CSC0088

Written evidence submitted by the Bridges Outcomes Partnerships

Bridges Outcomes Partnerships works with Local Authorities and community partners to deliver greater outcomes in Children, Adult, and Health Services. We would love the opportunity to have a conversation with the committee and share evidence and learning from our experiences working with LAs and community specialist partners designing, mobilising, implementing, and evaluating preventative services in Children Services. This could expand on the response below and explore potential solutions in this space to support LAs in this critical and challenging period.

Q: What measures can be undertaken to improve early intervention

Response:

1) Using Social Outcomes Partnerships to deliver flexible, accountable, and collaborative impact in early intervention

Social Outcomes Partnerships offer a more effective and better value way to address and prevent the most complex challenges to public services. Outcomes Partnerships deliver better results than traditional commissioning, particularly for preventative interventions and where services need to be organised around individuals with complex problems rather than through public service silos. This is particularly the case for children on the edge of care.

Outcomes Partnerships are more effective as they enable collaborative design, flexible delivery, and clear accountability for long-term outcomes. They are distinct from payment by results models and focus on long term outcomes. They also incentivise innovation in delivery through rigorous adaptive management and active monitoring – which is especially needed in delivering early interventions.

Outcomes Partnerships offer better value, as funders provide the upfront working capital (delivery funding) for a consortium of expert. Local Authorities only pay for outcomes met as per agreed. This supports LAs to take a longer-term and more strategic approach to their finances, especially for invest-to-save measures, as it ensures spending on early interventions result in real outcomes achieved. For example, Local Authorities may commission preventative services focused on outcomes around supporting families to stay together (preventing young people from entering care), avoiding costs associated to children care placements, and further costs in relation to adverse outcomes experienced in care.

Below are some examples and evidence in how this can be done:

2) Offering systemic and relational interventions to reverse children’s trajectory to care

• When supporting families to stay together, parents/carers and children/young people are often offered individual interventions (e.g. parenting programmes, young people behavioural programmes). Whilst family members may feel supported independently, new skills are not embedded in the context of family relationships and may not lead to long-term change; it may even create further alienation and conflict in families.
• Systemic interventions like Multi-systemic therapy (MST) or Functional Family Therapy (FFT) draw on the family relationships and emphasize behaviours in the context of the family dynamics and stresses. This means positive changes in communication and management of conflict can be more sustainable as a result. Yet, families are not accessing this early enough. Forty-five percent of families (46/102) who have completed FFT Intervention said they would prefer receiving the intervention earlier. When families can access these services before patterns of communication and behaviours are entrenched, they are more likely to sustain positive change and not be stuck in negative cycles of behaviours and “dysfunction” that may lead to a trajectory to care.
• Local Authorities Children Services teams benefit from joint spaces where clinical practitioners and social care teams can collectively identify children at risk of entering care (backed by rigorous evidence and experience), through resource panels and routine discussion, to intervene at the right time to prevent care entry.
• These approaches are not new, but they need to be delivered in an accountable and flexible way to meet the needs of the county and families. This can be enabled by Outcomes Partnerships.
• Outcomes partnerships delivering FFT/MST been successfully delivered in London, Essex, Suffolk and Norfolk to transform behaviours and help families to stay together safely.  Because these services were delivered with an outcomes contract, rather than a traditional ‘pay for inputs’ approach, teams could manage therapist capacity flexibly to meet the needs in the county (pre-empting fluxes of demand and when therapists are away), adapting the referral criteria to meet the corresponding age groups, trialling complementary individual counselling and mental health support and increasing resource in managing referral co-ordination to complement the social care practice and service ecosystem in the county.
• An outcomes partnership also enables robust measures and data to understand whether the intervention has led to longer-term impact and costs-avoided – an integral part of rationalising preventative interventions. This is done by establishing strong data and project governance accompanied by longitudinal research with participants. In these examples, this included routine monitoring on engagement and stability rates in families, improvements in well-being, longer-term interactions with social care (and whether the young person ended up in care for 2-3 years).
• All these enablers resulted in much more productive and effective services, as well as higher quality impact.
• Compared to the traditional approach, outcomes contracts delivered an average 25% higher quality service (measured by satisfaction) for 80% more families at 20%-50% lower cost per family. In Essex by introducing outcomes partnerships for the delivery of family therapy (family breakdown reduced by 30%).

3) Offering intensive personalised wrap-around services for vulnerable communities.

• In Plymouth, the Forward Outcomes Partnership supports women who have had multiple children removed into care to reduce the chances of further removals. The programme adopts the Pause model, and provides access to highly bespoke, personalised, and trauma-informed support to women. The flexibility of the partnership enables co-designing of the service with the community, acknowledging the individual journeys each person has, and offering supplementary funding to respond to emerging needs from isolation and the cost-of-living crisis. 99% of women supported since 2019 have not experienced any further removals.

Q: How combinations of kinship care, residential education, foster care and adoption could provide alternatives to residential care

Response:

• Step Down programmes providing holistic support to children to move from residential care into foster homes have resulted in increased long-term stability of placements compared to traditional approaches, reducing the risk factors for these children. Birmingham City’s ‘Step Down Programme’ saved up to £50k per child net in the first year alone while the longer-term savings to LAs and wider benefits to the child and society are significantly more.
   

Q: How children’s social care can impact a child’s educational or long-term outcomes and ways to improve outcomes for care leavers

Response:

Offering relationship-based support to care-leavers to draw on own strengths.

• From the Care Leavers Outcomes Partnership which supported care leavers into education, training, and employment, the programme evaluation points to the importance of practitioners acknowledging the “changing situation of the care leaver” when providing support, emphasizing the need of nurturing the relationships between professionals (e.g. support workers, personal advisors) and care leavers. The programme applied models such as Social Pedagogy and the Youth Version of the Acceptance Commitment Therapy framework in community settings – to draw strengths from, listen to, provide bespoke support, build and develop relationships with each young person. Hence, the flexibility and collaboration enabled by Social Outcomes Partnerships are crucial when designing service and implementing interventions to achieve greater outcomes when supporting care leavers. This programme engaged with more participants than target, more than fifty percent of individual care leavers have started employment.

January 2024