Adult family group conferences (FGCs) encourage and empower an adult and their family/support network to use their own strengths and resources to make plans for the future. Conferences can be used in a wide variety of ways, including with people who self-neglect; with young adults at transition to adult services, and with people living with dementia to make decisions about their future care and support needs. FGCs with adults can also support Making Safeguarding Personal, bringing together the adult at risk and their family to explore options and support them to make decisions. This one-day Knowledge Exchange Workshop will bring together agencies who either run or aspire to set up an adult family group conference service. It will provide a forum for: Sharing knowledge and expertise on setting up and running a service with adults. Consider ways of evaluating the impact that FGCs can have on outcomes for adults and their families. The workshop will also inform the development of a RiPfA publication which will support Family Group Conferences with adults. Aimed at: All those involved in adult family group conferences, including senior leaders, managers and coordinators who already run an FGC service with adults. Also those with an aspiration to set up/run a service within their organisation.

1. Family Group Conferences:
A knowledge exchange
Tim Fisher, Family Group Conference
Service Manager, Camden
Lydia Guthrie, RiPfA Associate
June 6th, 2017, NCVO, London
1

2. Agenda
10.00 – 11.15 Welcome, and introductions
Origins and key features of FGCs
11.35 – 12.45 What is your current position?
What are the priorities in your authority?
Review of the evidence base
Evaluating the outcomes of FGCs
1.45 – 2.45 Challenges in delivering FGCs in Adult
Services
Issues of Risk and Group Process
3.05 – 4.00 Guidance for setting up a FGC service
How can the Webinar and Resource Pack
best meet your needs?
4.00 – 4.30 Action Planning 2

3. Workshop objectives
› To share practice (in both setting up and running a
service, and recruiting support from key stakeholders)
› To understand the evidence base on the effectiveness
of adult FGCs.
› To start to develop a simple framework to measure the
effectiveness of adult FGCs in your organisation.
› Next steps:
− Webinars
− Resource pack
3

4. Family Group Conference: origins
› In NZ, A large number of Maori children were
removed from their homes and placed into care
› There was a conflict between the Western focus
on the nuclear family and the Maori focus on
community responsibility for raising children
› Family Group Conferences were initiated to
ensure that communities had the opportunity to
solve problems prior to statutory involvement
› Became part of legislative framework in NZ in
1989
4

5. Family Group Conferences in the UK
› FGCs have been used in the UK since 1992, and are
now widely used in Children’s Services
› 84% local authorities now offer a FGC service in
their Children’s Services (Family Rights Group Survey 2015)
› FGCs are gaining momentum in adult services
› The peer-led practice network for FGCs with adults
was set up in 2015, and now has 25 connected local
authorities and organisations
5

6. Family Group Conferences:
What are they?
› A FGC is a formal meeting where the individual
concerned, family, extended family members or
relevant others and professional practitioners, work
closely together to make decisions that best meet
the needs of the individual
› It is facilitated by an independent coordinator, who
is not part of the professional network
› The FGC aims to facilitate families/networks
working together to design solutions, and make
decisions which best meet the needs of the
individual
6

7. Family Group Conferences:
Value base
› Families/social networks are the experts in their own
situation. Professionals only ever see a limited
picture
› It is desirable to encourage individuals to work
together to find long-term solutions which will work
for them
› It is desirable to reduce reliance on services, if safe
to do so
› We are all more likely to stick to plans which we
have helped to develop
7

8. Family Group Conferences:
Value base
› FGCs enable families to cope with problems in a
manner that is consistent with their own culture,
lifestyle, history and resources
› Traditional approaches are often ‘family-centred’,
but a FGC is ‘family-driven’ (Merkel-Holguin, 2004)
› The approach is not aimed at the family, but
achieves results through the family.
› Family Group Conferencing mobilises the natural
resources of the adult’s family, friends and social
networks
8

9. Family Group Conferences:
Key features
› Participation of the service user is fundamental.
› He/she chooses who else to involve
› The service user is offered advocacy throughout the
process, and can be represented by a person of
their choice if they cannot/do not want to attend
› An independent coordinator (who is not part of the
professional network) supports the process
throughout
› Meetings are led by the family/network, who have
private time to develop a plan
9

10. Process of a Family Group
Conference
› Every FGC has three stages, although there may be
differences in how long the process spends in each
of the stages:
 Preparation
 The Family Group Conference
 The review meeting (s)
10

11. 1. Preparation Stage
› Usually takes 3 – 6 weeks
› Co-ordinator meets with the referrer, to ensure that
both sides understand the situation, and what the
FGC might be able to offer. A clear goal is identified.
› Co-ordinator meets with the service user, and with
family members, to identify any obstacles to the
process, to agree ground rules, and the focus of the
meeting
› Co-ordinator and referrer consider issues of risk and
consent throughout
11

