 2014:294). The balance between a focus on children and families as individuals with the capacity to change and improve their lives, against the statutory need to protect them from risks, is difficult to achieve. This is particularly the case considering that “protecting children (shielding them from painful discussions and difficult decisions) tends to increase their powerlessness” (Toros et al. 2013:1020). As such, there has been varied debate about the applicability of social democratic practices to statutory settings, particularly relating to the psychology based, person-centred approach (Toros et al. 2013:1015). Whilst on the surface it may appear that work with children and families is personcentred in nature, it has been suggested that a person-centred approach is inherently incompatible with statutory services (Murphy et al. 2013). Overall, there is significant discussion of the positive impact that a focus on children and families’ strengths and rights can be positive for service users. The needs and perspectives of service users should always be at the centre of any work with children and families, and therefore social democratic theories could form part of a whole workforce approach. However, given the apparent tensions between a social democratic focus and the demands of statutory services, a singularly social democratic approach may prove difficult to implement. Social Pedagogy Positives: As a set of principles, social pedagogy can underpin all work with children and families; highlighting the positive effects of communication, listening and critical reflection as important Negatives: This is a diverse and ambiguous approach; it does not provide clear practice guidance; as it has not been adopted widely in the UK there is little evidence available to support its adoption here Originally developed in education, social pedagogy is not a method, instead this perspective is “based on the belief that you can decisively influence social circumstances through education” (Hamalainen 2003:71). Social pedagogy can guide working with children and families, but does not in itself provide methods or interventions for doing so. This theory is popular across mainland Europe, but has not acquired much standing in the UK. 14 Catherine Goodall KTP Design and Implementation Analyst ‘Pedagogy’ simply relates to education and the practice of teaching and learning, and social pedagogy is a general perspective and understanding of individuals and society. “The basic idea of social pedagogy is to promote people’s social functioning, inclusion, participation, social identity and social competence as members of society” (Hamalainen 2003:76). The key principles involved in this approach are: that children, families and practitioners are all whole and complete people with the capacity to influence their situation; relationships are important and listening and communication are key; collaboration and team work is emphasised; the rights of service users are paramount; and reflection on practice and changes for families is central (Holthoff et al. 2011:9). To date this approach does not appear to have been developed or tested routinely in the UK in this context, meaning that there is a lack of evidence to support the use of this as an approach in children’s services. Overall, social pedagogy has beneficial elements which could have a positive influence on an approach to working with children and families. However, with insubstantial evidence of its effectiveness, it may be best to review using the principles of social pedagogy, without adopting this as a solitary approach. Formal approaches Whole family approaches Positives: focus is on the whole family which can address a range of issues, rather than focusing on one individual who may not be the most at risk or in need; Negatives: costly to train entire workforce in approach; difficult to implement when adult’s and children’s services are separate and numerous agencies are involved; whole family approaches may not be appropriate for every case Approaches which consider the whole family have been viewed positively both in research and in government guidance and policy. These approaches operate on the understanding that work cannot be carried out with a child or a family member in isolation from the others (Adams et al. 2009:308). In whole family approaches, a whole family assessment is required, which “looks at the needs of individual family members, as well as the family as a whole. A key distinguishing factor of family assessment is that it looks at the interrelationships between family members and how these relationships impact on individuals within the family” (Kendall et al. 2010:10). However, it is important to note that “it cannot be assumed that whole family approaches are appropriate or useful for all families or for all needs” (Morris et al. 2008:2). As with other theories which focus on families as the agents of change, whole family approaches can overlook wider and systemic effects and causes of family problems. Also, “the knowledge base for practice is thin and, often, the actual level of family engagement in practice is limited” (Morris 2012:10). In reality, despite widespread acceptance of the positive influence whole family approaches can have, evidence of their use in practice is limited (Morris et al. 2008). 