Effective leadership is evident at all levels with a highly skilled, well qualified and supported workforce working towards a shared vision
Early Intervention – Edge of Care
The Strengthening Families Team leads on the Edge of Care, Early Intervention and the Domestic Abuse Panels. The purpose of these multi-agency panels is to share information and plan for timely, targeted support to increase safety, reduce risks, and improve the functioning and wellbeing of families.
The Edge of Care Panel meets weekly and consists of attendees from Child and Adolescent Mental Health Service (CAMHS), Family Group Conferencing, Youth Services, Health, Youth Justice Service and Young Carers as standing members. It is a dynamic meeting where a Signs of Safety approach is used as a tool to consider the indicators of safety within a family. A plan is discussed and resources allocated if needed to help stabilise and strengthen a child and family situation.
Between April and December 2022, there have been a total of 57 families discussed at the Edge of Care Panel meetings. A further 23 families were discussed at the Early Intervention Panel meetings.
The Turnaround Project
The Conwy and Denbighshire Youth Justice Service (YJS) have been preparing to deliver the Ministry of Justice Turnaround Project from 1 April 2023. The programme has been designed using an Early Help approach to enable the YJS to improve outcomes for children on the edge of the justice system. The ultimate aim of the programme is to prevent young people offending or reoffending by:
- Achieving positive outcomes for children with the aim of preventing them going on to offend
- Building on work already done to ensure all children on the cusp of the youth justice system are consistently offered a needs assessment and the opportunity for support
- Improving the socio-emotional, mental health and wellbeing of children
- Improving the integration and partnership working between YJS and other statutory services to support children.
The Turnaround delivery model will use an Early Help approach which has proven to be a success with similar early intervention programmes, such as Supporting Families. A five-year impact analysis of the Supporting Families early intervention programme shows a 38% reduction in youth custodial sentences and a 15% reduction in youth convictions within the cohort.
What’s next?
As a service we will be required to work with 38 young people every year. We will provide Early Help support in assessing and addressing the underlying needs and risk factors which may have brought the child into contact with the justice system, with the aim of providing positive development. It is anticipated that referrals will be made to YJS primarily by the police and courts but can be made by any practitioners who have interacted with the child, as well as the child’s parents.
In response to this new two-year initiative, two new fixed-term posts have been created within the service, and we are currently in the process of recruiting to these roles.
Expansion of the Mental Wellness Team
The Mental Wellness Team aimed to expand their support following their inception during the pandemic, and have been successful in their plans. We have recruited a full-time Approved Mental Health Practitioner (AMHP), which is a statutory provision required by Local Authorities and a specialist professional role. An AMHP’s key responsibility is to make applications for the detention of individuals in hospital, ensuring the Mental Health Act and its Code of Practice are followed.
What difference has it made?
The data we gather on this service (provided during office hours) demonstrates a substantial increase in AMHP activity since the pandemic; with 292 referrals recorded in 2022, 15 more than the previous year. The team have also supported an AMHP student to qualify during the year and note that the majority of AMHPs have now been trained in Positive Behaviour Management to assist work with potentially violent individuals.
We appointed to the Section 117 Social Worker post, whose role is to support the aftercare process of individuals who have been discharged following being hospitalised under the Mental Health Act. There are approximately 298 people currently in Conwy who are eligible for S117 support, and having a dedicated and experienced social worker in this post is important to ensure that their needs are being met appropriately and proportionately, that their voice is heard and they are advocated for, and to provide continual review to avoid breakdown of placements.
Furthermore, utilising funding from the Area Integrated Service Board (AISB), we recruited an additional Intervention Worker and Community Support Worker who will provide a period of short-term, intensive support designed to help individuals in a structured, person-led, recovery-focused way, preventing crisis where possible, and facilitating the individual to regain stability. Ultimately, it would be beneficial for this role to offer support to people who are enrolling with the Recovery College, to facilitate their recovery-focused action plan and help them achieve their goals and aspirations within that setting.
What were the challenges?
For the AMHP service, the work itself is very challenging, dealing with very poorly people in the community. However, the key challenges with service delivery remain systemic in terms of lack of availability of Section 12(2) approved Doctors (who can recommend compulsory admission for assessment or treatment under the Mental Health Act 1983), delays in ambulances arriving to convey the person to hospital, and an overall lack of appropriate beds. This means that a full assessment may take up to 15 hours and often the person has to be admitted out of county.
