Scottish Government

Improving outcomes for children and families: Outcomes are results and within the context of the Getting it right approach we would expect to see them manifested in terms of the changes that take place in children and young people's lives as a direct result of the actions taken by the relevant services and agencies; the longer-term consequences in terms of their life chances and choices when they are older; and the level of service-user satisfaction experienced by those children and young people and their families as a result of the ways in which they were helped and supported. The report drew on data collated by the different services in Highland for statistical returns to the Scottish Government and for measuring the impact of their Children's Services Plan. It also draws on an analysis of the experiences of just under 100 children and young people who were tracked through the system.

• The rate per 1000 of children (0-15) on the Child Protection Register has fallen from 3.0 to 1.5 since 2005.
• The rate of registrations per 1000 has fallen from 2.5 to 0.8 over the same period.
• The rate of child protection referrals has also been falling over that time scale.
• The proportion of case conferences leading to registration is considerably higher than in Scotland as a whole.
• The proportion of children on the Register with repeat registrations has fluctuated over the last four years but began to fall in 2008.

These trends primarily reflect the raised awareness following child protection inspections undertaken in Highland over the last four years.

However, more recently it was agreed in Highland that the Getting it right approach

should also be followed in Child Protection cases and, although it is too soon to measure the impact of this, it would be anticipated that this would lead to a more holistic approach to assessment and planning which addressed not only the child's safety but also his or her other unmet needs.

Other indications of child safety, including provision for child protection, Looked After children, accident prevention and anti-bullying policies in schools indicate that children and young people in Highland are safer than they were four years ago.

The reliability of the mechanisms for monitoring incidents of bullying in schools and when travelling to schools varies from school to school and more could be done to identify and disseminate examples of good practice.

An analysis of three tranches of non-offence referrals by police in the pathfinder area to the Reporter's Office and to social work and the universal services indicates that non-offence referrals from this source have been reduced by between 70% and 75% in the last two years.

Over the same time period:

• The number of reports requested by the Reporter which were submitted within the target time has increased;
• The number of new supervision requirements has increased;
• The proportion of children seen by supervising officers within 15 days is now 100%

The main consequences of these trends for children and young people have been:

• A more proportionate response by police and social work to concerns;
• Social work, schools and health are producing fewer reports for the Children's Reporter;
• An assessment and plan is put in place more quickly for those who are not referred to the Reporter but for whom concerns still exist that may require additional or multi-agency support.

The length of time Looked After children have been waiting for permanent and adoptive placements has been falling over the last four years.

The proportion of children in kinship care placements has increased slightly.

The number of children and young people with a history of offending who have residential school placements has been falling.

The length of time that children are accommodated away from home is now beginning to fall.

These trends are a result of changes put in place over the last five years or more. The significant added value of the Getting it right approach here has been in:

• better integrated and more holistic planning to meet a wider range of unmet needs;
• a greater emphasis on engaging the young people in the planning process;
• a greater emphasis on helping the young people to take ownership of that plan;
• greater help with handling the transition from care to adult life.

The health targets for 0-5 year-olds will be met by 2010 with the possible exception of reducing the number of expectant mothers who smoke.

Essentially these are population measures and while they give a good indication of the extent to which Highland has met its priority targets for its last Children's Services Plan, they are less effective in terms of measuring the specific impact that the Getting it right approach has on individual children and young people.

The performance of the lowest attaining 20% has been consistently above the average for Scotland as a whole.

Significant progress has been made in terms of improving access to respite care, Sure Start support (or equivalent) and support for young carers.

There has been a significant decrease in exclusions from secondary schools as alternatives have been increasingly employed, although exclusions from primary schools are increasing.

The attainment levels of Looked After children, particularly those living away from home, and children from ethnic minorities are improving.

The analysis of the records, plans, reviews and experiences of 97 children and young people showed that:

• There was evidence of clear progress towards their intended outcomes in two-thirds of the cases analysed.
• In a further 20% of cases there was evidence that situations involving children and young people that had previously been escalating had now been stabilized but their needs were so complex and multiple that more time was needed before evidence of significant changes in their Well-being Indicators could emerge.

There is a cumulative impact here of many changes that have taken place in recent years in terms of professional practice in children's services and in terms of the resourcing of a range of different interventions for addressing many of the concerns and unmet needs confronting children and young people.

Nevertheless it is also clear that the gradual shift to an outcomes-led approach, the greater clarity in specifying the intended outcomes and the fact that review meetings increasingly focus on progress and not just on whether the actions in the plan have been carried out, are making an important contribution to ensuring improved outcomes for children and young people.

