This project has been taken in house by the London Borough of Ealing (end March 2013) with its volunteering service still commissioned from Coram.

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1 Title of practice/strategy/intervention Coram Ealing Children Centre Outreach Service Organisation/s submitting example: Coram Local authority/local area: Ealing Council Summary Coram Ealing Children s Centre Outreach Service provided a range of services including home visiting, targeted and universal activities to families with children aged under five. A priority was to improve access for the most excluded groups to Children s Centre services. 1. Context and rationale Background In September 2009, Coram was commissioned by Ealing Council to set up and deliver an Outreach service which improved access for the most excluded groups to the integrated service offer in Children s Centres, within the context of a universal service. At the time, particular issues for Ealing included: a substantial rise in the number of low-income families in 2007, 37% of Ealing areas were ranked amongst the 20% most deprived nationally compared to 28% in the 2004 indices. (Department for Communities and Local Government, Indices of Deprivation, 2007 and 2004) one of the highest migrant populations in London the number of people whose previous address was overseas was the highest in the whole of London. (Greater London Authority, 2007). This project has been taken in house by the London Borough of Ealing (end March 2013) with its volunteering service still commissioned from Coram. Evidence for the model The Outreach model was based on the Every Child Matters: Change for Children Joint planning and commissioning national framework for children, young people and maternity services. It took into consideration: The findings of the research review (National Foundation for Educational Research

2 2008) commissioned by the Local Government Association examining what works in narrowing outcomes gaps across the five Every Child Matters areas. The review identified that supporting vulnerable parents to develop their parenting skills had positive impacts on staying healthy and safe, economic well-being and participation outcomes, and also impacted on achievement outcomes. The summary of evidence from The Sure Start Journey (Department for Children, Schools and Families, 2008) summarising the main findings from the Sure Start research programme and, in particular, the recognition that reaching excluded and disadvantaged groups is particularly challenging and time consuming. The evidence suggests that principles of effective practice include: o having a strategy to target those who are hard to reach o developing a detailed understanding of the local community both through the local authority and through informal local research and knowledge o communicating with partner organisations to identify those in need o being sensitive to individual circumstances and cultures o developing a service that addresses the needs of a wide-range of users. A stakeholder consultation held in April 2008 to engage partners in the development of the model. Aims The Coram Ealing Outreach Service was therefore designed to provide a boroughwide network of outreach support through group work and home-visiting in partnership with health and children s services, the Jobcentre, community groups and others to: improve child outcomes through effective support for their parents; provide support, information and access to services for those families who cannot or choose not to come into the Children s Centres thereby reducing the risk of social exclusion; raise awareness in the community about the Children s Centre services on offer. The ultimate aim was for children and families to come to Children s Centres to receive services thereby improving access to Ealing s integrated Children s Centre service offer by the most excluded groups. The service model Coram is committed to a think family approach. Coram recognises that improved outcomes for children cannot be achieved without supporting parents in their parenting role. Whilst offering universal services to families with children aged under five, the Children s Centre Outreach Service also provided targeted support for the most vulnerable and those traditionally excluded from services. The outreach work was characterised by a no wrong door approach ensuring that any contact with the outreach service offered an open door into a system of joined-up support. This was achieved through developing a whole systems approach, supporting

3 children and families within Children s Centres and in partnership with the local community and other services. The Outreach Service has built on best practice in localities, forming and developing positive partnerships with a range of professionals including health visitors, midwives, speech and language therapists, psychologists etc. Achieving quality by a strong commitment to continuing professional development was therefore possible. 2. The practice How we set up and developed the service The service was set up in September 2009 although the Head of Service was not appointed until five months later. Initially, the service staff was comprised largely of front-line staff and Service Managers. Eventually, the service staff comprised a Head of Service, four Service Managers, two Administrators, a Volunteer Coordinator and 30 Outreach Workers. The staff were allocated to quadrant-based teams who then delivered services in each of the borough s quadrants. The service initially focused on delivering universal groups across 22 out of the 27 Children s Centres in the borough. This enabled Coram to make contact with parents/carers as well as to build relationships with Children s Centre staff and other local professionals (e.g. health visitors, social workers etc.). We also began providing home-visits to families needing more intensive support, who were identified through networking with other professionals. Subsequently targeted groups were introduced in order to meet specific local needs and address local priorities such as high levels of obesity or low rates of breastfeeding initiation. Introducing targeted groups also enabled Coram to make contact with families with children under one who had previously been under-represented in the families receiving our support. Quarterly monitoring meetings with Ealing Council enabled us to further identify what specific services were needed and which services were working well/not so well in order to develop our services further in each quadrant. Furthermore, each Children s Centre had specific local priorities which informed the choice of services that Coram provided for them. The services we provided The Outreach Service was delivered through a range of universal and targeted group activities within Children s Centres as well as outreaching in a variety of settings such as baby clinics, libraries, community centres etc. Additionally, universal to tier three family support was offered through home-visiting and supporting the delivery of

