Think Family: Getting the whole picture Chris Cuthbert

2 Contents Who are families at risk and why do they matter? What have we learned about support for families at risk? What would a system that ‘Thinks Family’ look like? How do we get there? What can you do?

3 Who are Families At Risk? Economic well being Communities and staying safe Health and family structures Poverty and debt Worklessness Education and skills Domestic violence Relationship conflict Mental and physical health Crime and ASB Alcohol and drugs Poor housing and homelessness Most Excluded Families

4 The influence of family (and parents) is rarely neutral Communities and staying safe HOUSING 51,060 families were accepted as homeless in 2006 WHY IT MATTERS Bad housing, overcrowding and homelessness is linked to poor mental and physical health for children and parents Homelessness can lead to missed school for children and lower levels of engagement with services such as Sure Start Homelessness can increase child vulnerability and increases the risk of a child being on the Child Protection Register from 1% to 12% Number of children living in non-decent homes across the social and private rented sectors fell by 1.4 million between Since 2001, the number of non-decent homes in the social sector has reduced by over 50% CRIME Around 162,000 children have a parent in prison 55% of female prisoners have a child under 16 WHY IT MATTERS Parental imprisonment disrupts contact between parent and child Children of prisoners have about three times the risk for mental health problems and anti-social or delinquent behaviour compared to their peers 63% of boys with convicted fathers go on to be convicted themselves Crime has fallen by 44% since 1995, representing 8.4 million fewer crimes in total ASB 9,431 ASBOs issued between WHY IT MATTERS Parents who engage in anti-social behaviour are more likely to raise children who also behave anti-socially Children who know of their parents’ involvement in drug misuse or crime are at increased risk of misusing drugs and engaging in offending behaviour themselves The Respect Action Plan (2006) focuses on addressing anti-social behaviour Family Intervention projects are aimed at improving parenting and strengthening communities

5 The influence of family (and parents) is rarely neutral Communities and staying safe WHY IT MATTERS Maternal drug use during pregnancy carries significant health risks for the foetus Parental problem drug use is associated with neglect, poverty, physical or emotional abuse, separation and exposure to criminal behaviour Expansion of drug treatment led to 181,390 individuals receiving structured treatment in DRUGS 2-3% of children have a parent who misuses Class A drugs ALCOHOL Around 1.3 million children live with parents who misuse alcohol WHY IT MATTERS Children of parents who misuse alcohol are at higher risk of mental ill- health, behavioural problems, involvement with the police and substance and alcohol misuse Parental alcohol misuse raises the likelihood of having caring responsibilities at a young age and poor educational outcomes Alcohol misuse has been identified as a factor in 50% of all child protection cases The government has a cross-cutting alcohol strategy entitled Safe. Sensible. Social. The Next Steps in the National Alcohol Strategy It focuses on the harms caused by drinking, including those to the family and the wider community

6 The influence of family (and parents) is rarely neutral Economic well being POVERTY 22% of children live in families on relative low incomes 13% of children experience persistent poverty WHY IT MATTERS Poverty can increase the likelihood of other parental problems such as unemployment, poor access to services, poor health and housing and financial exclusion Poverty also poses risks for poor child health, lower educational attainment and lower aspirations. Young people who have grown up in poverty are more likely to have very low levels of savings or assets. Although educational attainment can militate against poverty experienced during childhood and against its impact on adult outcomes, there is a strong association between parental income and children’s subsequent earnings as adults 600,000 children lifted out of poverty since 1998/99 Reforms since 1997 mean that the poorest quintile of families are on average £3,500 a year better off DWP Working for Children (2007) sets out steps to meet the 2010 poverty targets Tax credits support around 6 million DEBT 200,000 children live in households that have four or more households bills in arrears WHY IT MATTERS Problem debt is associated with material deprivation including housing problems. The stress of over-indebtedness is associated with relationship conflict and breakdown, and with a wide range of physical and mental health problems. Adults in arrears are twice as likely to leave their job due to the effect of problem debt on their health £47.5m invested in face-to-face money advice 400 new debt advisors have helped over 26,000 people get to grips with debt since April 2006

7 The influence of family (and parents) is rarely neutral Economic well being WORKLESSNESS 60% of children in workless household live in poverty compared to 8% in households where all adults work WHY IT MATTERS Being out of work can have a negative impact on parental well-being as well as on adult skills, motivation and confidence Children who grow up in workless households are themselves more likely to be poor and out of work in adulthood 443,000 fewer children live in workless households compared to 1998 There are 2.5 million more people in work than in 1997 EDUCATION & SKILLS Of those who experienced persistent poverty between 2001 and 2004, 19% had no qualifications WHY IT MATTERS Parental education and skills are key determinants of children’s attainment and well-being Lack of skills or qualifications increases the risk of unemployment and less than half of those with no qualifications are in work 1.6 million adults have achieved a first qualification in literacy, language or numeracy

