Written evidence from the National Family
Intervention Strategy Board (COM 103)
FAMILY INTERVENTIONS
1. I am the immediate past-president of
the Association of Directors of Children's Services (ADCS) and
chair the National Family Intervention Strategy Board (NFISB)—a
group comprised of national professional, representative and voluntary
sector organisations which provides advice to Department for Education
(DFE) Ministers. Membership of the Group can be found at Annex
A.
2. NFISB has a particular focus on children
at the edge of care and also leads a strand of work exploring
how family intervention can be used to reduce pressures on the
care system as part of a joint DFE/ADCS Cost Effective Children's
Services Programme. This submission is based on analysis of the
available national and local data and recent research and contributions
from local services, children and young people.
INTRODUCTION
3. Growing up in the small number of families
experiencing very complex health, social and behaviour problems,
often has a lasting and adverse effect on children's life chances.
These are families, where, in some cases, problems have been transmitted
from generation to generation, for example poor parenting and
the effects of domestic violence and abuse.
4. Intensive support for families with multiple
problems has shown to remove obstacles to disadvantaged children
succeeding, safeguard vulnerable children at risk and improve
the cost effectiveness of services.
5. Intensive family interventions are provided
nationwide with 4,870 families receiving support to date and 3,518
families between 1 April 2009 and 31 March 2010.
6. Family interventions often involve a
family getting practical support from a key worker who agrees
an informal contract with the family setting out the support they
will be offered (including from health services eg adult mental
health, drug & alcohol treatment and CAMHS) and the actions
the family and agencies agree to take. The combination of persistent,
respectful and trusted support from the key worker, a clear understanding
of the problems facing the family and a shared contract often
succeeds when everything else has failed.
7. These families make disproportionate
demands on the time and resource of schools and children's services
as well as the police, prisons and probation, job centres, GPs,
social care and the NHS.
8. Services responding to these issues have
grown rapidly over the last few years, supported by Government
grants and some strong examples of local practice. Family intervention
projects, Family Nurse Partnerships and Multi Systemic Therapy
have reported "overwhelmingly positive" outcomes and
have helped a range of local services avoid unnecessary costs.
9. ADCS and C4E0 made a joint call for examples
of local practice earlier this year. Further information about
what that call for evidence provided is at Annex B.
EVIDENCE
10. Better commissioning of services (including
family interventions) can lead to better outcomes for families
and cost savings, especially for the most disadvantaged.
11. Families with significant social, economic
and health problems are considerably more likely to require support
for health needs. The graphs below show the incidence of social
problems: total population compared to families with multiple
problems.
Drug and Alcohol Abuse
Adults from families with multiple problems
are 34 times more likely to have drug problems and eight times
more likely to have alcohol problems which need treatment.
[3] Measuring different aspects of problem
drug use: methodological developments 2006
[4] How to manage alcohol dependence and
harmful drinking—NICE/NHS 08/09
Mental Health Issues
Percentage of adults from families with multiple
health problems are 2.5 times more likely to suffer from mental
health problems which need treatment
[5] Patterns of Specialist Mental Health
Usage in England, ONS. Families with Multiple problem figures
are estimations based on figures taken from National Centre for
Social Research family intervention data—risk factors
of the 46,000 families are comparative with risk factors identified
by NatCen.
12. Analysis by the Social Exclusion Task
Force has shown that around 450,000 parents have mental health
issues and that children of these parents are twice as likely
to experience a childhood psychiatric disorder. The effects of
poor parental mental health can have a negative impact on the
child's cognitive development and their ability to form social
relationships.
13. One of the biggest reported problems
from family intervention projects is accessing health services—this
appears to be because the health issues of the patient (parent)
are considered in isolation without considering the impact on
the wider family, particularly children and young people. It is
critical that commissioning of services operates in a way that
ensures a whole family approach is taken.
14. Parental mental health problems are
a key risk factor for child abuse and neglect. If a child's mother
is in psychological distress then it increases the likelihood
of developing conduct disorder. The cost of a child with conduct
disorder has been estimated at £225,000[156]
over the course of a child's lifetime. This is largely due to
high costs of crime, which make up 71%[157]
of the costs with other problems such as worklessness and health
making up the rest.
15. Evaluation[158]
has shown that families who exited "family intervention projects",
or local variations of these (over 1,700 families), saw improvements
in circumstances across a range of issues including for health:
— Mental health (18% reduction from 31%
of families with the issue to 26%);
— Physical health (28% reduction from 9%
of families with the issue to 6%);
— Drug misuse (39% reduction from 34% of
families with the issue to 21%); and
— Alcohol problems (48% reduction from
30% of families with the issue to 16%).