15 Catherine Goodall KTP Design and Implementation Analyst This is due in part to the issue that conducting a whole family assessment may be particularly difficult in statutory settings where social workers are already under huge pressure with high case loads. Due to these issues, few local authorities have adopted a whole family assessment process, making it difficult to gain evidence on any impact from this (Akister 2006). ‘Think Family’ The ‘Think Family’ pilot was an example of a whole family approach, and was defined by the Department for Children Schools and Families (now DfE) as “making sure that the support provided by children’s, adults’ and family services is co-ordinated and focused on problems affecting the whole family”. This approach, by “assessing and identifying broader needs of all family members and supporting them all in a co-ordinated way can minimise duplication by frontline services and free up resources to provide additional support to the families that need it most.”(Glaser et al. 2012). Think family approaches were piloted in specific and intensive programmes in 15 Family Pathfinder local authorities between 2007 and 2009. The pilot aimed to aimed to “develop and test the effectiveness of intensive, family focused approaches to addressing the needs of families who face multiple and complex problems”(York Consulting 2011:i). The pilot tested practice at 15 local authorities implementing think family approaches where a “network is formed around each family comprising an intensive outreach worker (IOW) and relevant professionals from universal and ‘targeted’ adults and children's services”(Thoburn et al. 2013:229). This pilot focused specifically on families with severe and complex needs and was not tested in comparison to alternatives. The evaluation found that this approach had significant positive effects on around 45% of families, with around 13% experiencing worsening problems or increased needs. The negative impact on these families was in part due to incomplete or developing initial assessments, coupled with the substantial and complex problems faced by many of these families, which were prone to worsening. Work with families was estimated to cost £34,560 and bring an average net benefit of £15,327 per family. In particular, the evaluation found that using a specific dedicated worker, implementing effective leadership and creating sustainable, long term family care plans were particularly effective (York Consulting 2011). Overall, whilst working with a whole family approach is both logical and supported by policy developments, it can be challenging in practice. To employ a true whole family approach would require a substantial change to working practices, with creative solutions to service design and delivery, yet the potential benefits for families in doing so could be substantial. The principles of addressing, understanding and supporting the whole family are important, could be a key driving force for, and should form part of, any approach adopted. Signs of Safety Positives: the model is very simple and clear; the strong principle of ensuring safety provides a clear motive and standpoint; high level of involvement of service users and children in particular is 16 Catherine Goodall KTP Design and Implementation Analyst positive; it is supported in the Munro reviews and increasingly being adopted in local authority practice Negatives: limited in the range of issues it assesses; limited guidance and support for practice; the simplicity of the model may overlook wider issues faced by families; focusing on strengths and signs of safety could lead to increased risks Signs of Safety was developed by Turnell and Edwards in Australia in the 1990s, and is a model which is being increasingly adopted in local authorities across the country. “It aims to work collaboratively and in partnership with families and children to conduct risk assessments and produce action plans for increasing safety and reducing risk and danger by focusing on strengths, resources and networks that the family have”(Bunn 2013). The model has “six key elements. These include 1) understand the position of each family member, 2) find exceptions to the maltreatment, 3) discover family strengths and resources 4) focus on goals, 5) scale safety and progress, 6) assess willingness, confidence and capacity”(Bunn 2013). The model also involves the children in the process and because “case reviews have often found the child’s views to be absent in child protection work…the inclusion of these in the Signs of Safety approach is valuable”(Bunn 2013:69). The model is simple and asks 3 fundamental questions to each assessment, which are: What are we worried about? What is working well? What needs to happen? (Turnell and Edwards 1997) The model also involves rating current status and potential for improvement from 0 to 10 where 0 indicates certainty that the child will be abused and 10 represent safety to the point where the case can be closed. There has been critique of the model in its applicability for use in child protection cases and its potential for overlooking risks. Also, in a review of models and approaches, Signs of Safety was shown to be limited in the number of domains it assesses with families, and also lacks depth and clarity of guidance for practice (Barlow et al. 2012). 