Cambs CAF Impact Evaluation v2 24 May 2012 by L5gP4O

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									   Cambridgeshire County Council

  EVALUATION OF THE IMPACT OF CAF


                                    May 2012




        Authors:    Rachel Clark, Sector Specialist
                    Mike Powell, Project Accountant
                    Carole Brooks, Regional Associate
Date and version:   V3 – FINAL TO CAMBRIDGESHIRE
                    C4EO
                    8 Wakley Steet
                    London
                    EC1V 7QE
                    www.C4EO.org.uk
1. Context

The number of CAFs completed in Cambridgeshire has grown from 712 in 2006 to around
3,300 in September 2011, with the majority being initiated by schools. There is also an increase
in health professionals (including health visitors, GPs and school nurses) initiating CAF,
accounting for 14%. A central CAF team logs all CAFs, and Cambridgeshire felt that they had
turned the curve in terms of the number of CAFs being completed. However, there were still
some continuing queries around the consistent quality of the CAFs being completed and
resistance of some professionals.

Following a comprehensive audit of the CAF in 2009, a revised strategy was introduced in
Cambridgeshire County Council (CCC) in September 2010 and at the start of 2012, CCC
conducted a review of the CAF strategy to inform future development at a time when there was
more scope to adapt or adjust the framework to meet local need. This review, being undertaken
internally, was to determine whether the route to access early help, referral pathways and
thresholds were clear and well understood.

Whilst there had been some good anecdotal feedback around how effective the CAF was in
improving outcomes, there had been no formal evaluation of impact or how to measure this.

Cambridgeshire therefore commissioned C4EO to assist in undertaking an evaluation of the
impact, to focus on what difference the CAF had made to the lives of children and their families,
including the social return on investment (how much the CAF costs, and what longer term
savings to the Council, partners and society had this earlier intervention generated, if any).


2. Scope

The aims of the evaluation were to help determine the best way to collect clear measurable
evidence of impact, including service user views, to ensure that effort is matched by impact and
the costs and benefits of CAF can be quantified to inform future strategic direction.

The evaluation has had a very clear focus on the impact of CAF and does not review the
process or overlap with the evaluation that CCC were conducting themselves. It does not
include any evaluation of other provision within children’s services, but has considered the
interface between such services where this is appropriate. Care has been taken to ensure that
no single person can be identified for confidentiality. However, where in reporting findings it has
been necessary to attribute comments to groups of people, these have been kept as broad as
possible.




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3. Methodology

3.1 People involved

The evaluation has been undertaken by a team of two C4EO specialists, with project
management and quality assurance provided by C4EO’s Regional Associate, Carole Brooks.

   Rachel Clark, a C4EO Sector Specialist for families, parents and carers theme with
    experience of undertaking similar evaluation. Rachel also works for Nottinghamshire County
    Council as a Locality Manager for Early Years and Early Intervention.

   Mike Powell, Project Accountant for C4EO who helped develop C4EO’s costs and outcomes
    model which is based on The Cabinet Office social return on investment model, and who
    has extensive experience in undertaking cost analysis of a range of children’s services,
    including CAF.

The sector specialists have worked closely with key personnel throughout the assignment and
are particularly grateful to Lorraine Lofting, Jill Buckingham, the Locality Managers and their
teams in Sawston and Linton, March and Chatteris and Huntingdon, for their time and
commitment to this work.

3.2 The process

Prior to commencement of the evaluation, a scoping meeting was held with senior managers in
to explore the request for this peer to peer support in more detail and to obtain information
about the context of the work. A proposed methodology was discussed and agreed and the
meeting concluded with confirmation of dates for assignment work to be undertaken,
commencing in January 2012. The process undertaken is illustrated in the diagram below.




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The sector specialists spent a total of 30 days including time spent on:
    Initial meeting with key managers to explain project;
    Development of data collection tools and documentation;
    Briefing meeting for all staff and managers from the locality teams involved in data
      gathering;
    On –going support and quality assurance during the data gathering phase;
    Facilitated half day discussions with each locality team as part of quality assurance but
      also to draw out wider messages about the impact of the CAF. The discussions were
      also designed to allow staff to reflect on their work;
    Moderation panel to consider the proposed future scenarios in May 2012;
    All case activity and future scenarios costed;
    Presentation of the results at three area events in May 2012;
    Planned presentation to strategic leadership team in July.