Changing Practices: changing or improving the repertoire of established ways of proceeding when concerns have been raised about a child, young person or family

The procedures and pathways that are now followed by professionals working with children and young people in the pathfinder area are more rational and streamlined.

Business process mapping of the different paths and routes that a child takes from single to multi-agency support and from universal to specialist services has played an important part in identifying:

• duplication of procedures and processes;
• barriers to the delivery of appropriate, timely and proportionate support.

This in turn has contributed to strategic managers buying into the changes proposed.

When a concern is raised about a child that requires multi-agency support, A Child's Plan meeting is now the norm instead of different agencies holding their own planning meetings around different needs and concerns.

Staff working with children in the pathfinder areas are now using the same tools processes and procedures, with growing evidence of convergence of stronger shared multi-agency thinking and use of language across agencies at each stage of support provision.

The training provided has been critically important here for two reasons:

• It has been multi-agency;
• It has been workshop-based with a focus on using the new tools and processes to work through cases and typical scenarios.

Monitoring and quality assurance by operational managers and the development team has also been important during the implementation phase to ensure not only that the new tools and processes were being employed but also that they were being applied as intended.

Every child and young person in the pathfinder area has a Named Person in health or education responsible for making sure that the child has access to the right help to support his or her development and well-being.

Staff who have taken part in the training for Named Persons and Lead Professionals were more likely to:

• document the decisions that have been taken;
• ensure the evidence for taking these decisions are recorded;
• go beyond the immediate concern that has been raised to take into account where there is a wider range of unmet needs;
• demonstrate a clearer link between assessment and planning;
• specify the intended outcomes and what would constitute evidence of progress in the achievement of those outcomes.

Quality assurance and self-evaluation processes are also being developed to benchmark the new practices and ensure that these become the norm.

Opportunities for staff to meet periodically to reflect on the practice change process and explore ways of building this into the continuing professional development of those who work in children's services enhance the processes and help embed them.

Building good working relationships between Named Persons and Lead Professionals is critically important to effective assessments of needs and planning. This is particularly the case where Named Persons are not fully confident about multi-agency working where this is required of them, and is likely to impact on the stage of intervention.

Every child and young person who requires additional help and support from more than one agency has a Lead Professional who co-ordinates the planning and ensures that the different services provide a network of support around the child.

There is growing evidence that children's needs are being identified at an earlier stage by Named Persons and this is enabling the Lead Professional to get the necessary support in place much more quickly.

There are also clear indications that the role of the Lead Professional is contributing to a more focused response to children's needs and concerns.

The input from the child's Named Person is proving to be critical in facilitating the transition from single- to multi-agency support.

Understanding of the Named Person responsibilities at this interim developmental stage is still bedding in. There is still uncertainty remaining among Named Persons about this role, particularly about the implication of when they are required to adopt the Lead Professional role.

The early feedback from families and children and young people indicates that they:

• feel more integrated into the planning process;
• appreciate having access to someone with a clearly identified lead role;
• feel that they are now more aware of when things are happening and what the processes are likely to involve.

It has become the norm to invite the child and family members to planning and review meetings. A solution-focused approach to those meetings is also proving important in engaging children and families in the whole process. But a step-change is also needed where staff come to recognise the value of working with the child and family to find appropriate and proportionate solutions and building on the strengths that have been identified in the assessment process.

It is also important to ensure that Lead Professionals have the skills and tools to engage effectively with children and young people, particularly those under eight.

The process of gathering and sharing information about children's and young people's needs is now more consistent.

Improved information sharing is helping to highlight that the initial concern raised about a child or young person, and the initial interpretation of that concern, may not necessarily be the significant one(s).

This leads to a more accurate understanding of needs to be addressed and increases the likelihood of the support offered being more appropriate and proportionate.

Broadening the range of services providing and receiving information about a particular child is helping to produce a more holistic picture of that child and his or her unmet needs.

The quality of information being shared across children's services has improved to a significant extent during the pathfinder phase.

Staff raising a concern about a child or young person report that they are becoming more confident about giving reasons and evidence to support their concerns.

The language of tariffs, thresholds and levels has not disappeared entirely but is less common in inter-agency discourse.

While the training has been important in supporting the change process it is also critically important to reinforce this with effective quality assurance and self-evaluation processes and mentoring by experienced staff, particularly those who have been engaged in the development and trialling processes.

Generally we found that staff who use the new processes and tools on a regular basis mostly adapt their practice quickly and effectively. Those who need more support are the ones that only use the tools occasionally and may only act as a Named Person or Lead Professional on an occasional basis.