17 Catherine Goodall KTP Design and Implementation Analyst The Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis below neatly lays out some of the advantages and disadvantages of the model. (Bunn 2013:122) Overall, Signs of Safety has positive elements which have been shown to be effective with families in some limited studies. The principles of high levels of service user engagement, focusing on strengths and capacity to change, and the creation of sustainable and long term care plans for families, are viewed in the research as positive. There are practical issues with implementation and concerns over the adequacy of the model to deal with issues of risk, which would need to be addressed were this model to be implemented. Signs of Safety does have potential to be a whole workforce approach, but this would need to be tested in the local context and it is likely to be an expensive resource to employ. As with other theories and models, the principles Signs of Safety relies upon could be adapted and combined with others for local use. 18 Catherine Goodall KTP Design and Implementation Analyst Solely Social Care Approaches A number of local authorities have adopted widespread changes in their children’s social care only. These changes have been shown to have limited positive effects in the narrow situations they have been tested in. However, these changes in approach concern only the structure and staff within children’s social care, and usually only social workers, rather than the wider workforce. Systemic Unit Approach Positives: supported by policy; increasing in popularity across local authorities; cases are dealt with in teams providing a more robust and supportive environment Negatives: little evidence to support approach; supporting evidence cannot be attributed only to this model as positive effects could be due to a range of factors; costly and resource heavy approach Following from the Munro report which called for a more systemic approach to working with families, an increasing number of local authorities are adopting a systemic unit approach based on systems theory, despite the fact that there is currently little evidence to support the widespread adoption of such an approach. The systemic unit approach considers that “problems with the family are therefore seen to arise from systemic difficulties and to require interventions that help the family system change or alter its interaction with wider systems”(Forrester et al. 2013:4). The approach involves creating teams in children’s social care to deal with cases in a unit based and collaborative approach. An example from a pilot detailed below involved systemic units consisting of a consultant social worker, a social worker, a child practitioner, a unit coordinator and a part-time clinician. These units discuss, manage, and work with service users as a unit, unlike the traditional structure of a case being allocated to a social worker who is managed in a linear fashion by senior social workers and managers. One London local authority implemented this approach, and Forrester et al. conducted an evaluation with two other comparable authorities over the course of a year (Forrester et al. 2013). The evaluation involved using a range of qualitative methods and observation to explore the influence of the approach on departments. The report details positive findings from the evaluation, finding that a systemic unit structure and approach was demonstrated well in this specific local authority. However it also makes clear that these positive findings are not attributable only to the systemic approach, and that a range of other factors influenced the findings. Also “there is little data that could be considered to relate to ‘outcomes’ for children or parents” within the evaluation (Forrester et al. 2013:19). It also considers how this form of unit is extremely intensive in resources and therefore costly. The evaluation indicates positive but inconclusive findings on this radically different formation for social work provisions. Overall, there is currently little evidence to suggest the effectiveness of the systemic unit approach. Given that this is very different in structure to current provisions and would involve significant investment in time, resources, staff and reconfiguration of services to employ, it may be 19 Catherine Goodall KTP Design and Implementation Analyst inappropriate to adopt this approach at this stage. However, as any approach adopted should be tested and evaluated locally regardless of its evidentiary basis, the lack of sustained evidence for this model, or any other, should not exclude this from consideration entirely. As this approach concerns only social work teams, it could be piloted and tested locally to evaluate its appropriateness and success. Safeguarding Assessment and Analysis Framework (SAAF) The SAAF is still in very early stages of development, and as such the positive and negatives of this framework are yet to be established or proven Positives: a clear and systematic approach provides consistency and standardisation across workforce; currently being piloted across the UK (and in Nottinghamshire) by the DfE Negatives: Very little evidence of effects or success of the framework; particularly focused on safeguarding context which possibly limits its wider applicability and relevance The SAAF provides a systematic, robust, and time-efficient model and a range of methods for assessing and analysing in the safeguarding context. The SAAF involves assessment and analysis of: the nature and level of harm to a child or young person the risks of re-abuse/likelihood of future harm the prospects for successful intervention in child protection cases Seven-stage model of assessment, analysis and intervention 1. Identification of harm and initial safeguarding 2. Full assessment