Case Study: Development and delivery of early help

Introduction and background

There is a wealth of evidence that demonstrates that happy confident people, in control of their lives, with positive social networks are considerably less likely to have health and social care needs. As we have created increasingly complex public service structures, we have to some degree lost sight of people and real communities and what they offer; family, friends and community networks have much more impact on people’s lives than public services and we need to harness this, along with the belief that communities have the answer.

In 2013-14 we carried out a number of in depth studies to understand how we deliver our support services for residents in Oldham and what this feels like from a customer point of view. The studies highlighted the following issues:

  • An overlap and duplication in provision with different agencies providing support for single issues
  • Residents being passed around the system between services working in silos each responding to presenting symptoms rather than to holistic life experience
  • It was difficult to unpick what the outcomes were as each service had a different way of monitoring and measuring success, if they had any measure at all

Our response

With the findings in mind the Early Help service was developed with the following aims:

  • To fundamentally re-design mainstream services which are focused on helping people to help themselves; addressing the root cause of problems and focussing on strengths, giving them the skills to problem solve and be self-reliant.
  • To deliver a service consisting of a single offer created for all people across a wide spectrum of needs, with support available at different levels of complexity, from community support and group work to more intensive one to one support.
  • To deliver an offer which addresses all the issues an individual or household presents with, rather than passing people around the system; the Early Help approach means all needs can be addressed within the service

The new Early Help model is rooted in the belief that individuals and communities can and should be supported to do this; the community connector and capacity builder links individuals and families into local groups and activities and if can support them to take a lead in their community. This strengthens the co-operative approach by actively engaging local community and voluntary groups to provide peer support, life coaching and mentoring.

Redesigning services and refocusing resources

In order to realise the model we needed to fundamentally redesign the way services were currently delivered; this included decommissioning services and tendering for a new single service with a different ethos and approach. We wanted to create a service which works holistically with all the presenting issues at which ever level of support is required with a focus on residents changing behaviour in order to become more self-reliant.

To create the Early Help delivery team we looked to services whose core business was support and behaviour change. We found that services as diverse as housing floating support, smoking cessation, NHS health checks, parent support, support into employment and training, family support, and early years 2 year old eligibility for child care places were commissioned independently; these were decommissioned and brought together to form a single Early Help offer.

Bringing services together is just one element of the Early help approach. Here are some others:

(1)Self-assessment of need by service users

A key element of this reform has been the development of the Early Help Assessment Tool. This enables families to self-assess how ‘in control’ they feel about different aspects of their lives and give themselves a score which can be converted into actions to make change.

We are currently developing an app that will enable families and individuals to complete the assessment alongside workers, begin to formulate action plans and point them in the direction of support resources. In time we envisage this app will be used by residents to help them develop their own plans and provide an online support to build their capacity to self-manage.

(2)Changing ways of working and culture

In order to achieve this new way of working there was a need to change the behaviour and practice of the workforce to deliver an approach more focussed on enabling and coaching.This has been achieved via a large scale workforce training plan which included activity such as:

  • Ensuring teams within the Early Help service have been skilled across all areas of service delivery so residents are not passed round the system.
  • The engagement training modules which were been developed in response to our Troubled Families cohort, have been delivered to over 500 people across schools, police, GP’s housing and voluntary sectors.This training places a focus on workers becoming more self-aware, understanding how their approach impacts the engagement of residents, and gives staff the skills to empower families to take control of their lives and use services less. The underpinning theory and knowledge of attachment, resilience, listening and empathy skills, has been tailored to deliver Oldham’s cooperative approach.

Outcomes to date

General

  • Early evidence demonstrates high numbers ofreferrals (over 1330 referrals in the first 6 months) suggesting a high degree of awareness of the service.
  • Achieved positive outcomes for people supported by the service based on the assessment.The information below shows the proportion of people whose assessment score reduced by at least 1 point from open to closure:
  • Work and skills – 94%
  • Crime and ASB – 86%
  • School attendance and behaviour – 86%
  • Housing – 94%
  • Diet, weight and physical activity – 76%
  • Children’s mental wellbeing – 83%
  • Drugs and alcohol – 70%
  • Adult mental wellbeing – 71%

Evidence for investor services

Drug and alcohol

  • Of those with drug and/or alcohol issues on entry to Early Help
  • Only 3 have subsequently accessed One Recovery
  • 16 individuals accessed One Recovery prior to being referred to early help.
  • Of the closed cases that originally presented with drug and/or alcohol issues:
  • 69.8% (30 people) have shown a decreased score.
  • 25.6% (11 people) have stayed the same.
  • 4.7% (2 people) have shown increased scores. (disengaged from service)

Adult mental health

  • Of the closed cases that originally presented with mental wellbeing issues:
  • 71% (39) have shown a decreased score
  • 24% (13) have stayed the same.
  • 5% (3 people) have shown increased scores. 2 of the 3 cases were closed and escalated to specialist services, 1 case dis-engaged from early help.

Case study

  • SW was referred for Early Help support as she was unemployed and was having trouble parenting her 5 year old son whose behaviour was difficult.
  • The case was allocated to the Positive Steps Engagement team, which provides low-level support. A worker supported SW with strategies for parenting and confidence-building for herself and for her son; she was also supported with CV-writing and discussed the type of work she was interested in doing.
  • SW was really positive about the service she received and was recruited as a Positive Steps volunteer and was given work within the Early Help Team. This helped to build her confidence and ultimately to support her towards employment
  • In her volunteer role she isnow supporting an Early Help Engagement Worker to deliver advice and eligibility checks for the 2 year-old offer of free childcare places (this is a target for all Early Help teams). SW had been eligible for and made use of the 2 year-old offer herself; therefore she was in an excellent position to effectively support, advise and encourage people to understand the benefits of the offer. Her Urdu language skills mean she is able to engage with parents in communities who have been reluctant to take up the 2 year old offer; she has helped to increase the number of parents taking up places within this community
  • SW has demonstrated great empathy and engagement skills; she is making use of her Urdu language skills to make phone calls and facilitate visits to prospective clients.
  • SW has recently secured a job as a Care Assistant, but says she wants to continue volunteering for Early Help to continue to “give something back” as she feels the service put her on the road to employment and wants to share that with others.

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