3.3 Design Methodology

Part of the evaluation focussed on measuring impact in terms of cost avoidance, through Social
Return on Investment calculations using C4EO’s costs and outcomes tool, consideration was
also given to attribution (what can be attributed to the CAF process or to other factors) and
deadweight (what would have happened anyway). Softer intelligence about impact for the child
and family was also gathered to support measurement of impact of the CAF on the families
within the sample, and from from professionals about the impact of CAF generally. C4EO
Sector Specialists worked closely with practitioners, managers and finance staff to co-design a
methodology to explore both the costs and impact. The agreed approach involved sampling a
range of cases across all three localities in Cambridgeshire, to record actual costs and impacts
in the words of professionals and families themselves. An innovative and rigorous ‘futurising’
methodology was then used to agree the outcomes prevented, and to translate these into
avoided costs.

A final CAF activity template for each of the fifteen cases was agreed with C4EO and each
locality team following a moderator’s panel. Each case was then costed and future savings
estimated based on what would have happened without CAF involvement. Details of the costs
savings are provided in the Key Findings section.


3.4 Costing methodology

The costing methodology was based on NfERs LARC3 research and C4EO’s costs and
outcomes guidance and tool. A list of references and cost sources are also provided at the end
of the report.




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 Staff: Each case was costed taking into consideration the amount of time involving CCC Staff,
 Schools staff and other agencies involved such as CAMHS, Police, NHS etc. CCC staff hourly
 rates were provided directly by CCC where appropriate. An hourly rate was derived by dividing
 (Annual salary + pension and Employers NI + an element for central services) by hours worked
 per annum (Based on PSSRU guidelines). For non CCC/Connexions PSSRU, DfE pay scales,
 national pay scales were used to calculate an hourly rate.

 Services Used: CCC provided a list of some of the services used in the CAT process. Others
 were calculated using PSSRU data, C4EO data or National data.

 Costing future outcomes: These were costed based on using NfER’s LARC guidelines and
 methodology1. In each case, criteria agreed at the moderator’s panel meeting was followed so
 that potential outcome scenarios were critically appraised and where there was any doubt about
 the future scenario, decisions erred on conservative scenarios. It also excluded savings where
 there was a level of duplication over the time periods or a reasonable proxy to ascribe to that
 outcome could not be ascertained.

 The Sector Specialists have also spent time considering relevant research material, validated
 local practice and examples of ‘what works’ elsewhere in order to inform their
 recommendations.



 3.5 Sample size

 The evaluation looked at 15 cases from across the County, four from Sawston and Linton, five
 from Huntingdon and six from March and Chatteris. The localities were selected to represent
 the diversity of population and need across the County. Where possible, staff were asked to
 select cases which had been closed in the past 12 months. The sample was not random, and
 as such, results may not reflect every CAF undertaken within Cambridgeshire.

 The cases included support for children aged 0-17. The majority were in the 8-15 age bracket,
 however it was agreed that in terms of selecting cases, age was not as important as level of
 need. Accordingly, the cases reflected different levels of need across the Models of Staged
 Intervention (MoSI) scale.

Level of need on MOSI scale                                  All       Evaluation Sample
                                                             CAFS      Number of     %
                                                             initiated   cases
Level 1                                                         5%         1         7%
Level 2                                                        75%         7        47%
Level 3                                                        16%         4        27%
Level 4 (step down from previous social care involvement)       4%         3        20%



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 Staff were asked to carry out interviews with parents and carers, children and young people and
 other professionals involved in the case to ascertain their view of the CAF and the impact it had
 had on their family. They were provided with face to face briefing sessions, as well as a leaflet
 about the evaluation and written guidance and templates, with a contact for support in case of
 query.

 A review of the evidence collected from the interviews took place as part of a facilitated half day
 discussion with staff from the localities. Cases were then moderated by an independent panel
 and costed as described above.

 The findings, views and experiences of the two Sector Specialists and Regional Associate were
 then triangulated and key findings agreed. This report has remained as factual as possible
 based on the evidence available and its interpretation by the Sector Specialists. It must be
 noted that the evaluation undertaken does not offer a complete depiction of provision, practice
 and outcomes across the LA as a whole, but offers a snapshot at one point of time across a
 sample of families, staff and key partners.


 4. Key findings

 The 15 cases reflected a wide range of need, as shown in the table below.

Case features                              Number of cases            % of total sample (15)
SEN and disability                                  6                            40%
Behaviour                                           7                            47%
Attendance                                          3                            20%
Parenting                                           8                            53%
Family conflict/breakdown                           8                            53%
Parental mental health                              4                            27%
Housing and benefits                                4                            27%
English as an additional language                   2                            13%
Anti-social behaviour                               2                            13%
Domestic violence                                   2                            13%
Teenage Pregnancy                                   1                             7%
Inappropriate sexualised behaviour                  1                             7%
Transition                                          2                            13%

 Many of the cases contained a combination of these needs. However, a key feature that stood
 out in many of the cases was a sense of families feeling that things were spiralling out of control
 and a sense of powerlessness. This is reflected in the number of cases that feature parenting or
 family conflict as issues. In some of these cases, family conflict included violence between
 siblings and violence from children and young people to parents.




