Family Group Conferences for Adults
Hampshire
Evaluation Report
April 2010 – March 2012
1
Daybreak Family Group Conferences
Registered Charity no: 1077607
Company no: 3780726
Headoffice: West Lodge, Leyland’s Farm, Nob’s Crook, Colden Common,
Winchester SO21 1TH
Tel: 02380 696
Fax: 02380 696655
Email: [email protected]
Visit our Website: www.daybreakfgc.org.uk
2
Family Group Conferences for ADULTS
Hampshire
Evaluation Report 2010 – 2012
Contents:
Page
5. Executive Summary
7. Introduction
9. Referrals, FGC meetings and reviews
11. Referrals by area and client group
13. Service user participation
15. Outcomes
16. Comments from Service Users and Families
17. Working in Partnership
18. Comments from Referrers and other Professionals
19. Appendix
a) Cost benefits analysis (2007 – 2010)
b) Case studies
3
4
Executive Summary
During the period April 2010 – March 2012, Hampshire County Council provided
funding for continuation of the successful pilot undertaken in 2007 – 2010 using
Family Group Conferences for Adults.
With Hampshire funding, referrals could now be accepted across all client groups, for
any vulnerable adult aged 18years or over, for whom there were safeguarding
concerns. The majority of referrals (57%) were for older people, though in the
second year the proportion from other client groups increased, as awareness of the
service grew.






51 referrals received
34 had at least an initial FGC meeting (67%)
57% of referrals were for older persons
30% of referrals were for service users assessed as lacking the capacity to
make 1 or more of the decisions required
20 referrals involved known or suspected domestic abuse
12 referrals involved known or suspected financial abuse
Service User Participation:
 86% of all service users attended their FGC
 53% were supported by a trained advocate
 17% chose to be supported by a family member or friend
Feedback on the FGC process as experienced by service users, families and
professionals, and the outcomes for service users was overwhelmingly positive, with
all but 1 respondent saying that they would recommend the FGC process to others..
Although no cost benefits analysis for this period is currently available, a study
undertaken by Hampshire Adult Services of recognised savings post FGC for the
initial pilot of 2007 – 2010, showed total estimated savings of £77,000
(See appendix A)
5
6
Introduction
April 2010 brought many changes for Daybreak’s pioneering work with Hampshire to
provide Family Group Conferences for Adults. The initial funding from Comic Relief
had now finished, and the programme was now reliant on funding from Hampshire
CC. The focus of the Comic Relief pilot was to address Elder Abuse, and the referral
criteria reflected this in that the referred service user should be aged 50 years or
over, and either have experienced abuse or be at risk of abuse.
Hampshire Adult Services took the decision to extend the scope of the programme to
cover a wider range of safeguarding concerns, and to include vulnerable adults of
any age. Funding had been allocated for the financial year of 2010 – 2011, but the
financial cuts required from the start of the following year meant a significant
decrease in available funding. Nonetheless the service continued and excellent
outcomes continue to be achieved in a wide range of situations, for service users
and families across all client groups.
Information about using FGC for adult safeguarding is now included in the 6 day
safeguarding training programme in Hampshire, which is held 4/5 times per year and
is attended by staff from adult services, police and health. This helps to ensure that
new staff, and others working with vulnerable adults in a wide range of
circumstances, are all made aware of the service, and it’s uses and potential
benefits,
Daybreak has been working with the Social Care Institute for Excellence (SCIE) to
provide information and “Best Practice” guidelines for adult FGC, and this is now
available on the SCIE website, with a link to Daybreak’s website.
Interest in FGC for adults and the pioneering work done in Hampshire, is growing
throughout the UK, Europe and the US. Much of this interest was generated by the
“Safeguarding and Empowerment” conference organised by Daybreak in partnership
with Hampshire Adult Services in November 2011. The conference was hosted by
IBM at their Hursley headquarters just outside Winchester, and attracted delegates
from across Southern England. The conference was aimed at directors and assistant
directors of Adult Services, police commissioners and those with particular
responsibility for Safeguarding adults, and the feedback was extremely positive from
all those who attended.