12. 2. Family Group Conference meeting:
- Information Sharing
› The meeting takes place in a community venue, and
refreshments are provided
› Professionals offer reports, including information
about their role, what resources they can offer, and
current concerns
› Everyone at the meeting can ask questions, so that
they can have full information
› The aim is not for the professionals to give advice or
opinions – they must remain neutral
12

13. 2. Family Group Conference meeting:
- Private Family Time
› The service user, and their family and friends are
left alone to continue their discussion
› Their goal is to devise a plan which will best meet
the needs of the person at its centre
› They can call upon the co-ordinator or social worker
if necessary
› This gives them an opportunity to develop skills at
communicating and solving problems as a network
13

14. 2. Family Group Conference meeting:
- Agreeing the Plan
› The family outline their plan to the social worker
and coordinator.
› The coordinator may offer suggestions to make the
plan more specific
› If the service user has capacity, they have the right
to consent to the plan, or to withhold consent
› If the service user does not have capacity, (e.g. it is
being held as a Best Interests Meeting) then the
social worker must agree that the plan is in the
person’s best interests
14

15. 2. Family Group Conference meeting:
- After the meeting
› The service user and family decide who will monitor
the implementation of the plan
› They agree who will take action if the plan is not
working, and what that action will be
› The social worker is asked to agree to the plan, and
will do so, if it is safe and legal
› The co-ordinator writes up the plan, and sends it to
those who are involved
› A review meeting is scheduled (3 months – flexible)
15

16. 3. The review meeting (s)
› Usually around 3 months later (flexible)
› Follows the same format as the initial meeting
› The service user, family, social worker and service
providers will all comment about what’s going well,
and what has been difficult
› The aim is for services to withdraw at this point (in
line with the long-term aim of the family/network
becoming self-sustaining).
› However, with adult service users, two or even
three reviews are possible
16

17. Activities and discussions
› Video of a fictional Family Group Conference
› What did you notice?
› What questions do you have?
17

18. What kinds of needs/risks can FGC
be useful for in adult services?
› Safeguarding
vulnerable adults
› Transition from
children’s to adults’
services
› Supporting carers
› Planning discharge
from hospital or prison
› Promoting
independence
› Support for adults with
unmet care needs
(e.g.: mental health,
physical health,
dementia, etc)
› Support planning for
long term conditions
› Best Interests decision
making
› Self neglect / risk of
homelessness 18

19. Family Group Conferencing and
current legislation in adults’ services
› Family Group Conferences sit well with current
legislative and policy frameworks:
− Making Safeguarding Personal (2010)
− Mental Capacity Act 2005
− Care Act 2014
19

20. FGC and Making Safeguarding
Personal
› Key themes of safeguarding and personalisation
› Focus on empowerment of individuals, person-
centred ways of working, and strengths-based
approaches
› FGCs are recommended as a useful approach in the
MSP toolkit (2015)
20

21. FGC and the Mental Capacity Act
2005
› The MCA enshrines the right of adults to make
decisions, unless they are specifically assessed as
not having the capacity to make a decision
› The right of individuals to make unwise decisions is
enshrined
› FGCs can support individuals to make decisions, to
use their networks, and to make plans
› If a person lacks capacity to make a particular
decision, a FGC can be used as a best interests
meeting
21

22. FGC and the Care Act 2014
› FGCs fit well with all six principles of the Care Act
− Empowerment; prevention; proportionality;
protection; partnership; accountability
› FGCs promote personalisation, and are wholly
focussed on the service user’s wellbeing
› The FGC model is rooted in strengths-based
practice, and enabling the service user to best use
his/her resources and networks
22

23. Break
23

24. Activities and discussions
› Please reflect individually on your aims in
relation to FGC in your local authority.
› Section 4 of the Workbook offers some
questions to prompt your thinking (p5-6)
› Followed by group discussion
24

25. Family Group Conferences:
Outcomes (Workbook, Section 5)
› Measuring outcomes in FGCs is complex, because
there is no single criteria for a positive outcome
› An adult with capacity may choose to make an
“unwise decision”, but there could still be benefits if
the process led to increased awareness of risks, or
increased support, or communication, or improved
relationships
(Daybreak evaluation report, 2010 – 2012)
25