16. Intensive family intervention is cost
effective as it can help alleviate the burden on other services
including health. The average annual cost of delivering intensive
family interventions ranges from £8,000 to £20,000 per
family. In comparison, where these families are not in receipt
of intensive family support, one study estimated the annual cost
to the tax-payer as £250,000 to £350,000 per family.[159]
17. The savings that can be accrued from
family interventions are significant. Local areas should therefore
be encouraged to commission intensive whole family interventions
as they can improve health and wider outcomes and are cost effective.
18. An example of savings in the wider context
is Strengthening Families, Strengthening Communities, one
of the evidence-based programmes used by Youth Offending Teams
(YOTs), is estimated in the US to have a cost-benefit ratio of
approximately 7.5 or higher ie for every $1 spent on the intervention
there will be a saving (to criminal justice system and wider services)
of $7.50. Estimates for Functional Family Therapy suggest even
greater returns on investment of approximately 14:1.
19. Public opinion is strongly supportive
of interventions with parents. According to a Mori survey "Closing
the Gap" (2007) the public consider better parenting
as the best way to reduce crime. Furthermore 75% of parents think
that the parents of problem children should be made to attend
parenting classes with 81% thinking that these classes help parents
to control their children (DCSF Parent's panel omnibus survey,
Nov 2009).
20. There is strong anecdotal evidence from
YOTs that parenting interventions have a significant impact on
reducing offending, and preventing young people at risk from offending.
Those who proactively use Parenting Orders report that they can
be an extremely effective way in engaging hard to reach parents
with support, and that the majority of parents are subsequently
very grateful for having received the Order.
October 2010
Annex A
National Family Intervention Strategy Board
Membership.
Kim Bromley-Derry, Immediate Past President
ADCS (Chair).
Julie Jones, Chief Executive, Social Care Institute
for Excellence.
Christine Davies, Director, Centre for Excellence
and Outcomes in Children and Young People's Services (C4EO).
Clare Tickell, Chief Executive, Action for Children.
Ian McPherson, Association of Chief Police Officers.
Helen Johnston, Programme Director for Children
and Young People, LGA.
John Dixon, Executive Director Adults and Children
and Deputy Chief Executive of WSCC, ADASS.
Jo Webber, Deputy Director of Policy, NHS Confederation.
Bob Ashford, Head of Youth Justice Strategy,
Youth Justice Board.
Dharmendra Kanani, Director for England, Big
Lottery Fund.
Oonagh Aitken, National Adviser, Children Young
People & Families,
Local Government Improvement and Development.
Membership includes senior civil servants from
DfE and DH. Secretariat is provided by DfE.
Annex B
Whilst there is still much to do in order to
draw definitive conclusions from the emerging evidence NFISB believe,
even at this early stage, that:
1. Supporting families is the job of anyone within
universal services working with children, young people and their
parents (including adult services) with routes to appropriate
specialist help and support. This helps improve outcomes for children,
young people and families;
2. Working across both adult and children's services
is the best way to address the issues faced by families with multiple
problems. It avoids duplication for services and the confusion
and frustration often reported by families;
3. Intensive family support services such as
family intervention projects and Multi Systemic Therapy may reduce
the need for higher cost statutory interventions by supporting
families with complex needs so they are better able to take advantage
of support available within universal settings and protect children
and young people from the impact of poverty and crises that might
arise in their lives;
4. Family intervention should be prioritised
where one or more family member is facing a critical life event
eg a child or young person about to be taken into or released
from care or permanently excluded from school, a parent facing
imprisonment, or needing acute or intensive health care due to
mental health or substance misuse problems, or the family is facing
eviction from the family home due to anti-social behaviour;
5. Better outcomes can be achieved by balancing
support, challenge and enforcement in ways which the assessment
of individual and family needs suggests is most likely to secure
positive outcomes. However, the need to protect children, young
people and others that may be at risk is paramount;
6. Local services should reflect and take into
account existing good practice before "going it alone"
with untried and untested practice. Where they do decide to proceed
with a new approach, a sound rationale for the approach and a
plan for evaluation should be established; and
7. Intensive family support provides a cost effective
way of tackling the problems of the most challenging families.
156 Lesesne et al. 2010 Attention-Deficit/Hyperactivity
Disorder in School-Aged Children: Association With Maternal Mental
Health and Use of Health Care Resources Back
157
Friedli and Parsonage 2007, Mental Health Promotion: Building
the Economic Case Back
158
National Centre for Social Research, ASB Family Intervention
Projects, Monitoring and Evaluation (March 2010) Back
159
HM Government (2009) Youth Crime Action Plan: Handbook for practitioners.
London: Home Office (www.crimereduction.homeoffice.gov.uk/youth/ycap2009handbook.pdf). Back
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