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It is interesting to note that there was also a pattern of one, often quite serious, incident,
triggering the commencement of a CAF. However, the CAF process often revealed that the
family had had on going issues for some time before that, which other agencies had been
aware of. There were two cases where practitioners felt that universal services had held onto
cases for too long and a CAF should have been commenced earlier, and one case where the
parent had been trying unsuccessfully to access help for a while.

In two cases, the CAF was being completed for the second time. In one case, this was because
the process had not been followed after the completion of the form and in the other, it was
because the practitioner recognised the need to gather additional information from
grandparents, rather than parents. This was in a case where a young person had gone to live
with her grandparents and in this case, the information that the grandparents gave was more
helpful in terms of identifying need and appropriate services, rather than the initial CAF. This
evidences the fluid nature of a CAF as an on-going collection of information and provision of
support, rather than a time-limited ‘assessment’.

Interventions provided by the CAF included:

      Parenting support
      Anger management
      Emotional health and well-being support
      Housing and benefits advice
      Early Years provision
      Education Welfare

The CAF had a positive impact on the following areas:

      Attendance at school
      Educational attainment
      Aspirations (of children and parents)
      Family and peer relationships
      Relationships between families and professionals
      Parenting capacity
      Behaviour in the community and in school
      Happier, safer children and young people

The work also identified the possible future scenarios avoided, which include:

   •   Permanent exclusion
   •   Deteriorating mental health (of child and parent)
   •   Entry into the care system
   •   NEET (and eventually into adulthood as out of work)
   •   Family breakdown


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   •   Referral to social care or other specialist services
   •   Involvement in the criminal justice system

Thus, the impact of the CAF can be understood in two ways, firstly in terms of the immediate
benefits that it delivers for families, but also in terms of the longer term, more serious issues
that it helps to prevent.

Seven of the case studies have been summarised (Appendix A) to illustrate clearly the
presenting issues and outcomes of these CAFs.

The following key themes emerged as a result of the research:

1. The CAF as a tool for building family resilience, however, the form alone is not
   enough

In theory, there are three different pathways for a family requiring this stage of early intervention
at CAF level:
    1) The current CAF framework
    2) Any multi-agency framework or process (e.g., CCC’s previous Single Assessment)
    3) No framework, just professionals providing their individual service and talking to each
        other as appropriate.

The benefit of the CAF has been reported during the evaluation as improving information
sharing through consent; getting the right information more quickly; quality assurance across all
families and cases and easier for professionals to work within.

Families particularly valued the fact that there was a recognised plan and structured support in
place. This in turn seemed to help them to feel more in control and more empowered, which
impacted on the family as a whole. This was in stark contrast to their previous experiences of
single service interventions, which many felt had not helped and had not affected any change.
Key to this was following the whole CAF process, rather than simply just filling in the form

            “ It wasn’t explained properly, there were no meetings , nothing changed”
                                                  Parents experience of first CAF under old framework.

  “When the PSA explained it, I thought brilliant. The way she explained it I thought it was the
                                      only way forward.”
                                                         Same parent talking about their second CAF.




2. Improved engagement with services




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Parents seemed to value the voluntary nature of the CAF. This was particularly evident in one
case where the family had had significant previous social care involvement, which they had not
engaged well with. However, they did engage with the CAF and significant improvements in
their situation occurred as a result. Other parents acknowledged that whilst the process had
sometimes felt uncomfortable and they did not always welcome the involvement of services,
they recognised their value and the difference they had made. In other cases, parents felt that
the CAF process had resulted in speedier access to appropriate services. A key variable in
achieving a positive impact of the CAF, as one would expect, was the engagement of parents
and children in providing information during the CAF. One example was given where key
information was given late on only once a relationship with the lead professional had been
established.

 “Because of past experience, and I didn’t know that you could do this (home visits). Parents
don’t know who to turn to, who they can trust and if they have an experience like I did then that
                                   stops you from asking”.
                                 One parent who was not engaging with any services prior to the CAF




3. Improved relationships with some professionals, especially schools

In undertaking the evaluation, staff reported that record keeping is variable amongst other
professionals (for example health professionals), and that having a good relationship with other
professionals is very important. It was also reported that professionals do complete a CAF
differently depending on their professional, for example the CAF would ‘look’ different
depending on whether it was written by a health worker, teacher, locality worker, etc.

In terms of the value of the CAF in improving relationships, there were two cases where the
lead professional had played an important role as ‘go between’ for the parents and the school
and had thus helped prevent exclusion or the parents removing the child from the school.