7
Training/ presentations have also been given in Leeds, Newcastle and Sheffield in
the UK, Stuttgart in Germany, and at conferences in Utrecht and USA. Many of
these have led to further enquiries and opportunities which are being taken up during
2012/13. In particular, as a direct result of its success in Hampshire, Surrey and the
Royal Borough of Greenwich in London have commissioned Daybreak to conduct
pilot programmes using FGC for Adults.
During this period Daybreak achieved “Investors in People” status, and also became
a registered learning centre through the Open College Network. We developed the
first national qualification for FGC coordinators working with vulnerable adults, and
this is delivered as one module of the Accredited Coordinator Training, which is also
available as a stand-alone option, for already practising coordinators who wish to
expand their skills.
The last few years have been financially challenging for everyone working in Adult
Social Care, whether in the public, private, or non-profit-making sectors. Daybreak is
fortunate to have had the opportunity to work in partnership with Hampshire County
Council, who were willing to try out a new approach to Safeguarding. In particular
our thanks are due to Jane Duncan, Jane Selvage, Helen Eaton and all the
Hampshire Safeguarding Coordinators for their continued support, advice and
enthusiasm throughout the duration of this programme. We hope to continue to work
with you for many years to come.
Linda Tapper
Programme Manager
Daybreak FGC
January 2013
8
Referrals, FGC Meetings and Reviews
Although the number of referrals was down in 2011 -2012, it is interesting to note
that the number which reached an initial FGC remained the same. One reason for
this could be that as referrers become more familiar with the model, they become
better at identifying those situations which could best benefit from this approach.
201011
201112
TOTAL
Total number of referrals received
28
23
51
Number of service users involved in the referrals
31
26
58
Referrals involving domestic abuse (ie abuse by a partner
or family member): no of service users affected
10
10
20
Referrals involving known or suspected financial abuse:
number of service users affected
9
3
12
Initial FGC meetings held
17
17
34
Review FGC meetings held
10
9
19
% of referrals which resulted in an Initial FGC
61%
74%
67%
% of Initial FGC which had at least 1 review meeting
59%
53%
55%
On average across all Daybreak FGC programmes, 70% of referrals received and
accepted progress to an initial FGC meeting and 60% of initial meetings held have at
least 1 review meeting. This average tends to be lower for adults and for older
people in particular.
There can be many reasons why a referral may be accepted but not result in holding
an initial FGC meeting, and not all are negative. On many occasions the time that
the coordinator spends with family members, listening to their views and talking
through the issues and concerns, leads directly to individuals taking action to remedy
the situation, without the need for a formal meeting. However as Family Group
9
Conferences are voluntary, sometimes the service user changes his or her mind and
decides that they do not wish to proceed, and this will be respected.
It may also be the case that a decision is taken that a FGC would not be viable due
to a lack of family members to attend. Although there is no minimum or maximum
number of family members required, each case is considered on its merits, and a
decision made in consultation with the service user and the referring social worker.
On some occasions the client’s health has deteriorated making a FGC inappropriate
at that time, and in a few instances the client has died.
Rarely, but importantly, it may be necessary to decide not to proceed if the
coordinator and FGC manager consider that to do so would either present an
unacceptable risk, or would have a detrimental effect on the service user.
10
Referrals – by area and client group
2010-11
28
2011-12
23
Total
51
Havant and Petersfield
Fareham and Gosport
Eastleigh and Romsey
New Forest
Winchester and Andover
Alton and Fleet
Basingstoke and Aldershot
1
2
3
5
7
3
7
0
4
4
8
3
0
4
1
6
7
13
10
3
11
Older persons
Learning disability
Physical Disability
Other (inc MH; DV; drug/alcohol)
20
2
2
4
9
5
4
5
29
7
6
9
Total referrals received
From the above it is clear that some areas of Hampshire are more likely to refer than
others. It is less clear why this should be the case. Staff changes often mean that
social workers who had become familiar with the FGC model and referral process
move on and are replaced by new staff who may be unaware of the service
available. It was also apparent from talking to individuals that some people were
under the impression that the service had ended after the initial 3 year pilot funding
came to an end.
Since the expansion of the criteria for referral to include all client groups was
introduced, it is encouraging to see the numbers of service users referred with for
example, disabilities or mental health problems, are increasing.
