Jenny Gray, Helen Jones and Harriet Ward EUSARF Copenhagen 2014

+ Harriet : Looking After Children: The development of a methodology for assessing outcomes for children in care + Helen: The policy context + Jenny: How the Assessment Framework developed from this background

THE ASSESSMENT FRAMEWORK CHILD Safeguarding & promoting welfare Health Education Identity Family & Social Relationships Social Presentation Emotional & Behavioural Development Selfcare Skills CHILD ’ S DEVELOPMENTAL NEEDS PARENTING CAPACITY FAMILY & ENVIRONMENTAL FACTORS Basic Care Emotional Warmth Stimulation Guidance & Boundaries Ensuring Safety Stability Wider Family Housing Employment Income Family ’ s Social Integration Family History & Functioning Community Resources

Questions to answer: – What is an outcome? – Whose perspective? – When to assess outcomes? – How to assess outcomes?

+ Health + Education + Identity + Family and Social Relationships + Emotional and Behavioural Development + Social Presentation + Self Care Skills + Different issues at different ages but all dimensions an integral part of development

+ How far does local authority care provide children with that care which it would be reasonable to expect a parent to provide? + How far does care help children achieve long-term wellbeing in adulthood + DID NOT ASK: – How far is children’s development affected by parents’ capacity /reduced capacity to meet their needs? – How far is parenting supported or compromised by wider family and environmental factors?

+ Children Act Focus on outcomes for all children including the most vulnerable + Introduction of theories of child development into the rationale for service provision + Implementation of performance indicators through which progress can be monitored

+ State required to promote the well being of children by ensuring they received sufficient standard of care to achieve a satisfactory standard of development + Duty therefore on the state to ensure that this applied to children in care + Looking After Children provided conceptual and practical tools of monitoring progress + The developmental framework provided a common language across services

+ 1998: Quality Protects was set up to support local authorities in transforming the management and delivery of children's social services. + Policy focus on outcomes that has become such a strong feature of child welfare, with Every Child Matters, Care Matters and the Children’s Plan continuing this trend over the past decade. + Outcomes framed in child development terms + Focus on service integration + Includes focus on outcomes for expenditure

The best protection for children is high quality services - Utting report s: many enquiries into the deaths of children at risk and even those in care + Many studies into outcomes for these children but few standardised measures : Working Group publishes report « Looking After Children Assessing Outcomes in Child Care >> which had as its objective to link the abstract concept of ‘outcome’ to professional practice s: practical tools to support the developmental progress of children : developmental of the much wider Assessment Framework for children in need or likely to suffer harm and their families

Targeted support Integrated support Single practitioner Children with additional needs Keyworker/Lead Professional Common assessment Statutory CIN/CP/CIC assessments Children with no Identified additional needs (universal services) Children in Need MTFC KEEP FGC STATUTORY INTERVENTION SERVICES Looked after children LESS INTENSIVE /EARLY INTERVENTION FNP= Family Nurse Partnerships; PUP= Parents Under Pressure; FCG= Family Group Conferences; MST= Multisystemic Therapy; MST CAN = Multisystemic Therapy Child Abuse and Neglect; MTFC= Multidimensional Treatment Foster Care; KEEP= Keeping children with foster parents S17 S47 S20/S31 ASSESSMENTS SPECIALIST STATUTORY NON ASSESSMENTS STATUTORY Where appropriate/possible aim to enable children live at home/ return home FNP ATTACH Adopted Children PUP MST / MST CAN

+ Working Together to Safeguard Children (2013) incorporates the three domains of The Framework for the Assessment of Children in Need and their Families (2000), i.e. – Children’s Developmental Needs – Parenting Capacity – Family and Environmental Factors as does the Regulatory Framework and statutory guidance for care planning, placement and review

THE ASSESSMENT FRAMEWORK CHILD Safeguarding & promoting welfare Health Education Identity Family & Social Relationships Social Presentation Emotional & Behavioural Development Selfcare Skills CHILD ’ S DEVELOPMENTAL NEEDS PARENTING CAPACITY FAMILY & ENVIRONMENTAL FACTORS Basic Care Emotional Warmth Stimulation Guidance & Boundaries Ensuring Safety Stability Wider Family Housing Employment Income Family ’ s Social Integration Family History & Functioning Community Resources

+ Advantages: Child was at the centre of the process; strengths based and ecological; provided a conceptual framework for assessing children in need and their families; integrated family support and child protection on the same continuum; inter-agency/multi- disciplinary in approach; evidence based; recognised that assessment and intervention are part of an inter-related system. + Challenges: Huge dissemination task; training of all staff in all agencies at all levels, not just social workers; overcoming resistance to change; cultural change to focus on children’s needs; improving quality of recording and developing/using standardised records; helping all staff to understand that the skills of working with children, parents and families, analysis and making judgements and undertaking effective work with children and families were all part of implementation.

Developed as a tool to improve practice Policy intention to use the Assessment Framework for all children in receipt of children’s social services This included: Children in Need, Child Protection, Looked After Children, Children Leaving Care and Adopted Children Designed to maintain the focus on the child’s safety and welfare Intention was to record information electronically and only once, with information transferring across a children’s record and reduce recording burden on social workers as well as improve its accuracy

+ Assessment + Planning + Intervention + Review outcomes for children

Maltreatment (all types) Long-term outcomes Prevention before occurrence Prevention of recurrence Prevention of impairment UniversalTargeted From: MacMillan HL, Wathen CN, Barlow J, Fergusson DM, Leventhal JM, Taussig HN. Interventions to prevent child maltreatment and associated impairment. Lancet 2009;373:

19 © Child and Family Training 2013 The HfCF project includes Resources for Practitioners – a resource pack designed for work with children and young people and their parents and carers to prevent abusive and neglectful parenting and the associated impairment of children’s health and development.  The resources are aimed at all practitioners whose roles are to intervene to provide services to children and families where there are concerns that a parent may harm or neglect their child and where there is risk the child’s health or development is impaired. Aim of the Hope for Children and Families project and resources

Underpinning Research  Alternatives for Families and Multi-systemic therapy integrates a number of different approaches  Trauma-focussed CBT  The Project SafeCare approach, tackling neglect  Improving parent/child interaction and attachment using PCIT, Circle of Security and Bio-behavioural approaches  A variety of approaches to modifying disruptive behaviour, e.g. CBT and MST  In practice there are always combinations of abuse and neglect, and combinations of approaches. (Bentovim and Elliott, 2014) DEVELOPMENT OF THE HfCF APPROACH © Child and Family Training 2013

21 © Child and Family Training 2013 Key underpinning ideas about intervention  A common practice elements approach which conceptualises practice in terms of generic components that cut across many distinct specialist treatment protocols and specific clinical procedures and processes. (Forty-seven distinct practice elements were distilled from twenty-five random controlled trials.)  A common factors framework personal and interpersonal components of intervention (e.g. alliance, client motivation, therapist/helper/practitioner factors) common to all interventions are contribute to successful treatment outcomes. Underpinning ideas

22 © Child and Family Training 2013 Forty modules have been developed across 5 key areas:  Engaging families and engendering hope  Working with parents to modify abusive and neglectful parenting  Working with children and young people who have suffered emotional and traumatic impairment  Working with children and young people who have responded with disruptive behaviour  Working with the family – to manage relationships and to link with the community The Modules

Article Reference: Bentovim A. and Elliott I. (2014) Hope for Children and Families: Targeting Abusive Parenting and the Associated Impairment of Children. Journal of Clinical Child & Adolescent Psychology. Website: childandfamilytraining.org.uk