Hertfordshire Home-Start Review
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HERTFORDSHIRE HOME-START REVIEW Introduction Home-Start UK was established thirty years ago and is now one of the largest providers of support to families with children under 5 in the United Kingdom. Its core service provides volunteers, who are themselves parents, to provide impartial support, befriending and practical help to families under stress, preventing crises arising and the family unit breaking down. Volunteers visit families in their homes on a regular basis. Families supported face different situations, have to deal with a wide range of problems and are from very different backgrounds. The service provided is holistic, based on the needs of the whole family. Volunteers are carefully selected and are required to undertake relevant training programmes including child protection, cultural and disability awareness and confidentiality. There are presently nine individual Home-Start schemes located throughout the County of Hertfordshire: Albans City & District; Borehamwood & District; Watford and Three Rivers; Stevenage; Royston and South Cambs; North Herts (excluding Royston); East Herts; Dacorum; Welwyn Hatfield. Although a national organisation, service delivery is based on a network of locally governed and managed centres. Each centre is an individual charity, with a Board of Trustees from the local community. Appendix A details the scheme areas, the individual scheme’s link to the present Children’s Centre communities and the number of families each scheme is commissioned to support each year. The schemes are presently commissioned to provide a family service in line with the following strategic priorities: Hertfordshire’s Early Intervention and Prevention Strategy This strategy identifies objectives that through focused multi-agency working can make a difference to the lives of more vulnerable children. The aim is that by adopting a preventative and holistic approach there can be a reduction in families needing more specialist intensive intervention. Healthy Child Programme The Healthy Child Programme covering pregnancy and the first five years of a child’s life (DH 2009) is the early intervention and prevention public health programme for children and families. It supports improvements in the health and wellbeing of children, as part of an integrated approach to supporting children and families. Service Description Children and families experience a range of needs at different times in their lives. However, while all children and families require access to high-quality universal services, some of them also benefit from extra support to address additional needs, which may relate to health, social welfare, education or other areas. An estimated 20-30% of the population have additional needs at some point in their lives. In order to achieve the best outcomes for all children it is important that this additional support should be delivered at the earliest opportunity via a whole systems approach through integrated practice. This supports both national and local policy drivers. The key partners the schemes work with include: Children Centres; GPs; Hertfordshire Community (NHS) Trust (especially Health Visitors); HCC Social Workers; Relevant Voluntary and Community Sector organisations; HCC’s Thriving Families Service; School Nurses. Referrals to the nine Hertfordshire Home-Start schemes are made via a number of routes by a number of different agencies. For the latest monitoring period, the following % of referrals from the differing agencies were made: REFERRAL ROUTE % OF REFERRALS DURING MONITORING PERIOD Health Visitor 44% Self-referral 19% Children’s Centre 17% Children’s Services/Social Worker 9% Other (including Housing) 6% Other Health (including GP, CAMHS,) 3% School 2% The nine schemes have been commissioned to support vulnerable families in their own home who have one or more children under five years old and where there are emerging identified needs (principally level 2 according to the document: Meeting the Needs of Children and Families in Hertfordshire). The principle aims of the schemes are to: Provide flexible support and practical assistance in the family home and identified group settings through supervised volunteer workers to sustain and improve family life; Utilise a holistic approach when working with the family, ensuring that the children’s needs are paramount within that context; Identify and agree with the family how their identified needs can be best met ensuring a clear agreement of work that achieves outcomes required; Review the plan with the family as a minimum every 3 months to ensure that anticipated outcomes are being met, and referring onto to other agencies when necessary; Work in partnership with key stakeholders; Share information with the family’s consent, in accordance with national guidance and local information sharing agreements; Encourage and support families to access universal services; Service Coordinators to provide effective supervision and support for volunteers in their work, and to ensure access to targeted and specialist support when multiple and/or complex needs are identified. Whilst there are nine individual schemes across Hertfordshire, there are a number of similar operational processes that all schemes operate, including: The local Home-Start managers and their coordinators ensure that they are fully appraised of their volunteers particular skills and knowledge areas; The mangers ensure that during the first meeting with the families they find out exactly what type of support they families require. This enables them to accurately match the right volunteer with the family; The managers and coordinators offer their volunteers regular one-to-one support (usually on a month to three month basis depending on the scheme) to talk through any particular concerns the volunteers may have. Each scheme also operates telephone support as and when the volunteers may need this; Each scheme operates their own training programme for their volunteers although there are overlaps with specific training themes across the nine schemes. The schemes also ensure their volunteers are kept updated with local support services; Each scheme encourages their volunteers to meet up as a peer support group. However, this is done differently across the nine schemes (some of the differing examples being volunteers exchanging telephone numbers, get togethers, coffee mornings) and with varying success rates; Cross working with their local Health Visiting service and Children Centres. However, it is clear that some schemes do not have as close a working relationship with their local Children Centre as other schemes do. The schemes are commissioned to offer a family focussed service over a defined period of time agreed with the family at the initial meeting based on outcomes identified, but for a maximum period of 9 months. The core offer is two hours per week for each family, which will be determined by identified need. In addition to the service Home-Start organisations are jointly commissioned to deliver, some schemes also deliver services to their local Children Centre under separate local commissioning arrangements, such as: SCHEME DETAILS Watford and Three Rivers To run a positive Beginnings Group at a charge of £2,519.43. To run a Read and Rhyme session costing the Home- Start scheme £2035 (funded by a Community Funding Initiative. Stevenage Commissioned by four Children Centres to deliver 2 Parenting Puzzle, 2 Families Feeling Safe and 2 Cookery courses at a charge of £9,536. North Herts Healthy Eating and Exercise activities at a cost of £1,000. In addition, all the Hertfordshire Home-Start schemes report to sitting on their local Children Centre Advisory Boards with no recompense. Finance The Hertfordshire Home-Start schemes are jointly funded between Hertfordshire County Council’s Children’s Services, Herts Valley Clinical Commissioning Group, East and North Herts Clinical Commissioning Group and Cambridgeshire and Peterborough Clinical Commissioning Group. The total cost for the nine schemes across Hertfordshire for the 2014/2015 financial year is £598,085.00, and is split as follows: Children’s Services £391,565 East and North Herts CCG £86,100 Herts Valley £103,220 Cambridgeshire and Peterborough £17,200 TOTAL £598,085 The individual schemes are funded as follows: Scheme CCG Children's NHS Herts Total Name Services Contribution St Albans Herts Valleys £43,229 £24,751 £67,980 Hertsmere Herts Valleys £39,312 £25,195 £64,507 Watford Herts Valleys £50,249 £27,253 £77,502 Stevenage East & North Herts £44,546 £20,260 £64,806 Royston Cambs & £36,161 £17,199 £53,360 Peterborough North Herts East & North Herts £44,343 £20,351 £64,694 East Herts East & North Herts £44,284 £25,290 £69,574 Dacorum Herts Valleys £44,658 £26,021 £70,679 Welwyn East & North Herts £44,783 £20,200 £64,983 Hatfield TOTALS £391,565 £206,520 £598,085 Monitoring of Service Provision Historically, the monitoring of the individual nine schemes mainly revolved around quantitative analysis of numbers of families supported and the types of issues each family was being supported with. The qualitative aspect revolved around each scheme submitting 2–3 case studies of families supported. However, in order to gain a more accurate analysis of the effectiveness of the schemes and whether identified family outcomes are being met, a further two monitoring processes have been introduced for the 2014/2015 financial year focussing on outcomes and direct family feedback. Quantitative The 2014/2015 Home-Start service