In two of the 15 case studies, GPs had not instigated or referred for CAF or pro-actively seeking
early intervention for presenting issues when it would have been appropriate to do so.

Those professionals who did not appear to engage in the CAF process so readily, included
Adult Mental Health and substance misuse services, who may be focussing clinically on the
needs of their client, the adult rather than a holistic view of the family.

4. Process enables children and young people to see a future for themselves

The young people interviewed were able to clearly articulate where they saw themselves
without the CAF, in terms of having no future and doing nothing. These same young people
were now on college courses, doing well at school and had better relationships with their peers.
In almost every case, the aspirations of the children and young people, and in one case, the
young mother, were much greater after the CAF.

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     “It felt good, I feel stronger and like I could do stuff. I was more powerful and on top of the
                                                    world”
                                        One young person feeding back what difference the CAF made




5. Process enables whole family approach, with a wider impact on siblings

Both parents and professionals expressed the view that the process enabled them to look at the
needs of the whole family rather than focussing just on the child. They also pinpointed the
impact that interventions to address the needs of an older sibling had on the family as a whole.
Parents talked about family life being happier and more relaxed; there was less conflict between
siblings. Professionals identified potential issues around attendance and anti-social behaviour
for younger siblings that had been averted by the CAF intervention.

There is clearly a substantial ‘ripple’ effect where CAF has had a positive impact and in every
one of the fifteen cases included, there were a number where the siblings(s), grandparents or
other people close to the child and family, and in one case a newborn baby, who had benefited
from either the services themselves, or the results of the services on the child and family. This
‘ripple’ effect does not just relate to the time of the CAF, but could have longer term effect as
the influence is felt.

   “The CAF is like a jigsaw with everyone putting in their own pieces to complete a picture”.
                                                                              A locality team manager



6. Process also impacts on professional practice

Professionals were able to identify a number of ways that the CAF had impacted professional
practice and their ability to recognise need and solutions to appropriate support other children.
This includes providing an opportunity for professionals to learn from each other, increasing
agency accountability and sharing responsibility for case work. In one case, the school involved
in working with one young person with SEN and behaviour issues who was initially regarded as
just a ‘naughty boy’, reported that the experience enabled them to provide more appropriate
support for four other children in the school.

A locality manager also reported that the CAF framework enabled professionals to use their
skills, but also to develop new skills, in terms of managing the process and keeping parents
engaged.


7. In many (but not all) cases, the cost of generating the CAF and subsequent services
   is less than the cost of more intensive services if issues are allowed to escalate.


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All services and organisations need to use funds wisely and efficiently to secure the maximum
impact for children, young people and their families, and placing a financial value on outcomes
in the fifteen cases sampled indicates that the CAF process and the services provided as part of
this, provides a futurised cost saving (social return on investment). In two cases, it was clear
that without the support provided through the CAF, the child would likely be subject to Section
47 enquiry and become subject to a child protection plan, and in one instance, would have
become looked after – a far more costly intervention which research shows also provides less
positive outcomes for children and young people.

In terms of the cost to other services, children’s social care was not the only futurised
beneficiary. Parental mental health featured heavily in some of the cases and adult mental
health services avoided by services provided within the CAF. In one case, the parent
volunteered her own suicide as a possible outcome if things hadn’t improved.



5. Challenges and considerations

5.1 Other professionals and their viewpoints

The evaluation has concentrated on the impact of CAF from the point of view of the families and
professionals involved in the case studies. Other professionals whom it would be useful to gain
views from would include a general view and further discussion around the futurised impact
with:
     Manager of referral and intake team – to assess their confident in the CAF and use in
       stepping up/down from CAF to social care referral.
     Adult mental health services



5.2 The evaluation process and methodology

The evaluation took each worker of the 15 cases approximately 20-30 hours to complete, with
acknowledgement that it would have been easier to undertake the evaluation on new cases
rather than retrospectively. However, due to timescales for this particular evaluation, that was
not possible. A locality manager who had undertaken the interview with parents felt that this
interview in itself was of real value, and workers found the evaluation process a good reflective
practice. Limitations of the evaluation were:
     Purposeful, rather than random sample, in order to achieve a selection across localities,
        MOSI scales and child characteristics.
     Retrospective evaluation and collection of data about activity and costs, which is not as
        reliable as contemporary collection.




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5.3 Language and family focus

The title “Common Assessment Framework” is a bit of a misnomer, and discussion during the
evaluation concluded that a title which is more positive; reflects more the ethos of what a CAF
does and less social care sounding would potentially have a more positive impact in terms of
engagement with the family – sometimes the title itself was a barrier to undertake work.
Professionals felt that the ‘assessment’ part was ongoing and required updating with new
information as the circumstances of the family change. One CAF could therefore be open for a
long period of time. In a few instances, the parents had been ‘mis-sold’ the CAF as a way of
getting funding in order to gain their engagement.