What’s next?
We’ll continue to focus on prevention and early intervention, and on an individual’s journey of recovery. We will also continue to provide a responsive service and work with Health Board colleagues in developing strategies to overcome the process issues that create some of our challenges.
Positive Behaviour Support within Disability Services
Positive Behaviour Support (PBS) is a person-centred approach to supporting people with a learning disability, especially if they are distressed and at risk of harming themselves or others. The approach is based on working with individuals and their support network to understand why they are distressed, the impact their environment has on them, and the best ways to keep them safe and happy.
We have supported some of our in-house disability staff to attend training to gain PBS qualifications. The overview training has been compiled by an in-house Team Manager and Coordinator, and has been piloted with a team of Sessional Support Workers who work with children and young people with complex support needs.
Forms have been devised to enable the support workers to write up reports during or after each support session, enabling analysis of behaviours and identification of strategies to support the person to feel calmer during the day. A PBS working group has been established, consisting of Social Workers, managers and Support Workers who have started to generate ideas on how to embed PBS across the entire Disability Service.
For those who have undertaken qualifications and training, PBS has started to be used as everyday practice to improve the lives of people who receive services. We now:
- Have weekly team meetings to focus on one individual, identifying what is going well, what needs to change, and new opportunities
- Recognise early indicators that a person is moving away from their ‘baseline’ and can implement strategies to reduce the need for them to display behaviours to communicate their needs
- Give the people we support more choices in the activities they’d like to do
- Take positive risks, which in turn creates new opportunities and builds skills for the people we support
As a result of implementing PBS we have seen:
- A reduction in incident forms
- Improved communication between the service and families
- Improved lives for people with disabilities
- A reduction in the need for specialist out of county placements, enabling people receiving services to remain close to friends and family
- Reduced demand for input from Health services
- Improved multi-agency working
- Reduction in the use of ‘restrictive practice’
What were the challenges?
The qualifications are detailed and require completion of assignments and PBS-recognised paperwork, involving observations of the individual, speaking with all those involved with them to gather information, putting learning into practice, and training others to put learning into practice. This is in addition to the staff member’s main job role, managing time around busy workloads and other commitments.
Not everyone wants to buy into PBS, maybe due to a lack of understanding of what it is, and not seeing the positive changes that it can make, and the time that’s required to make those positive changes.
Other workload commitments for the PBS working group reduces the amount of time they’re able to commit to this initiative and drive the changes forward.
What’s next?
We hope to roll out the PBS qualification to all frontline staff and develop training to set out the main principles. We’d also like to develop training for families to help them understand PBS plans, the associated terminology and what changes may help them at home.
We’ll encourage support providers to skill-up their workforce in PBS practice, in turn increasing opportunities for people with disabilities living in Conwy.
We will continue to reduce the need for out of county placements and bring people back to the county by developing accommodation that fits the needs of the person.
Staff feedback from attending courses and training
The Workforce and Development Team have completed an evaluation of training courses which has highlighted significant obstacles for both Social Care employers and employees in accessing classroom and virtual training.
What were the challenges?
Increasing accessibility to training for the Social Care workforce has been challenging. Also, recruitment challenges have impacted upon a Social Care employer’s ability to release employees to attend classroom-based training.
Virtual training offers greater access opportunities as it eliminates travel time to a classroom setting. However, employees need to have a suitable digital device to access the training. They also need to have the skills and confidence to use such a device.
What’s next?
We are working on a new model for delivery of training to increase accessibility. This will include delivering core training within workplace settings. Also, it will increase access to virtual learning through the provision of digital tablets and support to employees in using the devices.
Consulting with our front-line staff
We regularly ask the staff who work in our front-line support teams how they feel about their roles, and the quality of care delivered by themselves and their respective services. We’ve set out some of the responses and feedback below.
Disability domiciliary workers
- 100% of respondents felt that they were sufficiently trained to undertake their role
- 96% agreed that, as a team, we listen to the individuals we support, ensure they have rights, and are able to make choices
- 100% felt that, as a team, we support individuals to live fulfilled lives and support their health and wellbeing
- 96% agreed that, as a team, we support individuals to stay safe and protect them from abuse and neglect
- All respondents rated the overall performance of their team as very good or excellent
Participants were asked what their service does well:
The service opens the door for opportunities for individuals to fulfil/reach their goals, dreams and wishes. The service offers excellent care packages for individuals and treats everyone as an individual and works hard to deliver the right support for that person.
