A description of the co-design process used by TONIC to create a new service to keep families together where children are on the edge of care due to parental drug or alcohol misuse www.tonicconsultants.com

1. Child and Adolescent Health and
Well-Being:
Addressing the Hidden Harm
Caused by Parental Alcohol
Misuse
Exemplar Project
Basildon Families First

2. Overview
1. Background
2. Insights
3. Co-Design
4. Model
5. Evaluation
6. More info

3. 1. Background
Problem Analysis The Challenge
• Defined complex families as parental • Funding from DfE
SM, MH, DV &Offending • Further our understanding of
• 50%+ children in care had 2 or more of the current system and what
these issues (Essex Vulnerable Parents: could work better
Vulnerable Families Report)
• Identified gaps in existing services
• Design something “game
• The annual cost of care for children of
changing” for families where
substance misusing parents estimated at
parental drug or alcohol
£30-60m in Essex misuse led to children being
• Children from these families may make up
in the child protection system
to 70% of the looked after population • Families involved as active
• Parents are under-represented in Essex partners in solution building
drug treatment population • A systematic learning
• Although parents do as well as non- approach
parents in treatment, 1 in 3 parents will fail
• Prototype & test new
• Many more parents will not seek help due intervention
to concerns oversocial care involvement
• Cost to other agencies of these families is
• Must be sustainable,
high estimated at £139k per year scaleable and cost saving
(ESSEXFAMILY Report)

4. The Development Process
Phase 1. Phase 2. Phase 3.
CREATE BUILDING CO-DESIGN TEST
BLOCKS
FAMILIES DYNAMIC PILOT
With experience of DESIGN Deliver pilot
substance misuse and WORKSHOPS project to 20
social care bringing together families
AGENCIES all parties to use
ALL those involved in “building blocks” EVALUATION
current system to develop a • Build business
ACADEMICS model together case to continue
Evidence of need and RECRUIT TEAM and scale up
effective programmes Team to work with • Sustainable
COMMUNITY Steering Group Investment Model
Identify key and Design
organisations& people Workshops to
STEERING GROUP finalise
Troubleshoot & intervention
Champion

5. 2. Insights: Review evidence base
• Small number of interve COMMON FEATURES OF EFFECTIVE
SERVICES
ntions or services with t
• Very intense direct work with families
his client group have ge
• Use crisis as a time for potential change
nerated positive results i
• Combine child protection & working for chan
n evaluations, inc. some ge
in UK • A variety of elements to the intervention
• Most have shown or ind e.g. family & individual work, therapeutic
icated an ability to redu & practical elements
ce the number of childre • Motivational Interviewing as a basic com
munication style
n entering care
• Emphasis on how services reach out to
• Some have shown impro engage families – e.g. home visits
ved outcomes for parent • A clear set of values & "mission"
s • Protected caseload for practitioners
• None currently have stro • High quality regular supervision
ng evidence of positive • Training and access to other ongoing ski
lls development
impact for children

6. 55 qualitative interviews with families & agencies
THE RIGHT BALANCE SUBSTANCE MISUSERS CAN
We must make sure that BE “GOOD ENOUGH”
Children are safe; Parents FAMILIES ARE THE BEST PARENTS
are helped with their PLACE FOR CHILDREN We have to approach each
problems; Families are This is central to the aims of family in the project as
helped to thrive Social Care and the wishes unique and believe that
independently; Understand of parents and practitioners they have the capacity to
the nature of addiction & parent well. Non-
work with it judgemental & honest
STRENGTHENING FAMILIES
CO-ORDINATION & Must support the whole
OPEN COMMUNICATION &
NAVIGATION family and build on their
A PARTNERSHIP APPROACH
All parties felt this could be strengths rather than just
Between families and
improved and, that if done focus on problems.
services; and between
better, it would improve Including fast
different services
outcomes responses, practical help
and intensive support
6

7. Insight Themes
• Barriers to treatment: Lack of childcare; Inflexible
services; Male & heroin dominated client group; Treatment
services not able to draw in other support for parents – e.g.
Mental Health, Housing, Family Support, Work etc.
• Barriers to social care: Parents don’t understand why
action is taken or how to get child back; Parents expected
to “sort themselves out”; Lack of social worker knowledge
about drugs; Social workers unable to trigger effective
adult support; Monitoring rather than strength building;
Poor communication; Opportunities for early prevention
missed; Unequal relationship / Not a partnership with
family
• Agency Issues: Targets and Timescales for social care
and drug treatment do not match; Individuals feel unable to
work differently or change the system; Fear of information
sharing; Hard to engage client group; Unrealistic aims to
have “drug free families”

8. “It’s full of men “When Proceedings
who do heroin start, there is the a
“Parents run away from & crack. It’s stand off between the
treatment at the first not a safe worker and parents
mention of social place for a which is just about
services” mum” assessing or
monitoring rather than
helping”
“Getting information
out of the service is
like getting blood “Finding the daily bus
“Services stop at
out of a stone” fare to get to day
their door. There
programmesis a
are no home
problem”
visits”
“When you are using
drugs, all your social
networks are about using “The process
drugs – support needs to is too slow”
“The family needs come from outside this”
to feel in control of
what is happening” “I am confused –
why do they say
“There are so many something that
things to trip over in the
process that in the end
happened to me
you feel you can’t get as a kid affects
up anymore” me as a parent 8
now?”