5.4 The grey areas of measuring impact: cause and effect

In determining the impact of CAF, other variables which could have contributed to, or achieved
the outcome need to be explored, although complex and difficult to do.
     Was the outcome gained a result of the CAF process, or the specific worker? (i.e. would
       a different worker have the same or better results).
     Within the case studies, we have explored what
     Child and parental motivation and engagement differs between CAFs and although
       difficult to quanitify, it is clear that where children and parents are engaged and motived,
       impact is greater, and quicker.

5.5 Other evidence of impact

There is additional information which would be useful for Cambridgeshire to collect in addition to
the evidence gathered in the case studies for this evaluation, including school attendance and
attainment pre-CAF and post-CAF, as outcome measures for each child subject to a CAF.



6. Conclusions

The evaluation has identified that of those cases sampled, CAF has significant impact across a
range of areas including cost and outcomes for children, young people and families, but more
importantly the softer impact of improvement in well-being, aspiration and achievement. There
is also evidence to indicate that it also has a range of positive impacts for professionals and
their practice.

There was strong evidence of staff commitment to the CAF process throughout the evaluation
process. This was mirrored by the high level of parental and young person satisfaction with the
process, in the cases that we looked at.




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This evaluation gave practitioners the opportunity to undertake reflective practice in both
gathering the evidence and undertaking the workshops, moderation panel and area events,
which they found useful.

However, the skill of the practitioner leading the CAF process seemed to be key to its success,
in terms of engaging families and keeping them engaged with the process. This echoes the
findings of the LARC 4 report, which identified the value of informal support, via the lead
professional and the multi-agency team, as well as more formal service provision. This has
implications for staff training in the future, particularly around the lead professional role.

Similarly, there was some evidence that for a small number of families, their initial experience of
CAF had not been positive, particularly when the process had not been followed. There is still
work to be done with some parts of the workforce, in particular schools, to ensure that the
process is explained properly to parents and they understand what to expect. There is evidence
to suggest that there are issues around schools capacity in terms of time and skill base to
complete CAFs. Having said this, the first CAFs in these cases had been completed some
years ago, when the CAF was relatively new, so people’s practice and understanding may have
developed since then.

Of the cases sampled, there was clear evidence of longer term cost savings and positive
outcomes for not just the child, but the whole family including siblings.

  “they (the children) would have been taken from me and I’d of topped myself (laughs) I don’t
                       know what I would do but it would have been worse”.
        Parent of one child, when asked what would have happened in two years if the CAF hadn’t have
                                                                                          happened.

Other findings from this evaluation mirrored the internal CAF review in Cambridgeshire around
evidence of CAF ‘avoidance’ by some individuals within agencies; that the flexible use of CAF is
not consistently understood and there is evidence of different thresholds/decisions about when
to start a CAF. In addition, the findings from LARC 4 research undertaken by NfER into
evaluation of CAF are also largely in accord with the findings from Cambridgeshire.
Cambridgeshire may find the recommendations from this useful.

As one locality worker commented “its not just a change for now, but a change for the rest of
their lives”.


7. Recommendations

The areas for improvement or development below are not indicative of any underlying concern,
but aim to provide ideas for Cambridgeshire in further developing the CAF and partnership
working. The recommendations below include suggestions how Cambridgeshire could use the
methodology and tools from this evaluation going forward, potentially as a longitudinal study.


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In addition, Appendix B contains examples of C4EOs validated local practice relating to findings
and discussions with CCC, around risk management; locality working and thresholds to provide
additional examples of ‘what works’ in this area.




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           Area for Improvement or Development                      Potential Solutions                           Impact Measures
1.   Rename CAF to be more ‘family friendly’ and          Professionals/parents to re-name and      Families and professionals feel that they
     relate to the early help agenda, away from social    rebrand.                                  understand the focus better.
     care jargon.
2.   Publicising the CAF, including more widely to        Countywide communication plan for         10 % Increase in parental and young person
     parents, and engaging families with the process      CAF for families.                         requests for CAF.
                                                          Potential use of Families Information     Note: better awareness of CAF leads to more
                                                          Service.                                  requests, and the service will need to be
                                                                                                    ready to deal with these to maintain
                                                                                                    quality/timeliness/impact
3.   Improved identification of the need for early help   Awareness raising, as above               Families report that CAF was initiated at the
     and awareness of thresholds/early intervention.                                                right time
4.   Lead professional training                           Planned programme of lead                 Increase in number of staff reporting that they
                                                          professional training across the County   feel confident in undertaking LP role.
5.   Interface between CAF and other specialist           To be agreed                              Reduction in duplication of assessment and
     assessments                                                                                    more integrated working.
6.   Addressing the capacity of schools to follow the     Using the locality teams to provide       Improvement in quality of school initiated
     CAF process                                          extra support to schools in following     CAFs
                                                          the CAF process                           Parents reporting positive experience of
                                                                                                    school initiated CAFs
7.   Engaging with schools and training                   Consider governor training and support
     professionals re: early intervention as well as      to schools initially (implementation)
     CAF
8.   Engaging with adult services (especially adult       Awareness raising sessions;
     mental health) re: understanding the needs of        attendance at service meetings;
     the child and early intervention                     factsheets; management directives
8.   Quality assurance of CAF and maintain                Undertake occasional ‘deep dive’ into     Number of CAFs audited.
     understanding of impact/effectiveness                individual cases to maintain the          Proportion who meet QA criteria.
                                                          evaluation of impact                      Remedial action suggested to improve.
9.   Encourage shared learning and reflective
     practice between practitioners and localities.
8. References

