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Change Matters Patrick Myers, Dorset Council
- 1. Patrick Myers Dorset County Council * 1
- 2. * *Deficit reduction *Public sector reform *Transforming *New models and practice 2
- 3. 3
- 4. * *Put simply, we “commission” in order to achieve outcomes for citizens, communities and society as a whole; based on knowing their needs, wants, aspirations and experience. *Use an integrated approach to better understanding citizens and communities and using this insight to work more effectively in order to secure better outcomes and allocate resources.
- 5. * *The approach also acknowledges the whole-system and interdependencies between citizens, communities, organisations and services. *The focus must be on commissioning FOR outcomes rather than simple commissioning OF services
- 6. * *The challenges to public funding mean transforming the delivery of public services is more important than ever; joint commissioning, fostering innovation, systems thinking, co- production and co-design with service users are key to finding greater efficiencies and better productivity.
- 7. * Present Policy A model that includes Focus on Deficiencies Focus on Assets Reactive response Opportunity Identification Charity Orientation Investment Orientation Grants and contracts to agencies Grants, loans , investments, leverage More Services Fewer Services High emphasis on agencies Emphasis on associations Focus on individuals Focus on communities and neighbourhoods Maintenance Development See people as Clients See people as Citizens and Co producers Fix people Develop potential Programmes are the answer People are the answer
- 8. * 8
- 9. 9
- 10. * Value QualityOutcome Maximum Value Right Outcomes Built on quality Service User Experience
- 11. * *Value *VFM (outcomes linked) *User value *Value to wider group *Political value *Social value *Environmental value
- 13. User value Value to wider group Political value Social value Environmental value
- 14. 14 *
- 15. 15 * *Peep *Incredible Years *Triple P *Strengthening Families * and……….. *IMPACT
- 16. * • 3 to 16 years • Parent , child/young person & teacher completion • Explores: conduct problems, hyperactivity/inattention, peer relationships, pro-social behaviour • Vaild, reliable, effective in measuring outcomes • Can help identify issues and inform goals Strengths & Difficulties Questionnaire (SDQ) • Any age child/young person • Parent completion • Explores: child development, parenting capacity, family and environmental factors • Valid, reliable and effective in measuring outcomes • Enables setting and measurement of personal & family goals Parent Concerns Questionnaire (PCQ)
- 17. 17
- 18. 18
- 19. * Pilot for 1 year Automated calculation toolkit Pre and post programme completion 4 month follow up Central collation & analysis
- 20. * Christchurc h East Dorset North Dorset Purbeck West Dorset Weymouth & Portland 1 1 3 1 3 2 The Participants (110) Number of Programmes (11)
- 21. *
- 22. *
- 23. *
- 24. -60.0% -40.0% -20.0% 0.0% 20.0% 40.0% 60.0% Emotional Symptoms Conduct Problems Hyperactivity Peer Problems Pro-social Behaviour Significant Borderline Normal *
- 25. * 82% • Reduction in total difficulties 57% • Reduction emotional symptoms 70% • Reduction in conduct problems 59% • Reduction in peer problems 61% • Increase in pro- social behaviour 80% • Reduction in stress 44% • More fun with child 46% • More confidence child will do as asked 45% • Felt good about child more often 39% • Child seemed happy more often
- 26. * • Improvement in problem situations76% • Improvements in child’s problems91% • Found course extremely or very helpful93%
- 27. 27 * *Change Matters *Value for money matters *Impact Talks *Investment Orientation *Sustained Change *`Proximal and Distal Outcomes *Make the case for your theory of change
- 28. 28 *
- 29. 29 * *Theory of Change *Measuring Prevention *Outcomes- Yes again *Maximising Value *Making the case-saving money *Information- what it looks like
- 30. 30 * *Making Life Better *Beneficiaries *Releasing Resource *Enabling me to do more with what I have *Moral Purpose
- 31. User value Value to wider group Political value Social value Environmental value
- 32. 32 What if?