26. FGCs – a wide range of positive
outcomes
› Produce safe plans (Forsyth et al 2013)
› Help individuals feel more in control and groups
more resilient (SCIE 2012; Malmberg-Heimonen 2011)
› Can be restorative (De Jong 2013)
› Can be more culturally sensitive (Forsyth et al 2013;
Camden evaluation 2015)
› Increased family involvement in ongoing support
(Camden evaluation 2015)
26

27. FGCs – a wide range of positive
outcomes
› Are valued by the people who use them (Marsh 2007;
Camden evaluation 2015)
› Produce personalised plans drawing on resources
from family and friends (SCIE 2012; Forsyth 2013)
› Can save agency resources (Marsh 2007; Daybreak
2011)
› Build trust between agencies and service users
(SCIE 2012; Forsyth 2013)
27

28. FGCs: Outcomes for service users
(RCT study based in Norway)
› Service users’ “Life satisfaction” increased almost a
whole point on a 5 point scale
› Mental distress and anxiety/depression measures
decreased significantly
› Positive trends on measures of emotional social
support and social resources
› Service users evaluated the experience positively
Malmberg-Heimonen, 2011
28

29. FGCs: Financial Implications
› Each FGC costs £1500 - £2000 per cycle on average
› FGCs have the potential to save on care package
costs, especially when a family co-produce a plan
which can be supported by professionals
› This can prevent escalation, and avert the need for
more intensive interventions (SCIE 2013)
› Kent evaluation: FGCs reduced budget expenditure
of Adult Services by around £7000 per FGC (Marsh
2007)
› Hampshire analysed 49 FGCs (2007 – 2010) and
estimated a total saving of £77360 (Daybreak, 2012)
29

30. A study into FGCs in mental health
De Jong et al, 2015
› Studied 41 FGCs held over a two year period– 23
seen as successful and 18 seen as unsuccessful
› All were concerned with issues of mental health
› Reasons for “failure”
− 6 stopped at preparation stage, because clients could not be
located or withdrew, or because of conflict in the network
− 5 stopped at the meeting stage, because a plan could not be
reached
− 7 agreed a plan, but failed to implement it fully due to
conflict within the network
30

31. However...
“A conference that does not yield a desired
plan still can have remarkable side-effects.”
› We need to be attentive to these side-effects, as
they can improve communication between all
involved. It is our role to notice them and to
articulate them
31

32. Side effects of FGCs which “failed”
De Jong et al, 2015 (1)
› uncovered the communication patterns within social
networks
› clarified from whom support could be expected and
from whom it could not
› provided insight to the social network to what extent
their help was valued by the main individual
concerned
› demonstrated that the gap between what the
individual wanted and what was actually (and
legally) possible was too wide
32

33. Side effects of FGCs which “failed”
De Jong et al, 2015 (2)
› offered learning opportunities so that future
threatening situations could possibly be averted
› indicated when the main individual and the social
network were not capable of overcoming the unsafe
situation, thus, clarifying the need for formal, legal
measures
› gave people, previously marginalised or intimidated,
a voice.
33

34. De Jong et al, 2015
“Another lesson is that a single family group
conference for public mental health care clients may
be unable on its own to counter a protracted history
of inertia, disillusion and care paralysis.”
“A single conference within networks lacking social
capital... is unlikely on its own to restore and
strengthen bonds.”
“Our findings indicate that when there is a lack of
clear purpose and pressure to reach a plan, clients
are insufficiently motivated to improve their
conditions. In such circumstances, professional care
is quickly called in once again”
34

35. Discussion
› The research identifies positive impacts for
service users, family members, professionals
and commissioners.
› Which of these outcomes do you anticipate
would be most relevant in your local authority?
35

36. Evaluating a FGC service –
challenges:
› multiple definitions of a successful outcome
› The process is so individualised that it’s difficult to
compare FGCs with each other
› The outcomes of a FGC may be complex, and may
only become apparent over a long time period
› It’s difficult to define which outcomes can be
attributed to the FGC process
› Long term conditions may worsen, which can affect
outcomes
36

37. Sample evaluation forms
› See Workbook, Sections 6 and 7, for
evaluation forms currently used in
Camden
› What other ideas do you have about
how to evaluate outcomes?
› What other support would you like;
for example, through the Resource
Pack or webinars?
37

38. Lunch
38

39. Create an online account - for
Partners
You can access our learning
resources by creating an online
account at:
https://www.ripfa.org.uk/login/
create-account/
With an account you can:
› Download resources
› Book places at webinars and
workshops
› Subscribe to RPU / bulletins
39

40. Challenges in delivering FGC in Adult
Services
› The model is very well developed in Children’s
Services, where there is a stronger legal framework
which provides impetus to reach an agreement
› Working in Adult Services poses additional
challenges, for:
− service users
− family members
− professionals
− senior managers/commissioners
40

