Post on 01-Apr-2015
transcript
Workshop Outline
• What’s the commissioning challenge for most vulnerable, resistant families?
• Why is (joint) commissioning so significant here?• What are some of the most effective approaches
to commissioning in this area?
The Population
• ‘Children and families experiencing severe stresses and at risk of significant harm, family breakdown or compulsory entry into the care system’.
(P Hardiker, K Exton & M Barker (1996) The prevention of child abuse: a framework for analysing services, National Commission of Inquiry into the
Prevention of Child Abuse, HMSO)
• Of those families, sub-population who are ambivalent, deny/avoid, unresponsive, hostile..
What’s the Commissioning Issue?
• Huge emphasis on prevention and early intervention in recent years.
• Great for vulnerable families with less complex needs
• Little impact on these most complex families
The problem?
• Level 1 and universal services are getting better at identifying CYP and their families with emerging problems but don’t expect to work with the more vulnerable families in the community.
• Level 2 services do not do enough to help universal services cope with more difficult CYP.
• Level 2 services are not well enough targeted to address the needs of the most vulnerable families.
• Level 3 and 4 services deal with too many inappropriate children and the most vulnerable families who are helped too late.
A vicious cycle?
Increasing numbers of vulnerable
children Tight narrow
definitionsand fiercerationing
Separateassessments
for differentresources
Intensiveintegrated support for
very few
Huge resources into post-
breakdown care
Inter-generational failing families
What is the commissioning issue?
5
Other children
Vulnerable children
Children with
complex needs
Tertiary (treatment
or remedial)
Secondary (intervention for at-risk populations)
Primary (universal interventions)
At
any p
oin
t in
the lif
e
cycl
e
Why Commissioning?
‘The process for deciding how to use the total
resource available for children, young people and
parents in order to improve outcomes in the most
efficient, effective, equitable and sustainable way.’
Achieving Better Outcomes, Commissioning Support Programme, 2009
Why Joint Commissioning for this Population?
• MULTIPLE and HIGH LEVEL needs• Integrated support is likely to be required to:
– Stay safe – Do better in school– Cope better with physical and mental health
challenges – Help their parents to parent better
• Services cant be developed or delivered in isolation• Effective assessment and co-ordination is vital
A Systematic Process Focussed on Need
Patient/ public
Petitions
Published prospectus
Review service provision
Assessing needs
Seeking public and patient views
Managing performance
(quality, performance,
outcomes) Referrals, individual needs assessment; advice on choices; treatment/ activity
Managing demand
Shaping the structure of supply
Designing services
Deciding priorities
National targets
Patient/ public
Petitions
Published prospectus
Review service provision
Assessing needs
Seeking public and patient views
Managing performance
(quality, performance,
outcomes) Referrals, individual needs assessment; advice on choices; treatment/ activity
Managing demand
Shaping the structure of supply
Designing services
Deciding priorities
National targets
Phase 1: Needs assessment and Strategic Planning Phase 2: Shaping and Managing the Market Phase 3: Improving performance, monitoring and evaluating Phase 1: Needs assessment and Strategic Planning Phase 2: Shaping and Managing the Market Phase 3: Improving performance, monitoring and evaluating
Look at outcomes for children and young people Look at particular
groups of children and young people
Commission –including use of
pooled resources
Identify resources and set priorities
Decide how to commission
services efficiently
Monitor and review services and
process
Develop needs assessment with
user and staff views
Plan pattern of services and focus
on prevention
Plan for workforce and market
development Process for joint planning &
commissioning
Look at outcomes for children and young people Look at particular
groups of children and young people
Commission –including use of
pooled resources
Identify resources and set priorities
Decide how to commission
services efficiently
Monitor and review services and
process
Develop needs assessment with
user and staff views
Plan pattern of services and focus
on prevention
Plan for workforce and market
development Process for joint planning &
commissioning
Look at outcomes for children and young people Look at particular
groups of children and young people
Commission –including use of
pooled resources
Identify resources and set priorities
Decide how to commission
services efficiently
Monitor and review services and
process
Develop needs assessment with
user and staff views
Plan pattern of services and focus
on prevention
Plan for workforce and market
development Process for joint planning &
commissioning
10
Commissioners deliver the CTB Agenda
Local Strategic
Partnership
Children’s Trust
Children’s Trust Board
Joint Commissionin
g Unit Operational Groups
Operational Groups
Operational and Advisory
Groups
LSCB
Operational Groups
Operational Groups
Localities
Note – governance arrangements are
different in all local areas
Evidence – Informed Change Agents
• Attention to consensus building and change management– Commissioning
agencies– Providers– Service users and
carers– Professionals– Politicians
12
• Evidence-informed analysis– National priorities,
emerging practice, and research evidence base
– Needs analysis– Market / service
mapping– Cost and quality
analysis
May and June 20091313
A realistic balance of evidence sources
• National and international research as well as government guidance and legislation.
• Population data and prevalence rates.
• Referral, assessment and service activity data.
• Illustrative care pathway/case studies.
• Engagement activities with patients/service users and carers, providers, professionals and other stakeholders.
The Goal – A Virtuous Cycle?
Positive engagement with these families
Recognition and early identification of families who’ll become most
vulnerable
Help to build up resilience and
avoidance of higherlevels of intervention
Resources drawn out of post-breakdown
care into earlier support
Holistic assessment and integrated
support targeted at these families
Ways Forward – Get a Clear Brief from the CTB
• Most vulnerable families as a CYPP priority, signed up to by all agencies with resources..
• Strong engagement from the LSCB
• Commissioning function with clear separation from service management
• An evidence base which speaks to all agencies – based on costs as well as need
• A clear remit to look at resources, AND at internal and external services, AND at identification referral and assessment, AND probably at locality arrangements
Ways Forward – Promising Commissioning Practice
• Systematic, planned project to develop and deliver and review a commissioning strategy over a year period drawing on the joint planning and commissioning triangle
• Evidence reviews which look at the characteristics of effective interventions with most vulnerable and resistant families (as opposed to non-resistant)
• Needs - Audit of 50 families most vulnerable / taking up highest level of resource across agencies in one area (to determine need in detail)
Ways Forward – Promising Commissioning Practice
• Needs – Detailed case reviews involving triangulation of workers, carer and child experience of interventions – to convince professionals..
• Redesign – focus both on pathways, decision-making and how to target support on these families as on services and intervention
• Quality assurance arrangements for localities..
Information and contacts
• www.commissioningsupport.org.uk • www.ssiacymru.org.uk
• keith.moultrie@commissioningsupport.org.uk
• katy.burch@commissioningsupport.org.uk