4 parenting classes using evidence-based programmes. A Volunteer project was developed, supporting parents to volunteer within the Children s Centres and participate on Children Centre Advisory Boards. Universal, open access groups Stay and Play open access drop-in sessions for parents/carers that integrated the Early Years Foundation Stage. Baby Massage drop-in sessions for parents/carers to learn how to massage their baby. Bumps to Babies groups for parents/carers with children under one; included support for new parents and children through play activities, treasure baskets and singing and health advice from visiting professionals. Movers and Shakers sessions involving song, rhyme, musical instruments and dancing to develop children s language, memory and coordination. Art Start arts and crafts sessions for families with children aged over 18 months; developing concentration, planning and social interaction skills. Messy Play sessions for families with babies and toddlers; developing children s cognitive and creative development, encouraging eye-hand coordination and motor skills. Targeted groups Talk Time groups were delivered by Coram staff who had been trained in a specific ICAN programme. They were run over six weeks for families with children aged 0 3. Some sessions were attended by a Speech and Language therapist. Sticky Fingers a six-week programme developed with dieticians to support parents to make healthier eating choices for their families. Coram Outreach workers were trained by dieticians to deliver and promote key messages within group sessions and through home-visiting. A dietician supported some of the sessions. Parenting Programmes Coram staff delivered the Strengthening Families, Strengthening Communities and the Family Links Nurturing Programmes. Young Parents weekly groups supporting young parents in parenting and in developing their aspirations for their children and themselves. Targeted programmes were delivered to young parents, fathers, women in refuges and Tamil parents. Fathers and Male Carers Group a monthly drop-in for male carers, providing a range of universal and targeted sessions. Outreach in the community Contact was made with families by attending other services in a wide range of community venues including: baby clinics, antenatal clinics and health clinics GP surgeries community centres and community groups

5 launch events places of worship libraries and supermarkets. Information on the Coram service was distributed by knocking on doors. Home-visiting The home-visiting programme offered support to families with needs varying from universal to tier three. Referrals were received from professionals and families were encouraged to make self-referrals. One-to-one support was also available in Children s Centres where parents attended group sessions. The Volunteering project The Coram Ealing Outreach Service volunteering scheme was set up to enable parents and service-users to develop their skills and participate in their community. As well as supporting the Outreach Service activities, some volunteers were also trained as Literacy Champions through the National Literacy Trust. In addition, Coram placed Breast Feeding Support Volunteers in Ealing Hospital and Children s Centres across the Borough, providing support at Bumps to Babies and Baby Massage sessions. Partnership working Some of the key partners included: Local Health Visitors who, for example, would get consent at their new birth visits for our staff to visit them at home, providing the opportunity to register families with their local Children s Centre and link to other services as appropriate. Outreach Workers have also worked alongside Health Visitors at clinics, providing information about Children Centre and Outreach services and taking referrals from families requesting additional support. Voluntary sector agencies such as Home Start, Family Lives and Empowering Action and Social Esteem (E.A.S.E.) who support community development, providing a range of services including domestic violence support. Connexions Ealing Housing Department Speech and Language Therapists and Dieticians Schools Community Mental Health Teams. We also regularly attended: SAFE (Supportive Action for Families in Ealing) allocation meetings Team Around the Child (TAC) meetings Local Advisory Boards and Partnership Boards.

6 Service outputs Between 1 April 2010 to 30 September 2012, the service delivered: 1,906 universal groups 2,041 targeted groups 2,245 home visits 7,683 outreach sessions in the community. Graph 1. Coram s model of service delivery and outputs April 2010 September 2012 Home visits: 2245 In -depth one to one support to deal with family issues Specialist groups: 2041 Open access groups: 1906 Medium support: readiness to school, health, parenting Light support : parenting, health, education Outreach sessions in the community: 7683 Registration with Children s Centre 3. Evidence and evaluation - making a difference to children, young people and families Performance measures The targets set for the service were that: Parents of young children would know that there was an outreach service that could provide support and advice and help them to access Children s Centre services that can benefit their children. Additional support would be available to families to access universal services so children would be: o healthier through being immunized and screened for health problems, enjoying healthy lifestyles including exercise, eating and sleeping; o safer through their families receiving support in keeping them secure and safe and having fewer accidents; o enjoying and achieving through their parents promoting their communication and opportunities to learn through play at home and, in early years settings, providing integrated learning, development and care; o confident in their relationships with others.