More work is needed to ensure all staff, including those working in health, social care
and the police are kept up to date, and service users from all areas of Hampshire
have the same access to a Family Group Conference. Recently Daybreak has
produced a “reminder” postcard which is being distributed to raise awareness of the
service. The offer of a Daybreak manager attending some team meetings to discuss
the use and benefits of FGC for adults will continue, whenever the opportunity
arises.
11
Family Group Conferences –
“ensuring that vulnerable adults have a voice”
12
Service User Participation
2010-11 2011-12
Number of service users involved in referrals
17
19
which reached an initial FGC
- assessed as lacking capacity to decide one
6
5
or more of the relevant questions
Number of service users who attended their
15
16
FGC
- supported by trained advocate
9
10
- with other designated support person
4
2
Number who did not attend, but whose
views were presented at the FGC meeting
2
3
%
30%
86%
53%
17%
14%
*A referral may involve more than one service user / vulnerable adult. For example if
a couple are both considered to be “at risk”, or the needs of more than one person
need to be considered in any plan made. For example this may be a situation where
the perpetrator of abuse is a “vulnerable adult”, and the “victim” is a carer, often a
parent.
As part of the FGC process all service users, and occasionally others involved in the
process, will be offered an advocate. Local advocacy services will sometimes be
utilised if available, but Daybreak also has a pool of trained advocates, mostly
volunteers, who can be available if required.
Some service users prefer to have the support of someone known to them, for
example a trusted friend, family member or someone known to them in a
professional capacity. If this option is chosen, the coordinator will need to ensure that
the chosen person understands their role, and that there is no conflict of interests.
Some service users refuse any specific support, and feel confident enough to speak
for themselves. The coordinator will ensure that they have the opportunity to do this,
and that the meeting is a positive and empowering experience for them.
Occasionally a service user may choose not to attend, or may lack the capacity to
make the decision, and it not be considered in their best interests to attend. It is the
coordinators responsibility to ensure that whenever possible the service user’s views
are obtained and presented at the meeting. If the service user has capacity to make
the final decision about the plan, the coordinator or advocate will check that he/she is
in agreement with any actions before the plan is finalised.
13
Family Group Conferences –
“bringing families back into decision-making”
14
Outcomes
There can be no single criteria for a “successful outcome”, although improved safety
is always a priority. If the service user has capacity to make their own decision, they
may choose to leave themselves at risk, however an outcome could still be
considered beneficial if the FGC process resulted in greater awareness and
understanding of risks and options, and increased support being offered, and
improved communication and relationships.
Financial benefits for the local authority may also be a desired outcome, but again
this cannot be a realistic aim in every case, and the needs of the service user may
require, for example that a residential placement be provided if support in the home
is unable to meet those needs, or if the service user prefers it. An evaluation of cost
benefits of the first 3 years of this project, showed clear overall cost savings. A
frequent outcome was shown to be much reduced social worker time after the FGC
process, often allowing cases to be closed either completely or to safeguarding. (See
appendix A)
Following each meeting, initial FGC or Review, all participants are sent a feedback
questionnaire, inviting them to comment on the service they received, the plan
developed and the outcomes achieved. The return rate for the questionnaire,
perhaps inevitably, is quite low (usually around 20%), but those who do reply are
overwhelmingly positive.
One of the questions asked is
“Would you recommend the (Daybreak FGC) service to others?”
Whatever the perceived outcomes in individual cases, all but one individual over this
2 year period answered “YES”
15
Comments from Service Users and Families
The following comments are taken from the feedback received from service users
and their families and friends:
“I found it an easy relaxed atmosphere for everyone to air their views in”
– step-daughter of service user
“I now have a little time to myself. My husband has time too, which
helps, and my children see my family more” – service user with physical
disability
“Dad is being looked after better now, as other family members are able
to help and get involved” – son of service user
“I am full of praise for the professional and compassionate way
Daybreak dealt with this awkward situation. I would be happy to endorse
you in any way” – daughter of service user
16
Working in Partnership
“I had never dealt with Daybreak before, but would not hesitate in contacting them
through a referral in future or recommending them to others” – registered care
home manager
Daybreak’s involvement with the service users and families referred to us is intense
but short-term. One of the main purposes of a Family Group Conference is to
involve everyone who is concerned about the individual - family members, friends
and professional service providers, and to ensure that any support plan is
understood and agreed by all.