Costings: Main sources for estimating Future savings


2 Unit Costs of Health and Social Care 2011 Compiled by Lesley Curtis
3 School Teachers’ Pay and Conditions Document 2010 and Guidance on School Teachers’ Pay and
Conditions DfE 2010
4 DfE Family Savings Calculator
5 Cambridgeshire Children and young people’s services: Placement strategy for looked after children
2011-2015
6 Extension of the Cost Calculator to include cost calculations of all children in need.
  Research Brief DfE RB056
7 Cambridgeshire County Council: Teachers Pay Scale 2010


Other References


1 “Early intervention, using the CAF process, and its cost effectiveness. Findings from LARC3”
(Easton,Gee and Teeman)


8 Easton, C., Featherstone G,. Poet, H., Aston, H., Gee, G. and Durbin, B. (2012). Supporting families
with complex needs: Findings from LARC 4 Slough: NFER.
APPENDIX A: EXAMPLES OF CASE STUDIES

Case 1: Bea (Julie’s case)

Presenting issues and what happened:

CAF jointly completed by EWO and School Nurse.

Loss of family business just before start of CAF. Mum expressed that family relationships had almost
broken down and she felt she wanted to walk away from Bea, who was exhibiting anger and aggression
at home and at school, with behaviour difficult to manage. School attendance was decreasing and there
were concerns over Bea’s safety through choice of friends and use of social network sites. However Bea
struggled with relationships with peers, had a lack of friendships and showed low self-esteem and
confidence and had previously self-harmed. Mum struggled to show emotions or affections.

Services put in: CAMH Sessions; School nurse intensive sessions; Parenting course; aspire involvement

Outcome:

Mum said first time she felt listened to and had someone to talk to. The locality and school nurse
support was consistent; Mum felt that the lead professionals were listening to her and if any strategies
failed, new ones were put in place at regular TAC meetings. Both Mum and Bea now feels that they can
ask for help if they knows things are getting tough.
Young People’s Worker involvement and support helped Bea to recognise her poor behaviour/attitude
and understanding of her risk taking behaviour. She can now sit and talk to parents and negotiate
situations. She has learnt to control her aggression and anger more which has helped Bea manage
friendships better.

Boundaries are in place at home and school. There has been improvement in course work and school
attendance and she now has a work experience placement. Bea now has career aspirations which
workers report are realistic as long as can sustain attendance at school, she has ability to do it.

While CAF open, there was initial assessment but closed as they felt CAF Team were supporting and
providing all they needed.


Summary of costs (inputs and costs avoided):

Put here as per ‘one case in detail’ from slides

Inputs:

Examples of costs avoided:
 Within six months:
 Within one year:
 Within two years:


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Summary of results:

(one line only, from summay of results)




Case name: Jake Caseworker = EMMA

Presenting issues and what happened:

Silo’d services – not working together, and medically driven with little early support for parents of this
child with a disability or strategies how to deal with his behaviour.

Jake had recently been diagnosed with Autism with characteristics of Pathological Demand Avoidance
Syndrome by the Community Paediatrician. He had limited speech and communication skills, his social
skills were poor and his imaginative play was limited. He would head bang at night and would only
sleep for around 3-4 hours. This caused a lot of anxiety for his parents and their neighbours would
complain. Jake would throw objects across the room with no warning putting him and others in danger.
Mum felt that the family unit was divided as her older children would often stay out with friends to
avoid his difficult behaviour. The parents were unsure how to discipline him effectively. Jake was not
potty trained or showing any signs of wanting to be and he would violently refuse to take a bath and
there were no facilities to shower him in. Jake had just started to attend pre-school for 1 hour a day,
three times a week.

Mum was on anti-depressants and was finding it difficult to co-ordinate the care being offered to her
child. The child was in the early support system and a portage worker, occupational therapist, and a
speech and language therapist were already involved with the family before the CAF was in place.