7 In addition, the service was set annual targets around: the number of children aged 0-4 it reached; how many CAFs were issued; how many disadvantaged two-year olds were referred to the Early Years Placement Panel for a free nursery place. In addition, the following data and outcomes were monitored: the number, profile and attendance of children and their parents/carers at the different services provided by Coram; outcomes for parents/carers specific to the different outreach services: o parenting outcomes o access to support o outcomes of the volunteering project; levels of user satisfaction with the services provided; staffing and cost data. Outcomes data Effective reach to the communities in need was a key outcome of the service. Data collected by the service showed that Coram effectively engaged parents in priority groups and substantially increased the overall reach in the community by the Children s Centres. Between April 2010 and September 2012, Coram engaged with 16,207 individuals of whom 7,851 were children and 8,356 were adults. Coram s outreach accounted for around 23% of the families reached by Children s Centres each month in the local authority up to September The numbers reached have decreased since due to reduction in staffing capacity.

8 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Graph 2. Coram s share in families reached by Children s Centres 1 Reach by Coram and Children's Centres 12,000 Coram Ealing Children's Centres 10,000 8,000 6,000 4,000 2,000 0 Reaching priority and excluded groups Data indicates that Coram reached a very diverse section of the community: nearly two thirds (61%) of carers who registered with Coram were born outside the UK in 138 different countries. Conclusions from a Children s Centre Ofsted inspection carried out in 2011 highlighted that Coram had been effective in identifying and supporting current and emerging needs. For example, parenting groups led by a Tamil-speaking member of the Coram team to Tamil families were delivered in the area. We also adapted our targeted groups to reflect particular cultures so that, for example, Sticky Fingers was adapted to be relevant to the diet of Asian families. The children reached were also more likely to be growing up in economically inactive families with parents either looking for work or choosing to stay at home 33% of adults reached were in employment compared to 67% of the local authority s overall population. 2 Through engaging families with high needs and facing social exclusion, Coram was able to identify families potentially at risk (safeguarding or developmental) and after initial assessment was able to support and/or refer onto appropriate services. In relation to young parents, Coram worked with the Connexions Teenage Pregnancy Lead to deliver parenting groups to young parents. Following restructuring within 1 The monthly reach figures calculate the number of individuals reached each month. Therefore the figures add up to a higher figure than the overall number of children reached by the project. 2 July 2012, ONS Annual Population Survey.

9 Connexions, Coram staff continued to deliver these groups to young parents. Coram monitors all its services referrals to Children s Social Care in relation to safeguarding. It was picked up, for example, that in one quarter seven referrals were made, indicating the level of need of families being referred to this outreach service, and discussion was raised with commissioners and referrers about this. Coram also held an event in July 2009 to launch their regular fathers group delivered by Coram s staff. The event attracted over 300 people including a high number of fathers. The project also hosted a Coram-wide workshop looking at how best to address issues related to domestic violence in Black and Minority Ethnic communities through outreach and similar services in July Improving access to formal and informal support Feedback from a sample of parents 3 suggested that many of the parents Coram supported had a weak support network before accessing the outreach service: 82% did not have people to turn to when in need; 83% did not know who to contact in the community when they needed help; and 75% did not have anyone to talk to when they were worried about their children. Access to both formal and informal support improved almost universally following the support offered by Coram with 97%-100% of parents reporting feeling more able to access support at the end of the intervention (see graph 3 below). Parents explained that having a relationship with a Coram support worker had reduced their isolation and knowing that Coram would be available to help if future issues arose had made them feel less isolated. However, it was also evident that parents had become better linked in with other support available in the community and with other parents. Graph 3: Improved access to support (N = 69) 3 75 parents who had received targeted one-to-one support completed in-depth outcome surveys.