of the child’s needs, parenting capacity, family and environmental factors; creating a comprehensive chronology 3. Establishing the nature and level of harm and harmful effects, and creating a profile of harm 4. Making a ‘safeguarding analysis’ to assess the risks of re-abuse/likelihood of future harm and to determine the prospects for successful intervention 5. Developing a plan of intervention to include therapeutic work in a context of safety and protection from harm 6. Rehabilitation of the child to the family when living separately, or moving on from a context of protection and support 7. Placement of children in new family contexts where rehabilitation is not possible (Bentovim et al. 2009) Evidence of the importance of using a systematic approach such as this to assessment and intervention is growing (Sheldon and Macdonald 2009:170). However, currently there is no “extensive evaluation data available” for the SAAF according to a systematic review of models, although it is gaining in popularity and receiving support from the Department for Education (Barlow et al. 2012:9). Caution has been advised in adopting standardised approaches to assessments, as some have claimed that increasingly assessments are being approached in a ‘tick box’ manner which can overlook or ignore much of a family’s history, and can have a negative effect on relationship building with service users (Sheldon and Macdonald 2009:95).Research suggests that whilst some practitioners and managers may find rigid procedures and processes accessible or comforting, that 20 Catherine Goodall KTP Design and Implementation Analyst inflexible reliance on these can mean that “practice tools and forms can, over time, become proforma processes”(Stanley et al. 2012:243). The SAAF is currently being piloted within children’s social care in the authority, which could present a unique opportunity to explore, evaluate and test the effectiveness and appropriateness of the model to the workforce and service users. Reviewing the piloting of the SAAF within the authority should provide the opportunity to investigate how the approach works in Nottinghamshire, as well as potentially identifying if the approach is appropriate and any areas for improvement in implementation in the future. The findings from evaluating this pilot could then be used to assess whether or not the SAAF should be adopted long term. Hope for Children and Families Like the SAAF which is a requisite element of this, Hope for Children and Families is still in very early stages of implementation, and there is currently no evaluation of the manual or programme itself. There is substantive evidence for the underlying theories and tools used within the programme. The Hope for Children and Families (HfCF) is a manual which “provides a “menu” of evidence-based, step-by-step modular interventions targeting the profile of abusive and neglectful parenting and associated impairments of children”(Bentovim and Elliott 2014:250) Using evidence from 22 separate RCTs, HfCF is designed to be “a step-by-step modular-systemic approach to intervention that is suitable to the needs of a variety of frontline practitioners in social care, health, and education”(Bentovim and Elliott 2014:270). The authors call for research to be conducted into the impact of the programme, as currently there is no evidence to support the modular programme arrangement itself, although the content is based on evidence verified in various studies and RCTs. The below table details various stages as envisaged by the HfCF programme. Modular training has been designed around these stages to provide professionals in a range of settings with specific guidance on theories and practice. 21 Catherine Goodall KTP Design and Implementation Analyst (Bentovim and Elliott, 2014:273) 22 Catherine Goodall KTP Design and Implementation Analyst The programme consists of 40 different modules covering a range of topics, as detailed in the list below2. Structural and strategic issues There are a range of structural and strategic issues which need to be considered and addressed when exploring and developing an approach to working with children and families: Crucially, “children and their families have a range of different needs which do not fall neatly into separate agency segments” (Sloper 2004:572). Similarly, families’ needs cannot be easily divided into children’s and parent’s needs, as if often the case in local authority service provision. It is widely acknowledged that there are “limitations of current organisational arrangements for provision… and the capacity to develop holistic responses”(Morris et al. 2008:14). The separation of children’s from adult’s services, statutory from discretionary services and voluntary organisations complicates provision for families further, despite policy drivers and evidence that a coordinated approach is most effective (D'Cruz and Stagnitti 2 Information gained from presentation available at: http://www.google.co.uk/url?sa=t&rct=j&q=%22child%20and%20family%20training%22%20review&source=w eb&cd=1&cad=rja&uact=8&ved=0CCAQFjAA&url=http%3A%2F%2Fwww.londonscb.gov.uk%2Ffiles%2F2010%2 Fdiary%2Fconference_2013%2F2._introducing_resourcepack_london_9.12.13.pdf&ei=lz_zU9exFuWaygPagYG 4Dw&usg=AFQjCNFH9sGdVrxsjorBZ9e4HUNoD2rL_w&sig2=5cspG3TQcHNWwCOQK4LqPg&bvm=bv.73231344, d.bGQ Accessed 19/8/14 23 Catherine Goodall KTP Design and Implementation Analyst 2008:831). Various authors consider the need to collaborate with a range of agencies