In many cases relationships and communication have broken down, and the FGC
coordinator will spend a lot of time in preparation working to restore vital links and
trust between all the parties.
2010-11 2011-12 Average
per
meeting
Number of family members/friends who
attended an FGC meeting during the
year
Number of Adult Services staff who
attended an FGC meeting during the
year
Number of Health Services staff who
attended an FGC meeting during the
year
Number of police who attended an FGC
meeting during the year
Number of other professionals who
attended
- Total number of professionals who
attended FGC meetings (excluding
advocates)
17
124
121
4.6
-
28
27
-
13
14
-
7
8
-
24
39
72
88
3.0
Comments from Referrers and other Professionals
The following are some of the comments taken from the feedback received:
“The coordinator was very skilled in chairing the meeting and facilitated
discussion in a non-challenging and direct manner that resulted in firm
commitments being made to support the family” – social worker
“I thought (the coordinator) chaired the meeting very professionally, but
at the same time she showed a great deal of warmth. I felt that this
approach helped put people at ease”. – health professional
“Excellent service to have available. Would be useful for some complex
cases when working with neurological conditions” – physiotherapist
“I think this is an effective way of resolving some extremely difficult
situations. The coordinator was very professional throughout in dealing
with quite a fractured family and ensuring that (the service user) was
listened to”. - health professional
“Overall, an amazing service – astonishing level of resource! I wish we
could have similar” – psychiatrist
18
Appendix
a) Cost benefits analysis (Hampshire 2007 – 2010)
As a part of initial pilot programme funded by Comic Relief in using FGC in
Cases of Elder Abuse, Hampshire CC undertook a cost analysis of the first 49
referrals which reached at least an initial FGC meeting. (The pilot also
accepted referrals from Southampton and Portsmouth Unitary Authorities but
these were not included in the Hampshire Analysis)
The following table shows some of the results:
Hampshire referrals which had at least 1 FGC
meeting (2007 – 2010)
Cases closed to Safeguarding following FGC
NFA from Adult Social Care services following FGC
Increased family/ community support
Reduced risk (in addition to those closed to
safeguarding)
Housing / accommodation issues resolved
Savings in residential care costs (returned home):
Savings due to reduced/cancelled domiciliary care:
Savings in social worker/ care management time*:
Total estimated cost savings :
49
29
17
10
8
8
£30,000
£12,480
£34,880
£77,360
*Some cost savings were due to reduced domiciliary care package costs, or
to the client no longer requiring a residential care placement. (Cost saving
calculated for 1 year only)
If the FGC resulted in reduced care management time the savings were
estimated based on perceived reduction in time spent per week over 1year,
as follows:
Estimated1 hr reduction in care management time: £1040
Estimated 2 hrs pw reduction in care management time: £2080
Reductions in time spent were estimated by the referring social worker, as
were the perceptions of reduced risk and increased family/ community
support.
19
b) Case studies (all names and some details changed to preserve anonymity)
I.
Mrs Pugh – age 88, living with son and daughter-in-law, and their teenage
children. Concerns are raised about the lack of care she is receiving, and
especially that she is restricted to using 1 room and has no access to bathing
facilities. Plans are in place for an adaptation which would provide facilities,
but the son is refusing to allow it, and is also resistant to carers being in the
house. Mrs Pugh pays to be taken to a local care home each week where
they can bathe her. Mrs Pugh also has a daughter who is increasingly
concerned but reluctant to be involved due to repercussions the last time she
tried to intervene. Mrs Pugh is adamant that she does not want to move into a
care home.
Outcome – A Family Group Conference was arranged, and although the son
was initially reluctant to engage with the process, both he and the daughter
attended. Mrs Pugh was also present, supported by a Daybreak advocate,
who helped her express her views. It was agreed that Mrs Pugh should move
immediately to live with her daughter, and plans made for the necessary work
to be carried out to the property, so that all her needs could be met.
Comment – Although this seemed a straightforward solution, before the FGC
referral this case had been on-going for many years, with no prospect of
improving the situation. The introduction of a independent person, (the FGC
coordinator), who was seen by all parties to be neutral, seems to have made
the difference in getting everyone around the table, to acknowledge the
problems and agree a way forward. Mrs Pugh was delighted with the result.
