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BRS Evaluation Study Final Report May 2002
Executive Summary
BRS Evaluation Study Final Report May 2002
Executive Summary
1. Introduction
The Department of Social Work Studies at the University of Southampton has
completed a three-year evaluation study of the Behaviour Resource Service (BRS),
one of 24 Child and Adolescent Mental Health (CAMH) Innovations Projects funded
by the Department of Health with matched funding from local sources. The study
commenced in 1999 for a three-year period, until the end of March 2002.
Recent national research has identified that there was a need for improvements in
the provision of support services for children and young people with mental health
difficulties (e.g. Kurtz et al 1994; the Audit Commission 1999, Meltzer et al, 2000).
The BRS is a multi-professional, inter-agency Tier 4 service offering assessment and
intervention via a residential unit and community team to children and young people
aged between 5 and 18 years of age with multiple difficulties and a history of using
other mainstream and specialist health, education and social services.
The evaluation study has focused on both policy and practice issues. It has been
conducted using a participative approach and incorporating a methodology based on
the triangulation of a range of qualitative and quantitative data generated from a
range of stakeholders via mixed-methods. Views were sought from children, young
people and their families using the BRS, agencies and professionals allied to the
BRS and BRS staff and management.
The findings and conclusions of the study inform the development of the BRS and
allied services in Southampton. They also make a contribution to the national
overview evaluation of the 24 CAMHS Innovations Projects1 and to the development
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being conducted by Young Minds http://www.youngminds.org.uk/professionals/MHG/index.html
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Executive Summary
of policy and practice in inter-agency responses to children and young people with
mental health and emotional needs.
Key findings are shown from each area of thee study as presented in the main
report.
2. Policy and service development context
The BRS was established from a well-developed set of professional and
inter-agency relationships within the local area.
In setting up an integrated inter-agency children and young persons service,
the project management (subsequently the Management Board) has had to
address specific aspects of service development amid continuous changes in
education, health and social services provision.
Developing policies and protocols, including those relating to referral criteria
and case closures have formed a key area of activity at both strategic and
operational levels
Issues of funding, financial management and the development of inter-
agency information management systems have been major preoccupations
throughout the three-year period of the study.
3. The children and young people who use the BRS
The service works with a relatively small group of children and young people
in Southampton and in the first two years of operation has reached its target
numbers (93) (plus approximately 38 for the LAC service).
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Referrals to the service peaked in the first six months, have remained steady
for the residential unit and shown a steady levelling off in the community
team.
The clinical features, together with the social and family characteristics,
illustrate the breadth and complexity of the young people the BRS works with
and the multiple disadvantages of these young people.
BRS service users present as having a high incidence of risk factors and a
lack of resilience or protective factors. Looked after children form a
disproportionately high number within the service population
4. Assessment and intervention activities
The residential unit works with severely damaged and distressed young
people. The high staffing ratios, multi-disciplinarity and short-term stays
contribute to the development of good attachments with young people with
which to engage them in their individual care programmes whilst in the unit
The work of the unit is emotionally and physically demanding of staff and this
has implications for the provision of appropriate support and supervision
Working relations between the residential and community teams are informed
by the different work priorities of each team. Integrated working is improving
with time and through the experience of joint working on a number of
individual cases
The availability of a multi-professional team informs the holistic emphasis
within the core assessment used by the BRS and is reflected in the personal,
health, familial and social and educational domains of need and addressed
through the assessment and intervention process
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There is a tension for the BRS in achieving an appropriate balance between
undertaking assessment and intervention work. External influences such as
resource levels within other local services influence the achievement of such
a balance
The BRS has used a form of assertive outreach with disaffected young
people in the community
5. Working together
There have been a number of staff changes in the service, which in part
reflect national trends associated with the recruitment and retention of both
nursing staff and clinical psychologists.
BRS staff have continued to hold high expectations and positive views on
working within a multi-professional service. Opportunities to develop more
flexible approaches to working with young people were especially welcomed.
Challenges facing the service in developing its multi-professional work have
centred on the balance held between specialist (professional specific) and
generic skills and associated use of professional supervision.
The BRS exists within a broad range of existing services that are both users
of this service and active partners in providing a network of services and
support for young people and their carers.
External agencies perceive the BRS as promoting a more integrated model of
working and providing an additional tier of expertise, primarily through a
detailed multi-agency assessment.
Networking activities are seen as an important feature of the BRS approach
to working with and involving other agencies. This can sometimes lead to
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additional demands on the time and resources of these agencies, especially
at time of case closure.