to ensure that children and families’ needs are met, yet none suggest that this is an easy process to achieve or manage (Katz and Hetherington 2006:246). Given the centrality of multi-agency working to the law, government regulations and statutory procedures, the lack of shared knowledge on how best to achieve this remains a problem. Ensuring successful multi-agency working is complicated further by the wide and changing nature of structures, practitioners and their roles, and families’ needs (Frost 2005). Certainly, “there are considerable barriers to joint working” (Sloper 2004:526). Barriers which contribute to this problem include strategic, structural and organisational issues; “issues concerning professional status and identity”; co-operation and communication between professionals, agencies and families; and so on (Moran et al. 2007:143, Sloper 2004)((Katz and Hetherington 2006). Research considers that the professional relationships of managers, practitioners and between agencies is crucial. Indeed, it has been suggested that “structural factors are far less significant than day-to-day interactions between practitioners and managers from different agencies” (Katz and Hetherington, 2006:430). It should be considered, then, that widespread structural changes may not bring about desired improvements, if they are not coordinated with changes to professional working and relationships. A longitudinal study in the US found that “organizational climate is a major predictor of the quality and outcomes of children’s services” (Glisson and Hemmelgarn 1998:402). This study highlighted that organisational culture (for example employee outlook, cooperation, definition of roles, level of conflict) is an important element of children’s services, and should not be overlooked in assessing and defining a framework, model or approach. Ofsted reflected this in its 2012-2013 annual report, noting that good authorities “spent considerable time, energy and focus in understanding front-line practice, in assessing what needed to improve and in ensuring that there was a coherent and urgent plan to address the identified areas of need. The quality of social work practice and direct work with families was at the heart of their change programmes.”(Ofsted 2013:22). It is important to consider the current and future political climate, and the effects that this may have on the department, and the choice to adopt a particular approach. Funding from central government is decreasing, payment is being linked to results, and the structure of funding is changing, such as schools being given increasing control via pupil premium. Political motivations and principles can have wide ranging and long term effects, and the general election next year could cause trickle down effects on the department, which in turn could influence the degree of control available over adopting any one approach. Whole Workforce Approaches 24 Catherine Goodall KTP Design and Implementation Analyst To involve, train and support a single approach for an entire workforce, especially one as large and complex as in Nottinghamshire, would be a substantial undertaking requiring a range of associated resources over time, both financially for training, and for other necessary resources. It is important to note that “local authority social work services are riddled with experiments and practices that have been discontinued once short-term funding ceases as well as mountains of guidance and bureaucracy” (Perrott 2009:113). Therefore, changes should be carefully planned over the longterm, with reflection, evaluation and development built into the process, and contingencies in place for changes and developments in the authority structure and political context. Establishing, implementing and maintaining a standard approach across an entire workforce would also require agreement, common understanding and a consistent culture, which may be difficult to cultivate in such a diverse workforce. Changes which affect the whole workforce are only likely to be successful if they are implemented in a ‘bottom-up’ method, with collaboration and consultation of practitioners (Connolly 2007). This may well be an option worth exploring as such a model for implementation can have positive effects, despite the potential difficulties (Kendall et al. 2010:32). Participation Many of the models, approaches and theories rest on the principle of involving families in the child welfare and protection process. To a greater or lesser degree, the majority of the approaches reviewed well in the literature recognise that engaging the family in the process is crucial. Within these approaches children are viewed as social actors with the potential to influence their care. Local authorities and policy makers have generally tended to overlook or ignore service users’ experiences and perspectives, particularly when they are deemed at risk (Howarth et al. 2012:155). This lack of engagement with service users undermines the design, delivery and reception of services (Beresford 2000:495). Any approach taken to working with children and families should involve the whole family wherever possible, and should acknowledge that service users have the right to participate in the process, and may in fact be able to provide greater insight into solutions to their problems. Swindon Borough Council Recently cited on the C4EO website as an example of emerging positive practice, Swindon have placed children and their families at the centre in