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Chapter Six: Plans, Outcomes and Evaluation
Introduction
2.6.1 Compared with the considerable focus on preparation and the conference, much less practice or research based attention has been paid to the content of plans, how these are implemented and outcomes for children and young people. This small scale review could do little to remedy the resulting gap in knowledge, but these topics were discussed in interviews and this chapter reviews the responses. It begins by outlining the nature of plans and arrangements for review. The focus then shifts to more formal means through which the impact of FGC is being assessed, both by agencies and through academic research.
Plans
2.6.2 Asked about the content of plans, most respondents replied that they were primarily concerned with how family members would support the child and parents. Several respondents emphasised that families generally made few demands on services, usually asking just for what they needed to do what was required, for example for a bed so that a child could live with a relative or spend weekends there.
2.6.3 On plan implementation, the most common response was that there was a lack of detailed information on this. Within most schemes it was fairly common practice to convene a review, the date usually being agreed at the initial conference. The timing of the review varied according to when it was thought likely to be most useful. Family members decided whether and when it should take place, but some co-ordinators did advise them to convene one. From having taken part in reviews, service providers knew that some plans were implemented very successfully, but that there were times when either family members or professionals did not deliver on what had been agreed.
2.6.4 Several service provider respondents acknowledged that monitoring the plan was the weakest part of the process. A common arrangement was for a family member to be appointed to oversee the plan, with an agreement that s/he should contact the social worker if any difficulties arose. One problem with this arrangement was that it replicated traditional client / social worker relationships, with the family members competing against demands on the social worker's time. A small number of service providers talked about the importance of social work services 'owning' the plan and treating it as part of the overall care plan. Concerns were expressed that some social workers forgot about the plan after it had been agreed.
2.6.5 Failure to implement the plan on the part of social work services was said to be more often down to lack of resources, for example the social worker might move and not be replaced, rather than a conscious decision that an aspect of the plan was not appropriate. Divergent opinions were expressed on whether co-ordinators or their managers should have a role in encouraging social work services to implement the plan, with some viewing this kind of advocacy as entirely appropriate and others considering it beyond their remit. Each point of view was expressed within in-house and voluntary/ independent schemes. On the part of families, co-ordinators were seen as having a responsibility to check out with family members that the plan was realistic, but beyond that, they had no authority to hold people to task. In one scheme family members were told they could contact the co-ordinator for support prior to the first review, but this did not seem to be common practice.
2.6.6 The most frequent response to a question about the impact of FGC on inter-agency working was that it was difficult to single out any specific impact, but that colleagues from other services usually contributed helpfully. Examples were given of health or education staff coming along to an information session to explain the impact of particular conditions affecting a parent or child. In terms of implementing the plan, the most common response was that other professionals would do whatever was within their scope, but could not produce resources which did not exist. Thus a head teacher might be creative in developing a time-table to suit an individual child and encouraging teachers to understand his/her particular needs, but could not produce a specialist educational placement, if that was what was needed.
2.6.7 Recognising the weakness of the implementation stage, Kent, following a review by Professor Peter Marsh, was looking to introduce an 'Implementation Model'. The plan was that a core group, chaired by a family member, would meet regularly to review the implementation of the plan. This is currently being developed, so its impact has not yet been assessed.
Assessing the Impact of FGC - Outcomes and Evaluation
2.6.8 The need for evaluation of impact was widely accepted and a number of authorities were beginning to develop systems for collating information on how children and families fared. It was proving more difficult to a) compare outcomes with those achieved through other forms of decision making and b) provide evidence of cost effectiveness.
2.6.9 A number of authorities had devised systems whereby key participants were asked to rate benefits for children. Fife asked social workers to rate the likelihood of children being accommodated at the point when the conference took place and at a point a year later. Trying to assess the specific impact of FGC, Kent asks social workers in evaluations to rate the extent to which FGC had contributed to: the child's return home from care; earlier resolution of court proceedings; avoiding court proceedings. Social workers are viewed as the service's harshest critics, so if they attribute a good outcome to FGC, it is assumed that this is a reliable assessment.