8 The influence of family (and parents) is rarely neutral Health and family life MENTAL HEALTH Around 450,000 parents have mental health problems WHY IT MATTERS Poor parental mental health is significantly associated with children’s own mental health and social-emotional development Effects of poor parental mental health are also transmitted environmentally through processes during pregnancy and through family relationships Between 2001/02 and 2005/06, NHS and local authority planned expenditure on mental health services has seen a cash increase of £1.65 billion PHYSICAL HEALTH About 12% of parents are disabled WHY IT MATTERS Parental poor health or disability increases the risk of worklessness and is strongly associated with family poverty and debt Parental poor health can lead to the child becoming a carer. Being a young carer can have detrimental effects on a child’s wellbeing Social Care spending has increased by £1 billion a year from Number of extra-care housing rose from 18,000 residences in 1997 to 25,000 in 2003 RELATIONSHIP CONFLICT At least 1 in 3 children will experience parental separation before the age of 16 WHY IT MATTERS Parental conflict and hostility can increase risk of anxiety and depression amongst children Children experiencing sustained family conflict tend to have lower academic performance, independent of their socio-economic status The number of couples receiving publicly funded mediation has gone up from 400 in 1997/98 to 14,000 in 2005/06

9 The influence of family (and parents) is rarely neutral Health and family life DOMESTIC VIOLENCE Estimates of UK children exposed to domestic violence begin at 240,000 WHY IT MATTERS 1 in 4 children who have witnessed domestic violence have serious social and behavioural problems ¾ of domestic violence cases result in physical injury or mental heath consequences for the woman Witnessing domestic violence as a child results in males being more likely to engage in domestic violence as adults The successful prosecution rate for domestic violence rose from 46% in 2003 to 65.4% in 2006.

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11 Families experiencing multiple disadvantage Approximately 140,000 families with children experience 5 or more disadvantages % Basket of indicators of disadvantages includes: No parent in the family is in work Family lives in poor quality or overcrowded housing No parent has any qualifications Mother has mental health problems At least one parent has a long-standing limiting illness, disability or infirmity Family has low income (below 60% median) Family cannot afford a number of food and clothing items Percentage of families with children experiencing 5 or more disadvantages

12 Enjoy and achieve Make a positive contribution Source: Families and Children Survey (2004 and 2005) Outcomes for children: Children from families facing multiple disadvantages are at greater risk of a range of negative outcomes

13 Be Healthy Source: Families and Children Survey (2004 and 2005) Outcomes for children Children from families facing multiple disadvantages are at greater risk of a range of negative outcomes

14 Stay safe Source: Families and Children Survey (2004 and 2005) Outcomes for children Children from families facing multiple disadvantages are at greater risk of a range of negative outcomes

15 Contents Who do we mean by families at risk? What have we learned about support for families at risk? What would a system that ‘Thinks Family’ look like? How do we get there? What can you do?

16 Services and programmes Services that ‘think family’ can improve outcomes and help build family capital Why we need to ‘think family’ To build on family strengths – family belief systems, family cohesion and coping strategies can all have a major impact on how effectively family members are able to respond to adversity. The problems of the individual do not exist in isolation – Understanding the whole family situation can be highly important in diagnosing the root causes of a problem and in developing appropriate responses. Examples Family Group Conferencing (FGC) Family Intervention Projects (FIPs) Multi-systemic Therapy (MST) Family Nurse Partnership (FNP)

17 Family Nurse Partnerships Family Nurse Partnership Pilots Structured home visiting programme for disadvantaged parents from pregnancy until child age two Goals Improve pregnancy outcomes Improve child health and development and future school readiness and achievement Improve parents’ economic self-sufficiency 30 years development and 3 large scale trials  Improvements in women’s prenatal health  Reductions in children’s injuries  Fewer subsequent pregnancies  Greater intervals between births  Increases in fathers’ involvement  Increases in employment  Reductions in welfare and food stamps  Improvements in school readiness £30m over the CSR period to expand the programme