redesigning their children’s service provisions. Before beginning processes of change, the council carried out workshops with around 300 children, young people and families to capture their views and experiences to inform service design and delivery. Substantial involvement of service users on such a scale not only ensures that services are relevant, appropriate and meet service users’ needs, but it also places service users at the centre of work to improve their lives. Limitations It is worth noting that the evidence considered in this review is almost entirely based on limited research which draws conclusions based on qualitative evidence, rather than firm evidence of 25 Catherine Goodall KTP Design and Implementation Analyst outcomes or impact for children and families (Barlow et al. 2012:9). Much of the research evidence draws conclusions for the positive effects of certain systems, structures and approaches, however due to the intensely complex and contested nature of children’s services, none of this has been attributed only to a change in approach. Any changes to be considered, should be critically and carefully reviewed and enacted through involvement with and reflection by the entire workforce. There is a great need to reflect upon and adapt the way the authority works with children and families, and any approach adopted should be tested locally to ensure its effectiveness and appropriateness. Implementation The implementation of any approach is a crucial issue. In children’s social care in particular, “training is only likely to be effective if practitioners also have regular times for peer or supervised case discussions in which new thinking can be embedded” (Glaser et al. 2012). As mentioned earlier, successful and effective authorities provide structured support for frontline practitioners and managers. If an approach were to be adopted, Payne provides a structure for establishing an approach: Outline professional expectations, background and preferences for theories, concepts and approaches Connect these with the needs of service users Explore both the singular use of a particular theory across the workforce, and individual use of appropriate theories and interventions in specific cases. Discuss, debate and test these with the workforce, and identify a central theoretical model and related methods for practice (Payne 2014:41) This could be a useful structure to follow were an approach or framework to be adopted. This would need to be an iterative process with cycles planning, action, testing and evaluation built in from the outset. A Framework Research has repeatedly demonstrated the need for local authorities to have a clear and explicit framework or model which lays out the concepts and theories which support its practice. Adopting an off-the-shelf formal model is not the only method available. One option would be to develop a single, central framework which would guide both the understanding of children and families, as well as how best to work with them, providing unity and stability across the workforce. To create such a framework, the general core principle/s, the desired processes for practice, common intervention strategies and a guide to desired outcomes would need to be established. It is also vital to build consideration of practitioners and their relationships with service users into any approach or framework, as the “relationship between professionals...and clients is fundamental to ethical and effective practice”(D'Cruz and Stagnitti 2008:159). 26 Catherine Goodall KTP Design and Implementation Analyst Example: The New Zealand Practice Framework As an example, Connolly established the New Zealand practice framework which was based on “three perspectives: child centred; family-led and culturally responsive; and strengths and evidence-based” (Connolly 2007). This framework clearly lays out the principles, theory and philosophy which underpin standard interventions and ideal outcomes. In this case, a single approach was studied and implemented which described both the principles which all staff would adopt, the interventions which were supported by these principles, and the outcomes for children and families which were anticipated. As part of the implementation of this framework, a simple poster and a manual were created alongside general training, which aided in ensuring that the entire department and its staff were working with the same drive, focus and structure. This framework does not appear to have been evaluated, and therefore its effects on the workforce and children and families cannot be assessed, but it is a good example of a practice framework. Exploring and developing a singular framework for practice such as the above could help ensure consistency and unity across the local authority and its partners. Whilst employing an existing standardised and formal model or approach may not be a suitable way to proceed, developing a clear, local framework could be beneficial in providing common understanding and consistency across services. Evaluation 27 Catherine Goodall KTP Design and Implementation Analyst Due to the lack of consistent and sustained evidence of the use of any one approach in working with children and families in a local authority setting, it is recommended that any approach adopted is evaluated and tested to establish local and ongoing evidence of its effects. Building continued critical evaluation into the process from the outset would ensure that the approach taken is appropriate