Services put in: 123 Magic parenting course; Support mum into positive activities

Outcome:

The child improved his communication skills so that he can hold simple conversations. The parents seem
much more confident in their parenting and find his behaviour much more manageable. He now sleeps
better. The child is fully potty trained. The child attends a different pre-school and is doing well. Mum
has come off anti-depressants.


Summary of costs (inputs and costs avoided):

Put here as per ‘one case in detail’ from slides

Inputs:

Examples of costs avoided:
Within six months:


                                                    18
Within one year:
Within two years:

Summary of results:

(one line only, from summay of results)




Case 3: Paula   case worker: SUE

Presenting issues and what happened:

Paula had run away from home, presented with very challenging behaviour at home and parents
described her as out of control. Her relationships with her siblings were poor and they were frightened
of her. Paula’s behaviour was beginning to affect the mental health of the mum and grandmother who
lived with the family. Mum wanted help and approached people to try and get help. There were no
other services/involvement before CAF.

Services put in:
Home Visits; PSP programme

Outcome:

Child is a much happier child and has a better relationship with her siblings. Mum is using the parenting
strategies effectively and says that she feels more confident, more in control and is able to deal with the
behaviour when it occurs. Using the strategies with the 3 girls she has been able to recognise that it
was not just Paula that was misbehaving but the other 2 siblings as well. Grandmother says she feels
more reassured and safe.

Summary of costs (inputs and costs avoided):

Put here as per ‘one case in detail’ from slides

Inputs:

Examples of costs avoided:
 Within six months:
 Within one year:
 Within two years:

Summary of results:

(one line only, from summay of results)




                                                    19
Case 4 Damien:     worker = CLAIRE

Presenting issues and what happened:

Family had been stepped down from social care as a CIN case, but after several months it became
apparent that Damien’s school attendance was declining. He presented in school as unkempt, tired and
often unco-operative. When investigated it was realised that he was not going to bed until very late,
sometimes early morning and needed very little sleep. Mum appeared to be suffering with her health
and family life was reported to be difficult.

A diagnosis of Aspergers syndrome was made. Prior to the CAF, all professionals involved said the family
would not engage with them and they had different views on the case and were working in isolation.
CAF brought them together to hear progress and responding from Mum and they gained a greater
understanding of the family and it’s needs as a result.

Services put in: Home Visits: Other services involved


Outcome:

Damien had improved attendance and takes part in ‘get out of bed club’. He is encouraged to
participate in school activities and ‘jobs’ i.e. taking registers to the office so that he has positive input on
mornings. His level of achievement has risen to nearer those of his classmates. Confidence and
aspirations have both been boosted as a result. Mum feels far more confident and feels happier.


Summary of costs (inputs and costs avoided):

Put here as per ‘one case in detail’ from slides

Inputs:

Examples of costs avoided:
 Within six months:
 Within one year:
 Within two years:

Summary of results:

(one line only, from summay of results)




                                                      20
Case name: Amy. Worker = DEBBIE

Presenting issues and what happened:

Amy was on youth offending order and had lots of services involved in monitoring (young offenders,
police), but not preventative services. Amy’s poor behaviour was escalating and she became homeless
after complete breakdown in family relationship and her mum and step-dad, would not have her
following physical damage to family property. Amy went to live with her grandparents, and after the
CAF was instigaged, grandparents felt able to made serious disclosures.

School had little or no issues with this young person.

Services put in: 1 to 1 sessions; Aspire programme

Outcome:

Grandparents are now supported by PSA (Parent Support Advisers), and feel more confident about
having a teenager living with them.
Amy is now at college and has blossomed. She has settled well with her grandparents, feeling she now
has a home where she is loved and appreciated. She is now better at dealing with relationships both at
home and with her peers. She has a better relationship with her mother.
Amy is happy to stay at home most evenings, which has helped her to stay away from the group of
young people who had been likely to encourage risky behaviour.


Summary of costs (inputs and costs avoided):

Put here as per ‘one case in detail’ from slides

Inputs:

Examples of costs avoided:
 Within six months:
 Within one year:
 Within two years:

Summary of results:

(one line only, from summay of results)




                                                     21
Case name Asif: caseworker = LESLEY

Presenting issues and what happened:

Asif (who has English as an additional language) was involved with a serious event in the first half term
of Y10 that involved police action. There were bullying, underachievement, and relationship problems.
There was real concern about the increasingly risky behaviour, the YP’s little sense of risk awareness and
persistent poor relationships.