Parents and young people’s involvement in network meetings varied
considerable suggesting that engagement with some families is not a
straightforward task. It may also reflect the estrangement of some young
people from their birth/adopted families.
6. The views of children, young people, parents and their carers who use
the BRS
The service users in the sample have in the main expressed positive views
about the provision of the BRS and generally positive views about their
experience of using the service
Mixed views were expressed about the impact the intervention has made to
specific difficulties over a sustained period of time.
Service users have provided a range of helpful feedback in relation to service
use. What they appear to be want are the basics of good professional
practice: respect, good communication, services that listen and respond
appropriately, that deliver on the promises that they make.
In addition there are clear indications from parents and more subtle ones
from young people that the single service, multi-professional response is
welcomed and indeed provides a more seamless, co-ordinated response
than traditional service models.
For some parents and children positive change in some areas will be
achieved but they may continue to need ongoing support and interventions
for the difficulties that are more ingrained.
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Findings indicate that if ongoing support for families after case closure is not
provided the positive work that has been achieved via or by the BRS may
unravel.
The contributions of users to dissemination activities have led a to a sense of
participation and empowerment for some service users
7. Changes in the lives of children and young people using the service
The language of outcome has to be carefully framed to acknowledge the
difficulties with attribution, that is in ascribing changes for service users to the
impact of the BRS, given the range of other influences in the often unstable
and chaotic lives of the young people and their families facing multiple
difficulties.
Positive engagement supported by initial compliance at referral appears to be
a successful indicator of positive change and that the proactive and flexible
approach of the BRS to facilitate engagement is an important contributor to
facilitating engagement.
Within the measurement of specific behavioural measures the evidence
suggests an overall positive trend with positive behavioural changes shown in
HoNOSCA scores, particularly in the areas of disruptive, anti-social or
aggressive behaviour and poor school attendance. SDQ scores show a
greater number of mean total scores in the normal range for forms completed
by young people, parents/carers and teachers at closure than at referral.
Placement disruption was a feature for many young people using the BRS.
There has been improvement in placement continuity for at least 4 young
people within long-term foster care and at least 2 others have accessed
specialist therapeutic provision following BRS assessments and
interventions.
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In relation to offending behaviour leading to convictions the evidence
indicates that for nearly half the consent group criminality was an issue. The
period available post-closure has been too short to use case volumes to
analyse trends in convictions levels but shows positive change for a small
number of young people, with indications of links between gender and age.
The picture for success in relation to education inclusion and associated
access to educational services is complex. Overall individual successes in
relation to school support and inclusion have been identified. There is also
evidence to show that the overall picture of school inclusion and availability of
appropriate provision is a continuing challenge for a significant group of
young people whom the protective factor of education could be key to their
long-term citizen health.
There is need for further development work of information management
systems for the retrieval and collation of routinely generated service data.
A case by case analysis provides an in-depth picture of the complexity of the
needs and situations facing young people using the service and gives some
indication of individualised interventions and the possibilities of change and
improvement.
8. Summary
The BRS is an interesting and forward-looking development for children and young
people with complex needs and their families in the Southampton area. In its
conception and development it has faced many challenges, from which others can
learn particularly in relation to inter-agency, multi-professional service provision with
complex, often long-term needs of children and young people.
The chances of sustaining of positive progress arising from the interventions of a
beacon tier 4 service are clearly informed by the quality and resources of the
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mainstream and tier 2-3 services with which it works. Building innovation on top of
foundations in local provision that are under-resourced and in the context of
continuous change is clearly problematic, especially in attempting to measure
change and impact of the innovation.
There is work to be done on improving service effectiveness by more rigorous
internal monitoring procedures, and a clearer articulation of intervention pathways.
These would enable ‘distance measured’ milestones to incorporate both hard
outcomes (such as access to school provision) and soft outcomes (such as
engagement and self-esteem).
The BRS has worked with over one hundred children and young people and offered
them assessment and support packages, as well as to many of their families and
other professionals who are also involved. Clear messages have emerged, namely
the value of intensive holistic assessments, of high quality residential provision, of
assertive outreach approaches with hard to engage young people, of network co-
ordination activities and of working with children and young people in a respectful,
individualised and non-judgemental way.
More details on the study can be obtained from
Julia Waldman,
Senior Research Fellow,
Department of Social Work Studies,
University of Southampton,
SO17 1BJ
Tel 023 8059 2523
fax 023 8059 4800
email jw@socsci.soton.ac.uk
Full copies of the Final Report can be read and downloaded from the website about
the study http://www.sws.soton.ac.uk/brs/reports
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