Community health

Adopting “whole-system” support for families in 2020 and beyond

By - Integrated Care Journal
Adopting “whole-system” support for families in 2020 and beyond

In the UK, children and young people are facing increasingly complex needs. Our families are experiencing a system that is struggling to cope as local authorities enter a perfect storm caused by rising demand and the impact of austerity on health and social care.

As professionals, we are understanding more about new and overlapping risks, leading to increasingly complex situations for our children and families, such as adverse childhood experiences (ACEs), trauma and neglect, grooming, sexual and criminal abuse and exploitation. At Barnardo’s, we understand the challenges children face and the disadvantages these cause. This includes children who are experiencing multiple adversities such as having unemployed parents, poor quality housing or a parent with a long-standing disability or illness.

A whole family approach 

Reforms to integrate health and social care provision promise to make services easier for families to navigate. Services need to respond to family needs holistically to ensure we can deliver improved outcomes for more vulnerable children, young people and their families. The current commissioning environment, which is increasingly driven by costs, compounds the pressures on services by encouraging competition over collaboration. Barnardo’s is seeing a greater shift towards higher value, regional and system-wide commissioning in some regions. This presents a good opportunity for organisations within the third sector to work more closely with local authorities.

One of the most impactful ways to help vulnerable children is by addressing the problems parents are experiencing. Parents and carers with very young children often need support to help them meet their children’s needs. However, they can feel cut off from friends and social support, meaning they miss out on emotional and practical help. Providing services to children, young people and families is now proven to be less effective than supporting families by placing their issues at the centre of provision. At Barnardo’s, we value methods of support that are based on co-production and engagement of children, young people and families so that they can make informed choices and set their own goals.

New ways of working

Working in an integrated multi-disciplinary team can be challenging for staff. Good leadership is crucial. It is important for managers to maintain the overall direction and ethos within teams, especially when they span different agencies. Clear governance must include a steering group that the designated leader reports to, overseeing the impact of an integrated health and social care service. Co-location of staff teams improves communication, information sharing and the cooperative ethos of work. Further to this, teams should participate in a core training programme, regardless of role, to increase the skills mix and capabilities of staff.

Evidence-based interventions should be at the heart of the service offered to families to encourage engagement and boost outcomes. Integrated health and social care teams must consider parental and children’s access and engage with workers easily in their own time and on their own terms. This is similar to a “no wrong door” approach.

Families say they only want to tell their story once and will often disengage at the point of transition to another team or service intervention. Therefore, enabling an integrated health and social care team to work within one case management system; a singular family record and family assessment, reduces the need for families to re-tell their story and increases information sharing opportunities.

Placed-based provision 

Our favoured approach to supporting children, young people and families is always through a mixture of universal, targeted and specialist provision that follows individual child and family needs. This place-based provision would include an opportunity for families to engage with their local service through assertive outreach teams who understand the community. For this to be effective, community assets must be used on a needs basis, providing workers and families access to other agencies such as community leaders, religious or faith-based services, sports and leisure and housing providers, etc. By adopting a hub and spoke approach to place-based provision, progress can be made to reduce a postcode lottery for families.

Fathers are often reluctant to engage with services, so it is important that the staff group and interventions reflect this demographic group. Targeting additional service provision to those identified as more vulnerable should be the responsibility of an effective outreach team of workers, employed and trained with the skills required to access the hardest to reach parents and carers. It is also important to ensure adoptive parents and foster carers (including kinship carers) access their entitlements. They too should have the opportunity to upskill, engage with their community and increase their social opportunities to ensure that cared-for children get the provision and oversight they require.

For more information, please visit Barnardo's here.

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