Ultimately the primary aim of the training, CPD, mentoring and quality assurance is not just to get staff to use the new tools and follow the intended pathways, it is to get them to apply these tools and process in an analytical way in order to critically assess the impact which the concerns are having on the child's growth, development and well-being.

There is growing evidence that staff are becoming more confident and competent in:

• using the Well-being Indicators to structure their concerns and guide their assessment;
• using the My World Triangle to understand the strengths and pressures in a child's world that impact on that child's development and well-being;
• supporting their professional judgments with evidence derived from their analysis of the impact that these strengths and pressures are having on each child or young person, though the Resilience Matrix tool remains underused as yet.
• Staff reports and analyses of records indicate that the use of the Getting it right tools is linked with the production of better quality assessments.

Changing professional cultures: bringing about a shift in the prevailing institutional and individual values, operating principles and established norms or ways of working together across agencies and services supports and reinforces changes in systems and practices.

There are clear signs that a sense of ownership of Getting it right for every child is emerging amongst professionals working with children and young people. This is most evident in social work and amongst a range of cross-agency workers. It is developing more slowly and more variably within the universal services and some specialist services but it is to be expected that this sense of ownership would take longer where:

• Staff only use the new processes occasionally, or
• Use additional tools and processes for specialist assessments.

One of the critical factors in developing this sense of ownership has been the fact that so many strategic and operational managers across the children's services have bought into Getting it right.

Another critical factor has been the role that a vanguard of staff who were actively engaged in the trialling process has played in encouraging and supporting their colleagues to adapt to the changes and new processes.

The notion that help for children should be timely, appropriate and proportionate is widely accepted across the pathfinder area as a guiding principle for their work.

Two parallel shifts in professional culture have been emerging in the pathfinder area:

• staff in children's services are increasingly recognising that a central part of their professional responsibility and identity is that they work with children and in order to do that effectively, need to understand the whole child;
• staff working together are moving away from the use of labels such as pupil, young offender, Looked After child, in order to see the child in the round.

While, initially, some practitioners thought that the Getting it right approach might impact negatively on their professional identities, in practice this fear has diminished. This is partly because of the training, partly because of a year's experience of using the new processes and partly because of the pre- Getting it right developments in Highland towards integrated children's services.

A common language around the Well-being Indicators and the My World Triangle is now understood and widely used across the services and agencies.

The language of tariffs, thresholds and levels has not disappeared entirely but is less common in inter-agency discourse.

The level of inter-agency trust is much higher than was apparent at the beginning of the pathfinder phase.

This has been supported by agreed data sharing protocols but it is also apparent in the fact that specialist and targeted services are now becoming more willing to see the universal services as the appropriate providers of support for children and young people with a range of additional needs.

There is a growing perception within the children's services workforce in the Highland pathfinder area that the effectiveness of integrated working needs to be measured in terms of the outcomes for the child and young person rather than in terms of whether or not the specific service outputs were delivered.

Getting it right is an outcomes-led approach to delivering children's services. It is important therefore that steps are taken to review whether existing procedures for collecting and reviewing data on children and young people provide the kinds of evidence needed, in order to judge whether changes in systems and practices are leading to improved outcomes for children and young people.

Systemic and Strategic Changes: changing or improving the ways in which structures, policies, IT systems, stakeholders and strategic management plan, guide, support and co-ordinate the change process in children's services.

Focus groups, interviews and questionnaire surveys with a wide range of strategic and operational managers, frontline professionals and other stakeholders, including children, young people and their families, indicate that the vision behind Getting it right is now well-embedded in the pathfinder area.

That vision is wide-ranging. It incorporates the aims and objectives of Getting it right, i.e. that every child has the right to be safe, nurtured, healthy, active, respected, responsible, included and supported to achieve their full potential and that this will, in turn, help to ensure that every child is confident, an effective participant, a successful learner and a responsible citizen. However, the vision also includes the means by which these aims and objectives will be achieved: a commitment to change the way services and agencies work together and in partnership with children, young people and families to ensure that every child gets the help she or he needs when they need it and for as long as they need it.

While some operational managers and key workers in children's services initially thought that Getting it right was targeted mainly on the most vulnerable children and young people that perception has now receded and Getting it right is now widely perceived to be having a significant impact on universal provision as well.

A communications strategy was needed which communicated the vision behind Getting it right as well as informing the stakeholders about the specific changes to systems and practice that were planned and when they would be implemented.

