Seamless Services – Smoother Lives
By Kay Tisdall, Jennifer Wallace, Evelyn McGregor, Dianne Millen and Andrew Bell,
Integrating services is a cornerstone of current policy on children’s services and social exclusion. This research aimed to explore – in-depth – integrated children’s services, focusing on the impacts on children and families using four services across Scotland: two family centres and two New Community Schools (NCS).
The sites involved in the research differed in their balance between targeted and universal services. The family centres were open access. Parents were informally referred to family centres by professionals, such as health visitors. Family centres sought to advertise their services, although still experienced difficulties in raising awareness of them. Eligibility criteria were present but in the background: staff respondents said that families who accessed the centre met these criteria and the eligibility criteria were not actively used as a ‘gate-keeping’ mechanism. New Community Schools had a more targeted approach. Referrals to the multi-professional team came through professionals and were typically triggered by a crisis. Most of the parents interviewed had not known about the NCS before they were referred. Set within the universal service of compulsory education, which virtually all local children accessed, the NCS were concerned that too much advertising would swamp their services.
The targeted approach of NCS brought difficulties in relation to stigma and concerns for protecting the confidentiality of parents. Their setting within schools, despite the attempts of Hubbards NCS to create an alternative space, did not facilitate parents feeling they could ‘drop in’ physically, although they did welcome the opportunity to speak to staff members on the telephone etc.
Just under half of the families had previously experienced frustration in using or seeking to access support services. Parents from these families particularly appreciated the ‘one-stop shop’ approach of the family centres and Hubbards NCS, where the multi-professional team ensured that the parents would receive quick and direct assistance.
Families’ experiences of using services
One method of integrating services common to all sites was the provision of support packages. For NCS, the primary focus was on support packages for the children. In contrast, family centres provided services to both parents and children.
All four sites provided evidence of strong integration of services amongst their team members and this was valued by parents. Integrated services, though, were not always guaranteed outwith the team. For some families, this did not seem problematic. For those families with multiple and perhaps interlocked difficulties, this lack of integration did seem problematic. These situations appeared to occur when there was more than one person in the family with difficulties, each with their own professional support staff.
Family centre staff were described as taking on ‘go-between’ or advocacy roles for parents in relation to difficulties they were experiencing, while NCS staff were more frequently described as mediators. Both these roles were valued by parents.
No parent or child asked for more involvement in decisions about their services. Parents at all four sites, though, did expect to be involved in decisions about services for them and their children. At NCS, decision-making was made at formalised meetings involving a number of professionals. The involvement of children and parents was problematic in these more formalised meetings. Parents described clear efforts by staff to consult them at meetings, as did certain children. Parents’ and children’s attendance, however, did not necessarily result in them feeling fully involved.
Family centres had review meetings but they were given less status and the informality and ongoing nature of decision-making was emphasised by parents and staff members alike. This meant that the question of parents or children being in or out of meetings was not raised and concerns about their involvement were not brought forward by children, parents or staff.
Impacts of services on children and families
The impacts described by families in this research may in the longer term assist in social inclusion. But most are not regularly quantified in official statistics nor captured by certain standardised evaluation measures. Sixteen of the 26 families identified positive impacts of service delivery. Parents and children across all sites referred to increased confidence; improved child behaviour and development; improved finances; faster access to services; and improved community relationships. Staff members also spoke of reduced stress amongst some families. Both family centres had helped certain parents into employment and training opportunities and one had an income maximisation officer, who had helped families in the study to significantly increase their income through benefits. The positive impacts identified by parents in the study were the result of the accumulation and interaction of different services. Both family centres had helped certain parents into employment and training opportunities and the financial help at Peggy’s Cove Family Centre was noted as particularly helpful, by staff members and certain parents who had used the service. This directly corresponds with the Scottish Executive’s social justice agenda targets to lower the proportions of ‘workless’ households and the UK Government’s pledge to reduce child poverty.
Ten families did not perceive positive impacts of their involvement, perhaps because the sites were not able to address the particular difficulties of the most ‘vulnerable’ families. For these families, a longer time frame may be needed for them to perceive the positive impacts of services.
Parents particularly valued the one-stop shop provided by family centres and one of the NCS because they could contact a team member and their need would be responded to. While the team may have internally recognised differences in remit and professional backgrounds, the parents’ experience was of team members being equally responsive and ensuring their needs were met. The fault line for seamless service occurred for some families where their service needs went outwith the particular integrated service team. This tended to occur when families had multiple difficulties (and in particular housing) and/ or when adults had difficulties with their own statutory service connections. The boundaries of an interagency team did lead to certain families having overlapping, fragmented or gaps in support services, with significant difficulties unresolved.
The reported difficulties of short-term funding and staff shortages are now well rehearsed for integrated services. Funding sources for NCS were largely initiative funding and thus subject to particular insecurity but family centres too were on short- to medium-term funding arrangements and Peggy’s Cove Family Centre juggled several sources of funding from diverse national initiatives.
The findings show that, from the families’ perspectives, continuity in services and relationships is very important. These relationships provide support in themselves; they provide a conduit to other services, easily and quickly accessed; they provide the basis for staff to assist families in negotiating other services. ‘Seamless services’, from these responses, would be as much about flexible and responsive services and relationships as they might be about formal service integration.
About the project
In order to provide an alternative perspective to the predominantly quantitative evaluations carried out by local authorities and the Scottish Executive, this study evaluates good practice on the basis of qualitative indicators. A case study approach was taken to consider two models of integrated service provision: family centres and New Community Schools. Four sites were recruited: two NCS, managed by local authorities, and two family centres, managed by voluntary organisations.
The fieldwork took place over a three-year period, in three phases, in order to incorporate a longitudinal aspect into the research. A total of 24 staff and 26 families with children provided data. Phases one and two involved semi-structured interview techniques with parents, children and staff. Phase three involved open discussion sessions for families and staff at each site, convened by the researchers, in order to give all interested participants an opportunity to comment on the analysis.
For further information
The full report, Seamless services, smoother lives by Kay Tisdall, Jennifer Wallace, Evelyn McGregor, Dianne Millen and Andrew Bell, is published by Children in Scotland (price ?00 for Children in Scotland members and ?00 for non-members.