41. Challenges for service users
› Not wanting to “cause a fuss”
› Reluctance to be open about their situation with the
family network
› Complex relationships with family network
› Wanting the continuation of service provision
› Shame and vulnerability
41

42. FGC and Shame
› “with the help of Family Group Conferencing,
downward spirals of social exclusion can be averted”
› ...shame on one side acts as an engine for
withdrawal and avoiding contact with family and
friends but, on the other hand, can also act as a
catalyst of breaking through deterioration and
isolation.
DeJong and Schout, 2011, p11
42

43. Challenges for family members
› The root problems may have become very
entrenched, and relationships may be strained
› Family members may be fearful of being asked to
take on more responsibility than they feel able to
accept
› Family members may feel that they are already
doing everything they can, and be reluctant to
engage in another process
43

44. Challenges for professionals
› There needs to be a genuine offer to share power
with the service user and the network
› It would be a corruption of the FGC model to
attempt to pressure networks to rubber stamp a
plan which was largely devised by a professional
› Social worker reports to the FGC must be truly
neutral and factual, naming risks, describing
resources/services, and outlining the legal position
44

45. Challenges for senior
managers/commissioners
› FGCs, properly resourced, cost £1500 - £2000
› The savings may accrue over a long term, but the
costs are immediate
› There can be a temptation to cut corners – such as
by removing the independent co-ordinator role, or
asking social workers to act as co-ordinators
45

46. Discussion
› Which challenges seem most relevant to you in
your local authority?
› Can you anticipate any others?
› What ideas do you have for addressing them?
46

47. FGCs: Issues of risk and group
process
› Family relationships can be very fractured, as
difficulties may have persisted for many years.
› FGCs are not a therapeutic or mediation service. The
goal is to solve a problem / meet the adult’s needs
› The offer is to put aside conflicts in relationships,
and come together to solve a problem
› Relationship repair / mediation is never the focus,
but can be a side effect of a FGC
47

48. FGCs: Balancing the roles of the
service user and the network
› “There is an amount of ‘compassionate interference’
from the informal network which is to be embraced,
while at the same time paying mind to the
autonomy and identity of the adult”
Metze et al, 2015, p75
48

49. FGCs: Abuse and vulnerable adults
› There can be advantages and disadvantages of
involving perpetrators of abuse in FGCs
› FGCs have a focus on the future, rather than the
past, so can help with recruiting the support of the
network for a safety plan, and widening awareness
of risks
› Need to monitor attempts to use the FTC process to
continue abuse/controlling behaviour
› The service user’s wishes are very important
49

50. Examples
› Case study: Mrs Begum
› Workbook, Section 8
50

51. Break
51

52. Developing a FGC service for adults
› Extending existing Children’s FGC service
Can be cost-effective, but there is a need for
additional training, and adaptations to the
management structure in order to work with
adults
› Providing an in-house FGC service
It can be tempting to ask social workers to take on
the FGC role in addition to their jobs, but this
carries many risks and is likely to compromise
their efficacy
52

53. Developing a FGC service for adults
› Commissioning an independent provider
−This could either be an existing provider of FGCs
in Children’s Services, or a new provider.
−The costs will be higher at the beginning of the
contract
−Consideration should be given to starting with a
pilot scheme
53

54. Developing a FGC service for adults
› However the service is delivered, there will be a
need for adequate training for FGC coordinators,
and for existing social workers (to ensure that they
make appropriate referrals and understand their
role)
› Two recognised training routes for coordinators:
− Daybreak (Hampshire)
− Family Rights Group
54

55. Reflection and action planning
› Questions to prompt individual
reflection
Workbook, Section 9
› Questions to prompt action planning
Workbook, Section 10
55

56. References
› See Workbook, Section 11
56

57. Next Steps
› Webinar: 12th July
−How could this be most useful to
you?
› Resource Pack: October 2017
−Webinar – to launch the Resource
Pack, 18th October
−What content would be useful to
you?
57

58. Create an online account - for
Partners
You can access our learning
resources by creating an online
account at:
https://www.ripfa.org.uk/login/
create-account/
With an account you can:
› Download resources
› Book places at webinars and
workshops
› Subscribe to RPU / bulletins
58

59. Please complete an evaluation
› Go to www.ripfa.org.uk/login
› Log in to your account
› From the MyRiPfA page, select
My feedback from the left menu
› Select this event in your Open items
list and give us your feedback
› This will unlock your certificate in the
Completed items list once the register
has been recorded
59

60. Contact
60
https://www.ripfa.org.uk
help@ripfa.org.uk
@ripfa