At home during the previous summer (2011) Asif’s mum had a total breakdown in her relationship with
him, feeling he was all the time argumentative, disrespectful of boundaries, unhelpful and oppositional.
This had risen to crisis level during the summer holidays so Asif’s mum had sent him to live with the
biological father, who was a virtual stranger to the child, for the rest of the holidays.

Services put in: Triple P; One to one self esteem programme

Outcome:

Asif is able to understand the impacts and consequences of his current choices and understands how to
make positive progress at school. He has positive relationship built between school and home and he is
positively engaged and made steady progress with targets. One of the professionals working during the
CAF stated: “The CAF interview process can enable, in extremely difficult circumstances, a strong,
positive relationship to develop between the parent and school which underpins the any work done. It
also facilitates information sharing should further agencies need engaging in the future to support
sustainable outcomes or those involved. It can be a restorative process”.

Summary of costs (inputs and costs avoided):


Put here as per ‘one case in detail’ from slides

Inputs:

Examples of costs avoided:
 Within six months:
 Within one year:
 Within two years:

Summary of results:

(one line only, from summay of results)




                                                   22
Case name Gemm: case worker: T INA

Presenting issues and what happened:

Gemma’s CAF was initiated when she presented at her booking in appointment with the midwife during
pregnancy. She was currently living at home with her mother, step-father and two step siblings in an
overcrowded house, but well supported by her family. The baby’s father lives approximately 10 miles
away, and both young people are financially supported by their parents.

Gemma has no friends locally as she was previously living with her dad in another part of the county.
She was in full time education but has decided to take a gap year while she has the baby then will finish
her college course at a later date. Gemma was in a car accident a couple of years ago which left her
with low mood and anxieties, her mother is concerned that Gemma is becoming depressed due to the
lack of local support, lack of money and relationship difficulties with her boyfriend.

Services put in: Ante Natal, Baby Massage, Mother and Baby etc.; PSP programme; Romsey Mills Baby
Project

Outcome:

Gemma has engaged well with health professionals and is breastfeeding her baby successfully and they
are both enjoying the benefits of this. She continues to keep in touch with the family worker and has
been introduced to classes at her local children’s centre. She has also accepted the opportunity to
become a peer mentor for other breastfeeding mothers.

Gemma says “If I hadn’t received the support that the CAF process offered I would not have felt
confident as a mother. I would not have known about the young people’s project and the children’s
centre so would have just stayed in-doors all the time and been sad and isolated. My relationship with
my mum and boyfriend would be horrible with us arguing all the time because I would feel depressed
and unhappy. I would think that people were judging me and criticising me all the time.
The baby would be unhappy and crying all the time because I would be depressed and this would make
me not bond with him very well, I probably would not want to breastfeed him for very long, I would give
him a bottle so my mum could feed him”.



Summary of costs (inputs and costs avoided):


Put here as per ‘one case in detail’ from slides

Inputs:

Examples of costs avoided:
 Within six months:
 Within one year:


                                                   23
   Within two years:

Summary of results:

(one line only, from summay of results)




Case name Peti and Laima. Caseworker = SUSAN

Presenting issues and what happened:

Peti is a 16 year old young boy whose family moved to England from Lithuania. Peti witnessed the
murder of his step-father. There were concerns about the amount of school Peti appeared to have
missed; he was causing trouble being rude and aggressive to staff, not popular with his peers and was
also bullied. There were also concerns around his health.

A CAF was instigated and professionals found out that the family were living in shared accommodation
(two rooms) with 3 other families. There was a second child, Laima, discovered at the family home, who
had a genetic disability (learning difficulties and health problems) and was not attending any school, as
it was expected in Lithuania that he would just stay at home all the time.

Services put in: Schools Guidance advisor, Doctor, physiotherapist, Nurse, Speech and language
therapy, interpreter.

Outcome:

There was a significant impact for all family members. Their English is much improved. With support
Mum was able to meet with the housing department and help with entitlements.

Peti has had educational support and since November 2011 has been accessing the Alternative
Curriculum Education (A.C.E.) in Peterborough, which proved extremely successful and where he is
working hard and learnt new skills. His attitude has changed his Mum says he is happier, he smiles, and
he has been accepted to college from September. His mother says that now he has a future.

Laima was found a placement at a special school in the county and at his annual review he stated that
he wanted “to stay on at school after his sixteenth birthday, to stay as long as he could then go to
college then get a job and a girlfriend”. He is able to do things for himself and is becoming more
independent each day.

As part of the evaluation, Mum said “Finally I am getting some help. I felt that I didn’t know what to do
or where to go for help. I was worried and cried”.



Summary of costs (inputs and costs avoided):


                                                   24
Put here as per ‘one case in detail’ from slides

Inputs:

Examples of costs avoided:
 Within six months:
 Within one year:
 Within two years:

Summary of results:

(one line only, from summay of results)




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