The breadth and scale of the potential impact of Getting it right on so many services and agencies meant that it was essential that all stakeholders had an overview of the planned developments in addition to information about how these changes would affect them directly.

Without a shared overview there was a risk that each service, agency and stakeholder group would have a fragmented view of Getting it right shaped primarily by the priorities of their own agency, department or post.

The Chief Officers and the other Lead Officers in the more targeted and specialized services working with children and families have all bought into the vision and the implementation plan for Getting it right.

While the championing of Getting it right by the Chief Officers sent out a clear and consensual message to all the stakeholders and to managers and staff at every level it was essential, particularly in the early days of the pathfinder, that Chief Officers and Lead Officers also ensured that:

• pathfinder developments were effectively integrated with other policy initiatives within their services and agencies;
• conflicts relating to joint working (e.g. over sharing confidential information or over responsibilities for co-ordinating action) were quickly and effectively resolved.

Health board members have also bought into Getting it right.

This has also been the case for the local elected representatives.

This is a development which has had cross-party support from the outset and strong links with the Community Planning Partnerships.

This has been particularly important at three levels. Elected members have had an important role to play in:

• explaining the thinking behind Getting it right to local service-user groups;
• establishing important links between the pathfinder and strategic committees;
• ensuring that committees and strategic managers involved with services for adults were kept aware of key developments in children's services.

The development work and implementation of Getting it right in the Highland pathfinder was undertaken by a team seconded from the various services and agencies working with children and families. The secondments were full-time for the duration of the pathfinder phase. This was jointly funded by Scottish Government and the agencies which make up the Highland Community Planning Partnership.

The time required for development work, establishing multi-agency links, consultation with practitioners and operational managers, trialling new tools, procedures and protocols, organizing training and reporting on progress was extensive. It is difficult to see how this could have been done across all children's services without staff from different services being freed up to do this on a full-time basis.

Several organisational changes were also introduced to support the development team and to facilitate the implementation process in the pathfinder area. These included:

Reference Groups were set up in each service and each sector comprising operational managers and senior practitioners who had a mediating function between the development team and the operational staff in each service/sector.

Multi-agency strategic planning groups were established around priority themes, examples of which included Looked After children, youth justice, early years and childcare, disabilities and mental health issues.

Integrated Service Officers, formerly Senior Family Liaison Officers, were delegated to oversee the interface between universal and targeted services and to take on a quality assurance role to ensure consistent standards of support were provided to children and young people.

Local Service Managers Groups who became involved whenever the requirements of a child's plan could not be met from within area resources or where there were disagreements between professionals and agencies about the most appropriate and proportionate response to a child's needs.

Prior to the pathfinder phase a broadly-based governance and strategic planning structure had emerged in Highland specifically designed to co-ordinate policy for children's services and facilitate joint planning and decision making between the local authority, the health board, the police, the Children's Reporter's Office, the voluntary sector and other stakeholders, including groups of service users. This has continued to operate during the pathfinder phase and has played a key role in supporting pathfinder activity.

The inclusiveness of these structures has been an important factor in ensuring that all the relevant stakeholders supported the planned changes.

Also the elected members have acted as a link between all the key strategic committees on the council and health board and the pathfinder and the wider process of integrating children's services across Highland.

Strategic links between the pathfinder development team and other developments and initiatives impacting on children's services have reduced the potential for duplication and overlap of effort.

These Strategic links have been particularly important at two levels:

• managing the key transition points, e.g. from health to nursery, nursery to primary, primary to secondary and children's services to adult services.
• reducing the likelihood of parallel pathways emerging for the assessment and recording of children's needs and the development of appropriate plans.

When a transformative change process such as Getting it right for every child involves pathfinder activities across so many different services and agencies and so many practitioners being asked to respond to new demands and take on new responsibilities, then it can be particularly difficult to manage expectations. Some agencies rolled out specific tools, pathways and procedures before the pathfinder process had been worked through which meant that they were being used in a multi-agency context with staff in other services who had not yet been asked to adopt new practices. In other instances some staff started using new tools and pathways without waiting for the trialling process to be completed.

While the Strategic Chief Officers Group can reduce the likelihood of each agency rolling out some aspects of the new processes ahead of time it is also the case that operational demands within services and the fact that the administrative boundaries for different agencies may not be co-terminous can still present problems. Again it is important that the planning and management of the change process is co-ordinated at a multi-agency level in order to better predict the possible implications for other services and plan accordingly.

At the individual level it is important that operational managers introduce some degree of quality assurance during the development and implementation phases to identify where practitioners may be using developmental tools and pathways inappropriately.