10 Access to informal and formal support systems 100% 80% 99% 100% 97% 60% 40% 20% 0% 18% I have relationships with people who provide support when I need it 17% Before: Agree or Strongly agree I know who to contact in the community when I need help 25% When I am worried about my children I have someone to talk to After: Agree or Strongly agree Improved parenting ability Analysis of questionnaires completed by a sample of parents 4 at the start of the Coram intervention showed that: over half (51%) had issues with meeting their family s needs within the resources they had; two-thirds (66%) had difficulties in planning family activities; nearly half (49%) had difficulties with advocating for their family; and nearly half (45%) lacked confidence in their parenting ability. It was also evident from parents stories that parenting practice was affecting their children s development and behaviour: My toddlers behaviour became unmanageable, D often bit C and they used to fight all the time. We were also concerned about language development and C wasn t expressing himself talking, he would just make noises and dribble, even though he wasn t a baby any more. C was a very fussy eater and would only want to drink milk and eat very few solid foods. Feedback from parents at the end of the Coram intervention showed that confidence in their parenting and advocacy skills improved for nearly all parents who had lacked these skills previously. Similarly nearly all parents felt more able to plan their family s activities to reduce stress and 90% felt more able to meet their family s needs with the resources they had. Graph 4: Improved confidence in parenting ability (N = 61-68) 4 75 parents who had received targeted one-to-one support completed in-depth outcome surveys.

11 Parenting confidence and ability to meet basic needs 100% 80% 90% 99% 97% 98% 60% 40% 20% 49% 34% 51% 55% 0% I know how to meet my family's needs with resources I have I make choices about family activities that reduce family stress I can stand up for what my family and children need I have confidence in my ability to parent and take care of children Before: Agree or Strongly agree After: Agree or Strongly agree Furthermore, 89% of parents agreed or strongly agreed that the service had helped them to improve their parenting skills (see graph 5). Graph 5: Improved parenting skills (N = 75) This project helped me to improve my parenting skills Strongly agree, 76% Agree, 13% Not sure 4% Disagree, 1% Strongly disagree, 4% The story catches completed by some parents 5 also showed the progress their children had made, through socialisation, improvements in language and eating and being happier : The support I have had has been an important turning point in our family life. At the 5 56 parents completed story catches with a Coram outreach worker.

12 centre my children can play with other children and learn basic values like respect and sharing. They are getting on a lot better. We feel more equipped as parents with the tips we have received and we know where to ask for help if we need it. We now know lots of local services available and feel more confident to ask for updates. C was referred to a speech and language therapist, who recognised that C wasn t aware of the muscles in his mouth and taught us some exercises to do with him that involve mouth movement. This helped a lot as now C is talking more. Other feedback from parents User feedback questionnaires completed by 75 parents revealed very high levels of satisfaction: 93% of parents felt that the staff had treated them very well; and 90% strongly agreed that the service had helped them. Outcomes from the Volunteer Project Between August 2010 and September 2012, the volunteer project registered 242 volunteers and placed 180 volunteers in the community. The volunteers took on a variety of roles in universal, targeted groups and general outreach. Coram also placed Breastfeeding Support Volunteers in Ealing Hospital and at Bumps to Babies or Baby Massage sessions throughout the borough of Ealing. Forty eight of the volunteers subsequently entered employment or engaged in further training which included NVQ2/3 in Childcare and Teacher Assistant training. Outcomes achieved by volunteers and the type of work they carried out are illustrated in the stories below. Volunteer 1: M volunteered with Coram for over a year ( ). She volunteered twice a week in the stay and play in Horsenden Children s Centre. M went on to complete a Level 3 NVQ in Childcare Learning and Development and is now working in childcare. M received support through written feedback to her course tutor and one-toone supervision during her volunteering with Coram. Volunteer 2: In Feb 2011 a single dad attended a father and baby session at The Young Adult Centre with his daughter. In April he became a Coram volunteer and volunteered in Art Starts at the Grange Children s Centre and volunteered at Pops and Tots (father and baby sessions). He went on to start an NVQ and is doing his placements as part of his volunteering work. Since September 2011 he is doing 3 sessions a week. He was offered a job as a nursery worker and he is considering this once his daughter is old enough for school. Volunteer 3: A mother of one has been volunteering since November 2010 to date. She has covered Stay and Plays, Bumps to Babies, Sticky Fingers and Talk Time sessions in different Acton Children s Centres. Coram supported mum to register on an NVQ Level 2 in Childcare which she is due to finish in June, and she will start NVQ Level 3 in