Listen to and act on the needs of the children/young people we support. Support staff and make them feel valued. Go that extra mile!
They were also asked what the best part of their role is:
Getting it right; noticing a change in communication, having that barrier between staff and individual come down as the trust is building…
Knowing you have made a positive impact on someone’s day
Seeing young people achieve something, no matter how small. Seeing young people enjoy doing something. Forming positive relationships with the young people I support.
We asked individuals who work alongside the in-house disability teams for their views on the quality of the service. We received responses from the practitioner teams who work with individuals under 25 years of age, over 25 years of age, and within day services.
- 100% felt that we listen to the individuals we support, enabling them to make choices about the care and support they receive, and the opportunities available to them
The team are incredibly person-centred….and approach care and support with the individual at the centre. They think creatively and ‘outside of the box’. This is clear within the management team and I feel it filters down to the staff on the ground.
- 94% felt that the team respond in a timely manner when contacted with an enquiry
- 100% felt that the team respond promptly to requests when concerns arise around individuals accessing the service
- 100% felt that the team respond appropriately to requests when concerns arise around individuals accessing the team
- 100% agree that the service supports individuals to stay happy and healthy
Support from the team allows families and children to access services, opportunities that otherwise may be unavailable to them, offer periods of respite to parents as a secondary result, and offers professional and caring relationships to the children.
- 100% agreed that the service supports individuals to protect themselves and stay safe from abuse and neglect
I was involved with a particular case…where the team went above and beyond in providing care for the child. They raised concerns when they felt other agencies were not providing appropriate care. They treated the child with respect, compassion and empathy.
- 100% felt that the service is flexible and adaptable in order to meet the needs of the individuals we’re supporting.
- Examples of effective partnership working were sought, and participants responded with lots of instances, between individuals, internal teams, knowledge- and skill-sharing, and partner organisations, such as Health.
Older People domiciliary care workers
As part of our suite of surveys we also asked the older people domiciliary care workers for their views on the service they provide and the support they receive from management.
- Over 90% feel that they have the necessary training and supervisory support from their manager to undertake their role
- 100% agree that, as a team, they listen to the individuals they support, ensuring they have rights and are able to make choices
- 94% feel that, as a team, they support individuals to live fulfilled lives and support their health and wellbeing
I actively visit those on my caseload daily or weekly to monitor, support, help, and signpost to facilitate their needs and to listen to them and those around them.
By encouraging individuals to do as much as they can for themselves, building their self-esteem and raising their self-confidence. Also encouraging individuals to attend lunch clubs and other social events so they can build friendships with their own age groups and have things to look forward to.
- 97% agree that, as a team, they support individual to stay safe and protect them from abuse and neglect
- 54% rate the service they work in four out of five, and 34% give it a rating of four.
I am very happy with the service I work in. I enjoy having full and open access to all services which enables me to fast-track individuals to the help and care they need.
In this fast-paced environment, I find that information sharing is very good and any concerns/changes are listened to and acted upon promptly.
The additional comments suggest that, despite the current challenges within social care, the teams remain positive and determined to deliver the best possible care to older people in Conwy.
We asked colleagues from the Council, Betsi Cadwaladr University Health Board, and Housing Associations for their views on this service’s performance. Again, the feedback was very positive overall, with an acknowledgment that the demands on domiciliary care teams are high.
- 100% of respondents agree that the service listens to the individuals we support, giving them choices about the care and support they receive and the opportunities available to them
- 96% feel that we respond in a timely manner to enquiries, and 100% feel that we respond promptly and appropriately to concerns about an individual accessing the service.
- 100% feel that we support individuals to stay happy and healthy
- 100% agree that we support individuals to protect themselves and stay safe from abuse and neglect
- 91% feel that the service is flexible and adaptable in order to meet the needs to the individuals we’re supporting, with additional comments appreciating that this takes place against a backdrop of staffing and capacity pressures, and time constraints
I have worked in partnership with the Reablement Team on numerous occasions and find that their staff are very supportive and engage well with service users and families. They provide a high level of quality of service, can address emergencies when identified, and [are] an excellent resource in the community.
During one of the ambulance strikes one of the senior carers did not hesitate to support me with a service user. During Covid the carers were our eyes and ears and if they had concerns regarding a service user they swiftly updated me.