and results in the desired positive change on outcomes. The Head, Heart and Hands2 project began in 2011 and involves piloting social pedagogy for foster care in several local authorities and private fostering organisations in England and Scotland. This four year project seeks to promote, establish and test the use of social pedagogy in a fostering setting, evaluating the effects that this approach can have. In order to begin the evaluation and measure the impact of the approach so far, a baseline – change method has been adopted which takes initial measurements of outcome points, and measures the change in these over time. This also allows interviewees to introduce important issues at the beginning of the evaluation, which can be tracked and measured for change, which could bring up important issues which otherwise may have been missed. The evaluation also separates the project into the impact on children and young people; the impact on foster carers and practice; and the implementation process, outcomes and changes in the system. By dividing the evaluation into these three elements, the individual effects on different groupings and processes can be assessed and measured. The approach may have positive effects for one group, yet negative for another, and this evaluation strategy allows for easy identification of the impact of the pilot. 3 The above strategy is a useful example of one method of evaluating the effects of adopting an approach in a local authority setting. There are numerous potential ways to test the impact of adopting an approach, and a strategy for evaluation should be decided upon at an early stage and built into the planning and implementation processes. Conclusions A variety of options currently exist for models and approaches to use when working with children and families. Forrester et al, found that their study of local authority implementation of a systemic units model had far wider implications. “The systemic unit model allows us to re-imagine the delivery of services in fundamentally different ways” (Forrester et al. 2013:23). In examining this new model: it opens up a different way of delivering Children‘s Services. In doing so, it allows us to question some of the fundamental assumptions that have tended to pervade the way services are organised and run in the UK and many other countries, such as the almost universal tendency to allocate families to individual workers and the rarity with which 3 Information on project provided at 4th July 2014 Conference on Safeguarding Children at Loughborough University by Sam McDermid and others. For more information, see http://www.fostering.net/head-hearthands/what-is-head-heart-hands#.U7qgFZRdW8A Accessed 7/7/14 28 Catherine Goodall KTP Design and Implementation Analyst Children‘s Services specify and then support the intervention methods they think workers should be using (Forrester et al. 2013:187). Research supports the need to openly and critically review the structure, strategy and delivery of children’s services, and to debate the possibility, efficiency, effectiveness and costs of potential changes, informed by practitioners and with service users’ needs and perspectives at the centre. However, it should be noted that adopting one, formalised approach such as those examined in this review is not necessarily the only way of proceeding. Flint et al discussed approaches and concluded the following: Rather than attempting to identify one project or model of delivery that is most effective there is a need to recognise that a range of initiatives and approaches are required to achieve positive outcomes with a diverse range of young people and families. However, holistic whole family approaches, multi-agency partnerships, a key worker, intensity and longevity of engagement and access to specialist and statutory support services will be common elements of successful approaches. (Flint et al. 2011:131) This review has highlighted a range of different approaches for children’s services, many of which have great potential for improvement, yet no one model stands out as the most appropriate, effective or efficient. It has also highlighted the incredible complexity and difficulty involved in making widespread changes in local authorities. In order to implement changes in such a complex and intricate system there is a need “to prioritise changes, introduce change incrementally, and support those involved in the change” (Sloper 2004:576). Adopting a singular, fixed and formal approach may not be appropriate or effective for the authority, but exploring the principles and practice implications an approach could have is crucial in ensuring that services for children and families are at their best. 29 Catherine Goodall KTP Design and Implementation Analyst Glossary Acronym/Term CAF CAMHS CB CSC DfE EHAF HfCF LAC MST SAAF SCR SEND Meaning Common Assessment Framework (now EHAF in Nottinghamshire) Child and Adolescent Mental Health Services Cognitive Behavioural Children’s Social Care Department for Education Early Help Assessment Form Hope for Children and Families Looked After Children Multi-Systemic Theory Safeguarding Assessment and Analysis Framework Serious Case Review Special Educational Needs and Disabilities 30 Catherine Goodall KTP Design and Implementation Analyst Bibliography ADAMS, R., DOMINELLI, L. and PAYNE, M., 2009. Social Work: Themes, Issues and Critical Debates. 3rd edn. Hampshire: Palgrave MacMillan. 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