13 Childcare in September Volunteer 4: A mother of three has been volunteering since April 2011 on a weekly basis at Bumps to Babies in Acton. After about 8 months volunteering she applied for a job as a teaching assistant and was successful. She is currently working there full time. Our impact A report produced by Ealing local authority in 2010 (available from the C4EOTeam@nfer.ac.uk) highlighted the following benefits of the service: There was a significant increase in the number of children and families in the local authority area accessing Children s Centres which was attributable to Coram outreach and early childhood services. Children s Centres had developed very positive relationships with Coram and had a high regard for the service, recognising Coram s ability to accommodate the needs of local communities and the priorities of different Children s Centres. Families had been engaged who might otherwise have fallen through the net: Coram has enabled children and families who seem to be in and out of social care to be supported and their needs highlighted appropriately particularly where there has previously been an ongoing history of intermittent intervention. The staff were highly qualified and there was a strong commitment to continuing professional development to enable staff to deliver additional core service at Centres. Coram contributed to a developing partnership with early childhood health services delivered in Children s Centres; relationships were established with health services, with Coram outreach viewed as complementary. 4. Sustaining and replicating your practice Sustainability Ealing is taking the Outreach service in-house from April The service s legacy includes: volunteers who, through Coram, have acquired knowledge, skills and experience and who will now be able to run groups and support families in Ealing; Children Centre staff trained as part of the exit strategy. Costs and benefits The report produced by Ealing Council in 2010 noted that the service offered value for money with each contact costing The increased emphasis on the contribution of volunteers to the overall service delivery further enhanced value for money. In , the unit costs of Coram s service were calculated as: for universal groups for targeted groups

14 51.41 for home-visits. Learning Key learning points from delivering this service are that: providing community-based services enabled us to maintain a presence and provide a foundation of on-going support to families both formally and informally; it was particularly important to keep an open door and offer informal, pro-active support to families with children up to the age of five; agreeing information sharing arrangements with other service providers is critical in order to reach families with children under five and would have enabled the service to better target its outreach through door knocking, leafleting etc. Challenges Some partners were not initially clear about what Coram were offering. The shift away from universal provision to targeted work meant skilling up staff to work with more complex cases, which required considerable training and support. Replicability The targeted programmes we have developed are fully resourced and could be delivered in a range of settings by family support workers or early years practitioners without needing specialist training. C4EO Golden Threads You can do it: many of the services we delivered helped to develop parents and children s resilience e.g. Sticky Fingers, Talk Time enabled parents to develop their skills, strategies and confidence to support their child s learning and development. They also helped to support school readiness. Together with children, parents and families: again, programmes such as Sticky Fingers and Talk Time involved working with parents and children together, with an emphasis on supporting learning at home. It takes a community: our Think Family approach to casework meant that whilst the child was the focus, the needs of parent/s and other family members were considered on their own and in terms of their impact on the child. Unite to succeed: by providing services for families at both a universal and a targeted level, we could provide a continuum of support enabling them to step up or step down and making use of volunteers to provide additional support. Shape up and keep fit: ensuring we had a highly-trained staff team was crucial to the delivery of our services. We organised both external and in-house training for staff around Safeguarding and Child Protection, EYFS update; domestic violence; Solution focused Brief Therapy etc. Feedback from parents emphasised the quality of the relationships they had built up with Coram staff and the commitment shown by staff. They particularly appreciated the flexible and non-judgemental approach of the Coram staff.

15 5. Core leadership behaviours The following eight core behaviours have been identified as part of successful elements of leadership (see National College for Leadership of Schools and Children s Services/C4EO (2011). Resourceful leadership: how directors of children s services improve outcomes for children. Full report. Nottingham: NCSL. The following behaviours apply to this example. Openness to possibilities - we needed to be open to delivering our services in different ways in the different Children s Centres. Each Centre had different demographics and priorities. Ability to collaborate - we worked effectively with a wide range of other partners in order to provide support for families. Collaboration at all levels was important and as such links were made with front line staff as well as managers within the various services. Part of the work required understanding the priorities of other services and identifying common areas and targets. Demonstrating a belief in team and people - typical of a new service, it was not possible to know exactly what the service would look like until delivery began. We quickly shifted from the provision of majority universal groups to delivering targeted groups. At the same time commissioners made contract changes which increased the level of need supported from tier 2 to tier 3. We demonstrated commitment and belief in the team, invested time and training and we ended up with a highly skilled and trained team). Personal resilience and tenacity - the staff showed huge resilience and tenacity through their focus on delivering a quality service when in the early days partnerships with the Children s Centres were not easily formed. Ability to learn continuously - we adapted and developed our services on an ongoing basis. Through regular monitoring and evaluation we were able to adapt delivery where appropriate. Through analysing data, we were able to identify gaps in provision e.g. the lack of take up by under ones led to the development of Bumps to Babies. An early audit of case files led to the development of a case recording policy document and in house training on recordkeeping.