2.6.10 As part of a recent review of the Kent service by Professor Peter Marsh, key participants including family members, social workers and teachers were asked, using a five point scale to rate children on the five aims of the Df ESEvery Child Matters programme. These are: be healthy; stay safe; enjoy and achieve; make a positive contribution; achieve economic well-being. The ratings were made at the point when the conference was held and three months later. The (as yet unpublished) review 28 found that family members were able to score children using the outcome headings, and that those scores and the predictions were very closely matched to professional ones (including education professionals). There were twenty three family group conferences involved in the research, nineteen social care and four education. All showed a positive increase in scores over a three month period, and three of the education and twelve of the social care showed major increase (in the judgement of families and professionals). This was a practice-led study with quite small numbers, so Professor Marsh has warned against over-generalising from the results. In addition some of the children were in a foster care placement, so improvements also reflected that they were settling in there. Nevertheless, overall he considered success to be very good, with clear indications that FGC 'delivers' on government headings.
2.6.11 A larger outcome study is currently underway at the University of Cardiff, led by Dr Sally Holland and Abyd Quinn Aziz. The research aim is to evaluate outcomes for families participating in conferences across Wales.. Data, on their circumstances, difficulties and outcomes at 6 and 12 months, is being collated by professionals and forwarded to the research team. The intention is to use the large data set to identify patterns, while at the same time using individual data to understand how the process worked for specific children. Initial results are expected later in 2006, with the research due to conclude in 2007.
2.6.12 Attempts to compare outcomes from FGC with those from professionally led decision making meetings have not borne fruit within the UK. Dr Louise Brown from Bath University was unable to complete a planned random control trial comparing the two approaches within the child protection system, because DoH guidance did not allow for families to be diverted from mainstream decision-making processes. In addition, there was a very high refusal rate among families referred for FGC on a random basis, i.e. not as a result of social worker discretion. This raises important questions about whether families who engage with FGC have less serious difficulties than others, thus undermining any comparisons, unless samples are randomly allocated. It can be assumed that this selective effect will lessen in authorities which have introduced systems of mandatory referral, opening up important possibilities for future research.
2.6.13 Several people interviewed for this review emphasised that they had experience of FGC being effective with extremely hostile and troubled families. Most of the service providers interviewed believed that the benefits for many children were clear, with some who would have gone into care being cared for throughout their childhood by a family member. There were also examples of children having on-going contact with relatives who would otherwise have remained peripheral in their lives. Children could also benefit greatly when relatives started to support their parents in apparently small, but significant ways, for example by meeting up with them once a week. The general view among service providers was that mainstream practice would not have found ways of drawing on what these relatives had to offer. Some were impatient that it was taking so long for research to highlight these benefits, because, on the basis of their own experience, they were clear.
Cost Effectiveness
2.6.14 Given the difficulties in comparing outcomes from FGC and standard decision making processes, there has been little scope for systematic cost/benefit analysis. Several service provider respondents pointed out that it was very difficult even to compare costs of the two systems, because reliable cost information was not available.
2.6.15 Some respondents took the view that effective partnership working was a worthwhile benefit in itself, so that the value of FGC schemes should not simply be based on improvements in measurable outcomes. Several people also pointed out that standard ways of working were seldom subject to the same scrutiny as that applied to FGC. Nevertheless, there was wide spread recognition that cost effectiveness had to be borne in mind. The main expected area of savings was in relation to avoiding care placements. A manger in one English authority claimed that the annual cost of his service, which comprised himself and four social workers, could be met by avoiding the need for two out-of-county placements. However a particular outcome could not always be attributed solely to FGC.
2.6.16 Apart from the costs of co-ordinator time and other resources needed for the family group meeting, none of the respondents thought that FGC made high cost demands on local authorities. While attending the conference was time-consuming for social workers, it was considered rare that it would generate a huge amount of work for them. Where that did happen, for example if relatives had to be assessed as a carer, this was seen as avoiding work in the future, so not a net increased demand on social worker time.
2.6.17 It seems likely that the costs of individual services will vary. In interviews we heard of one service which quite often conducted preparatory by phone and regularly kept preparation time down to about 2 weeks. The more usual estimate for preparation time was 6 weeks, with face to face visits being preferred. This highlights that any value for money assessments would need to ensure they were comparing like with like.
Summary Points
2.6.18
- Relatively little attention has been paid to the content of plans, how these are implemented and outcomes for children and young people. Several current studies are addressing these issues.;
- A number of respondents indicated that there could be difficulties in implementing plans, because either the family or social work services did not keep the agreement. One authority was setting up core meetings chaired by a family member to monitor plan implementation.;
- Some current research is focusing on outcomes for children who have experienced FGC, but comparative studies with children who experience mainstream decision making present a number of difficulties.;
- Cost savings from FGC are difficult to identify, partly because data on costs of mainstream services are seldom available and because it can be difficult to attribute particular outcomes (e.g. avoiding accommodation) solely to FGC.
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