9. 3. Co-design
Process Outputs
• Bring together those • A core model agreed by the
interviewed & new group with much consensus
stakeholders • Options paper to Steering
• Play back insights & evidence Group for decision
• Provide an informal and non- • A rich set of data for the
hierarchical space for this intervention team to start with
group to work together using once they are in place
the “building blocks” • A group of local services&
• Task 1: Generate a shared parents to help recruit, give
understanding of the problem advice and shape the
• Task 2: Explore the evidence intervention – providing a
of what works and generate “reality check”
new ideas, local good practice • Good ownership and
• Task 3: Create the various championing of model by
elements to make a new fit for steering group
purpose intervention – • Agencies agreeing to share
principles, values, skills, behav learning, lead recruitment,
iours, language etc. unblock barriers etc.

10. COMPULSORY
SHARED PROJECT
UNDERSTANDIN MANAGER RADICAL
4 G 4 Good people skills 26 CULTURE 2 2
of professional Fund raiser CHANGE
roles Staff supervision
&organisations 15
1 AGREED
HOLISTIC PLAN
HONESTY By all involved
Humanistic
FAMILY
MENTAL & AN
CENTRED
EMOTIONAL CONTINUITY & UNDERSTANDING
APPROACH OF NEEDS OF
WELL-BEING QUALITY OF 8
2 e.g. psychologist, family 13 SERVICE
Choices ADULTS &
therapist, play therapist, Non- CHILDREN
counsellor, complimentary Within the family
therapies
Judgemental In change process
Joined up
“Working Together”
AIM TO KEEP
FAMILIES DESIGN WORKSHOP
TOGETHER IF
40 POSSIBLE 3 Core Model
And support this
Values & Principles
SOCIAL ABLE TO PAIR
UP WITH EX-SERVICE SUBSTANCE
People & Skills WORKER
FAMILY USER MISUSE
With family & child Mentor SPECIALIST
1 background 4 Able to develop & 3 Parent
4 CPN, General
provide a single
Practicalities & Spec [NOTE: No meaningful Volunteer Nurse, Doctor, M
consensus about relationship:
background] programme H, Midwife
Trusted, Empathic
& Personal
Most difficult
ENABLED TO CREATIVE &
thing to get right CONSTANT DO WHAT FLEXIBLE
WRAPAROUND TOTAL
6 FAMILIES In responding to
SERVICE MUTUAL 3
Priorities for the 7 4 NEED! 1 the whole range of
24/7 RESPECT
Service With no time limit
Both the service need: Shopping,
(Score based on 3 & the staff budgeting, getting
points for Top priority, 2 about
points for 2nd priority & 1 1
point for 3rd priority)

11. 4. Model for Intervention
Who it’s for What it does
• For families where: • Co-located with both social care and
substance misuse services
– Children are on the edge of
• Strengths identification and building
care, CP plan or at PLO activities (e.g. parenting, resilience
– In care with plan to return home & coping skills)
– Parental drug or alcohol misuse • Skilled staff (social care, MH
is the major factor for concerns nursing, experienced manager)
• Aims to maintain children • Whole family assessment and
working to a family-led plan
within their families, or • Intensive 4 – 12 week programme
extended networks, provided • Motivational Interviewing
that this is consistent with the • Solution focused exercises
child’s well-being and within • Delivered in community venues and
their timescales in family home
• Family must agree to take part • Flexible & out of hours
• Practical & therapeutic
• Additional to CP plan – • Strong focus on supervision &
reporting to Core Group reflective practice
• Exit plan – brokering services

12. 5. Outcomes & Evaluation
Evaluation Outcomes
• Tilda Goldberg Centre for • Reduced period of time
Social Research spent in care
• Professor Donald • Avoiding use of care
Forrester & Dr Cherilyn
Dance • Quicker decisions to use
• Compare outcomes to care
control group • Shorter CP plan duration
• 18 month report • Improved treatment
• Commitment to a 5 year outcomes
follow up • Cost avoidance & savings

13. 6. More info
TONIC reports Contact details
• Draft BFF Handbook Matthew Scott
• Essex Vulnerable Parents: TONIC
Vulnerable Families (2011)
07827 339 761
• ESSEXFAMILY Databook
and Deep Dive (2012) mail@tonicconsultants.com
• Basildon Exemplar www.tonicconsultants.com
Development Report
• Castle Point &Rochford
Complex Family
Intervention & Toolkit