18 Family Intervention Projects The Dundee Families project, established in 1997 by the NCH charity, has successfully helped families with multiple disadvantages and who cause problems for their communities, supporting them to resolve their issues ranging from a lack of basic parenting skills to alcohol and drug addiction. 53 of these projects have now been rolled out across the country Key Components:  Dedicated key worker with low case load and persistent and assertive working style who takes the lead in engaging families and coordinating agencies and services  Whole family assessment which ensures the needs of the whole family are met and regularly reviewed  A contract which sets out the changes in behaviour that are expected and the support that will facilitate change  Intensive and structured support which enables key workers to engage, assess and focus intensively on their families for as long as is needed  A coordinated and integrated response where agencies commit to working together, sharing appropriate and relevant information, agreeing objectives and dedicating resources to resolve a client’s difficulties

19 The next piece in the puzzle? Adult services can play a key role in improving outcomes for children and families  Parenting support Promoting effective parenting Increased investment in parenting support National Academy of Parenting Practitioners Expansion of Family Intervention Projects  Children’s services Investing in the individual child ECM integration of children’s services Investment in education Expansion of early years provision Adults’ services ? Do adults’ services recognise and respond to the parental and family roles of their clients? Are we exploiting the opportunities to tackle the parent-based drivers of poor child and family outcomes? Opportunities and outcomes for children and families

20 Systems reform There are opportunities to improve outcomes by building on progress in systems reform The systems of support around families at risk are inadequate because they: Are complex and highly fragmented Intervene too late Lack a focus upon the most at risk families Three key areas of opportunity for systems change: Extending the logic of collaboration from Every Child Matters beyond children’s services to better coordinate all of the services working with families at risk Capitalising on the reach and expertise of the public and third sectors to identify and intervene earlier to support families better Ensuring we have effective services to work with families and to address parent-based risks and getting the incentives right so that support reaches those who need it most

21 Working with families

22 Contents Who do we mean by families at risk? What have we learned about support for families at risk? What would a system that ‘Thinks Family’ look like? How do we get there? What can you do?

23 Think Family: The key characteristics No wrong door Contact with any service offers an open door into a system of joined up support

24 Look at the whole family Services working with both adults and children take into account family circumstances and responsibilities Think Family: The key characteristics

25 Think Family: The key characteristics Build on family strengths Practitioners work in partnership with families recognising and promoting resilience and helping them to build their capabilities

26 Think Family: The key characteristics Provide support tailored to need Tailored and family- centred packages of support that knit together relevant interventions are offered to all families at risk

27 Contents Who do we mean by families at risk? What have we learned about support for families at risk? What would a system that ‘Thinks Family’ look like? How do we get there? What can you do?

28 ECM and Children’s Trusts have introduced a dynamic for increased collaboration between children’s services Child Health Housing Police Child Social Serv Schools Specialist Serv LSC Youth Vol orgs Child Leisure DAT YOT CAMHS Outcomes for children and young people

29 However, systems around families facing multiple disadvantages are still highly fragmented Child Health Housing Police Child Social Serv Schools Specialist Serv LSC Youth Vol orgs Child Leisure DAT JC+ Adult Health Housing Police Adult Social Serv Private orgs Specialist Serv LSC Vol orgs Adult DAT Leisure Probation Prison YOT Advice services CAMHS AMHS

30 Opportunity to extend the logic of cooperation from ECM to encompass all services working with the family Child Health Housing Police Child Social Serv Schools Specialist Serv LSC Youth Vol orgs Child Leisure DAT JC+ Adult Health Housing Police Adult Social Serv Private orgs Specialist Serv LSC Vol orgs Parent DAT Leisure Probation Prison YOT Advice services CAMHS AMHS Family

local Family Pathfinders £13m Family Pathfinders to test and develop the Think Family approach: Aim to improve outcomes for families at risk, including those not being effectively engaged and supported by existing services Build on ECM and encourage greater cooperation between children’s services and key adults’ services, including social care, employment, housing, adult mental health etc. Develop locally led learning on how system change across adults’ and children’s services can improve support for vulnerable families Tell us what works – and what needs to change Share learning (e.g. linking into the LGA Narrowing the Gap network of LAs) £3m Extended Family Pathfinders for young carers: 5-6 areas will extend their work to include systems and support services which will address directly and in more detail the support needs of families with young carers

32 Family Pathfinders: testing local systems change

33 What can you do? Ask what more could be done in your area to ensure systems and services are truly ‘thinking family’? Ask families about their experiences of services – what they like and what they want to see changed. Talk to practitioners to find out what helps and what inhibits them from ‘thinking family’ Let us know about innovative work with families in your area Champion the ‘think family’ approach and...spread the word! For a Family Pathfinder application pack visit: Deadline for receipt of bids 29 th February 2008