Feedback from referring social worker: “We got a very good outcome for
the client. The coordinator made rapid progress on a case that before her
involvement was going nowhere”
20
II.
Mrs Davy – aged 82, with dementia and severe memory loss, living in a
nursing home. Prior to moving there Mrs Davy had spent a great deal of time
with a long-term friend Mr Jones. Many of her immediate family disliked Mr
Jones and strongly disapproved of the relationship, alleging that he was
abusive towards her. Mrs Davy was assessed as lacking capacity to make the
decision, but the 2 family members who held joint Power of Attorney could not
agree, and one instructed the nursing home to bar Mr Jones from visiting. Mr
Jones was very angry about this and had on occasion been verbally abusive
to staff. Mrs Davy clearly remembered him and often asked where he was.
Outcome: The FGC was held with Mrs Davy’s views brought by an advocate.
Mr Jones attended along with family members and several long term friends
and neighbours of Mrs Davy. There was a lot of animosity between the
participants, which initially threatened to prevent progress, but eventually
most family members accepted that Mrs Jones had freely chosen to spend
time with Mr Davy before she lost capacity, clearly missed him, and it would
be in her best interests to continue to have contact. A plan was agreed to
include visits and outings but with arrangements that would help ensure a
safe environment at all times. Mr Jones agreed that his behaviour towards
staff had been unacceptable and by the review meeting everyone agreed that
relationships were much improved.
Comment: inevitably not all family members were happy with the outcome,
but some very balanced views expressed by friends and neighbours,
acknowledging that although many people found Mr Jones “difficult”, Mrs
Jones was always very happy with him, had a strong impact. At the time of
referral, family members were already talking about needing to involve the
Courts to get a decision. In this case the FGC provided a resolution which
prevented a much more confrontational, longer-term dispute.
Feedback from OPMH Consultant: “I think this is a very positive way to
address difficult issues, especially where there are conflicting views from
different parties, or disabling tensions. Objective, impartial, facilitated
discussions like this are very valuable and may serve to deflect difficulties in
professionals contact with clients/families”
21
III.
Charlotte – age 25 years, living with parents. Charlotte has long-standing
mental health problems including OCD, and cannot manage living alone; she
is assessed as currently needing 24 hour care. Parents are finding it
increasingly difficult to cope with the high demands placed on them by their
daughter, who has no insight into the situation and refuses a live-in carer.
Sleep deprivation is a major issue for both parents and mother is close to
breakdown.
Outcome: The FGC was held and attended by Charlotte with her Daybreak
advocate, and 9 members of the extended family which included friends and
neighbours. Several professional service providers were invited and brought
information on several support options. The family plan involved provision of
regular local authority respite, (which Charlotte agreed to), but a
comprehensive programme of on-going support was arranged by family and
friends.
Comment: Parents wished to continue to care for their daughter, but felt they
were at breaking point, and could not see how to improve the situation. The
FGC allowed everyone to address the problems holistically, and consider
support for them as carers as well as Charlotte’s needs.
Feedback from referring care manager: “It gave the family a chance to
speak their minds in a protective atmosphere. A lot of issues were spoken
about and some were painful to hear. Excellent service – definitely worked for
this family”
22
DAYBREAK FAMILY GROUP CONFERENCES
“A world where all who are vulnerable and disempowered are enabled
to participate in decisions affecting their lives”
- Daybreak Vision Statement
23
The Daybreak Vision Statement:
“A world where all who are vulnerable and disempowered are
enabled to participate in decisions affecting their lives”
The Daybreak Mission Statement frames our Vision in terms
of what we strive to achieve:
“Empowering children, families and vulnerable adults to make
good decisions and enhance their life chances”
The Daybreak Value Statement outlines the core beliefs we
share
 A belief that families have the ability to make decisions
about members of their own families
 A commitment to the empowerment of families to make
those decisions
 The demonstration and promotion of mutual respect
 Promotion of the active participation of all involved in the
process
 The recognition and valuing of difference
 A commitment to openness and transparency
 A recognition and valuing of the roles and responsibilities
of agencies
24