- 33. 33 *
- 34. 34 *
- 35. Economic pay-offs per £1 investment NHS Other public sector Non- public sector Total Early identification and intervention as soon as mental disorder arises Early intervention for conduct disorder 1.08 1.78 5.03 7.89 Health visitor interventions to reduce postnatal depression 0.40 - 0.40 0.80 Early intervention for depression in diabetes 0.19 0 0.14 0.33 Early intervention for medically unexplained symptoms 1.01 0 0.74 1.75 Early diagnosis and treatment of depression at work 0.51 - 4.52 5.03 Early detection of psychosis 2.62 0.79 6.85 10.27 Early intervention in psychosis 9.68 0.27 8.02 17.97 Screening for alcohol misuse 2.24 0.93 8.57 11.75 Suicide training courses provided to all GPs 0.08 0.05 43.86 43.99 Suicide prevention through bridge safety barriers 1.75 1.31 51.39 54.45 Promotion of mental health and prevention of mental disorder Prevention of conduct disorder through social and emotional learning programmes 9.42 17.02 57.29 83.73 School-based interventions to reduce bullying 0 0 14.35 14.35 Workplace health promotion programmes - - 9.69 9.69 Addressing social determinants and consequences of mental disorder Debt advice services 0.34 0.58 2.63 3.55 Befriending for older adults 0.44 - - 0.44
- 36. 36 * *Headlines *Stories behind the headlines *Sustained Change- checking *Logic Models *Systematic and robust *Performance Orientation *Knowing your theory of change
- 37. 37 *
Editor's Notes
- This is a behavioural screening tool about 3 to 16 year olds with versions for completion by parent(s)/carer(s), teachers and children/young people themselves. The tool explores emotional symptoms, conduct problems, hyperactivity/inattention, peer relationships and pro-social behaviours.The SDQ was selected as there is a strong evidence base that the questionnaire is both valid and reliable, is already used by some Dorset agencies, allows for the identification of areas that are causing difficulties and so helps plan work with families and it has already been proven effective in measuring the outcomes of interventions if used before and after the intervention takes placeDeveloped through research with children and families, this is completed by the parent, is simple and easy to use, and takes no more than 10 minutes to fill in. The information it provides is clear and straightforward to understand. Informed by current thinking on the psychology of child development and is divided into three areas: Child Development, Parenting Capacity and Family and Environmental factors. The PCQ was selected because there is a strong evidence base that it is both valid and reliable, allows for parent(s)/carer(s) to identify issues and goals that are important to them, is consistent with the Common Assessment Framework (CAF) and has been shown to be effective in measuring the effectiveness of the outcomes of interventions if used before and after the intervention takes place. In addition this tool can be used for children of all ages including those under the age of 3.
- We agreed to pilot this approach for 1 year to see how effective it was,Developed a toolkit – not without difficulties, teething problems, training, now have a new version (is working) – Benefit to Pracitioners as well as managers – Colour coded, individual family progress, whole group progressCompletion before and after – in order to measure distance travelled4 month follow – to measure sustainability of changes, not well completed so haven’t included in this evaluationWe agreed to pilot some central collation and analysis during the pilot period
- We received results from across the county from a total of 11 programmes – distribution shown above. All localities represented but received the most from North Dorset and West Dorset.A total of 110 participants completed pre and post questionnaires (participated in the evaluation) – this is not all the parents attending the courses.28% from North Dorset22% from West Dorset19% from Weymouth & Portland
- Levels of difficulty before attending courseStandard SDQ scoring system. Categorise problems into normal, borderline and significant – can help workers and parents to understand where to focus effort. Import to look at this as it provides an indication of the effectiveness of out targeting of courses – make sure those attending need to be there and will therefore benefitDorset as a whole county - Over 60% significant (1/4 normal on SDQ but may have other problems not picked up by SDQ, therefore use of PCQ important)W&P (81%), CC (67%) and WD (63%) – highest % of parents with significant problems – more effective targeting? More significant levels of need?
- SDQ scores for different types of issues – before courseBy far the greatest concerns expressed by parents were ‘conduct problems’ – over ¾ of all parents significantMost likely to return normal scores for Pro-social behaviour (2/3)Peer probs and hyperactivity similar at 40%
- Note on completion rates – definition 80% attendance at course70% completion rate (high)Greatest completion North Dorset (85%), lowest completion in W&P (57%) and CC (56%) – but worth noting these are the areas where parents had higher levels of significant problems, therefore greatest complexity so it is possible that they would find engaging with a long programme more difficult.Completion rates at parenting programmes was being considered by gov as a PBR measurement for Children Centres
- Pre and post testing on SDQThere was improvement in all categories and parents/carers were most likely to return ‘normal’ scores at the end of the programme than beforeAt end of course the proportion of parents returning normal scores were: 80% Pro-social, 55% Peer Probs, 60% Hyperactivity, 65% Conduct Problems, 80% Emotional Probs)Graph above shows percentage changes in symptoms from before to after the programme. As you can see the greatest change was in conduct problems, there was a 56% reduction in the number of parents reporting significant problems in this area and a corresponding increase in the % of parents reporting normal or borderline – suggest real success at improving this.
- Small snapshot of some of the impacts from the summary reports. Some of these came from the SDQ and some from the PCQ. Huge proportion of parents showed a total reduction in total difficulties, huge reduction in conduct problems.
- High scores – speak for themselves