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Target E:
By 2008, ensure that children and young people who need it have an integrated package of appropriate health, care and education support
SUMMARY EVALUATION
A4.143 Target E is working toward the implementation of an output premised on the understanding that this integrated approach to service delivery provides additional benefit to service delivery organised by component part. Target E is therefore an output measure, which measures with service provision more than the impact of that provision. The processes and outputs required to meet this Target are either in place or under development, and to that extent, the Target may be said to have been met.
A4.146 Two key groups of children and young people have been identified as particularly representative of the need for action in relation to Target E: all who appear at Children's Hearings, and those targeted through the Additional Support for Learning legislation. It will be viewed as an indication that Target E has been achieved if progress is made toward providing these children in need with an integrated package of care and education support. It is anticipated that an evaluation of progress will be possible by the end of 2007.
WORK PROGRAMME AND POLICY CONTEXT
A4.147 Target E was announced in December 2004. The Target refers to provision for 'children in need', which includes children in need of protection, looked after children, young carers, children with disabilities, and children in substance-misusing households, among others. The overall aim of this Target is expressed in the Scottish Executive Children and Young People Delivery Group's Vision, which states that 'in order to become confident individuals, effective contributors, successful learners and responsible citizens, all Scotland's children and young people should be safe, nurtured, healthy, achieving, active, respected and responsible'.
A4.148 The Target E work programme is set against a more broadly based drive to transform the delivery of children's services in Scotland. In addition to the broader drive towards Integrated Children's Service Planning ( ICSP), there is the implementation of Getting it Right for Every Child, which aims to provide integrated service provision packages for those individual children and young people defined as being "in need", who are the client group for Target E.
A4.149 In relation to CtOG, Target E relates most closely to Targets G, B and F. The CtOG website describes a range of supporting activity in the Target delivery plan. These include a new action framework aimed at improving early identification of children's health issues: Health for All Children (Hall4); a framework for promotion, prevention and care in children and young people's mental health; new policies around adoption and fostering; implementing the recommendations of the Hidden Harm report into supporting children in substance misusing households, and the Development of a National Youth Work Strategy
A4.150 The Children (Scotland) Act, 1995 sets the basic principles of children's care policy in Scotland, and includes the duty of local authorities to consult with other service providers in the provision of care for children. For Scotland's Children - An Action Plan (2001) identified the preparation of joint children's service plans as a key requirement for effective service integration 17. The Education (Additional Support for Learning) (Scotland) Act, 2004 also promotes joint working between agencies to co-ordinate care provision.
A4.151 Integrated Children's Services Plans ( ICSPs) bring together a number of previously separate core statutory and other planning requirements; these include: Children's Services Plans, Statements of Education Improvement Objectives and Progress Reports (required under the Standards in Scotland's Schools, etc. Act, 2000), the child health elements of Local Health Plans, Joint Health Improvement Plans & Child Health Strategies, and Youth Justice Strategies - as recommended in the National Standards for Scotland's Youth Justice Services, 2002. ICSPs require all local agencies involved in children's services to jointly plan integrated services based on agreed improvement objectives and outcomes. The Scottish Executive has proposed that by the end of the 2007-08 financial year ( i.e. 31st March 2008), it and its partners in local government, the NHS and other statutory and voluntary services will have policies, plans and working practices in place to ensure that all children and young people in Scotland have access to personalised care as required to meet their needs.
A4.152 In 2005, the Getting it Right for Every Child consultation document proposed a unified approach to providing services for children as the key delivery mechanism for this Target. Getting it Right recommended the development of a single assessment process and action plan for individual children with a greater focus on monitoring outcomes. It also proposed new duties on agencies to identify children in need and be alert to their needs, to co-operate to develop plans, and evaluate and monitor their progress.
A4.153 Funding for children's services is provided to local authorities and NHS Boards through mainstream budgets, e.g. Grant Aided Expenditure allocations to local authorities. There are also several specific funding streams, including the Changing Children's Services Fund (£65.5m in 2007-08), the Integration in School Education strand of the National Priorities Action Fund (£26m in 2007-08) and, the Sure Start Scotland programme (£60m in 2007-08).
EVIDENCE
A4.154 Scottish Executive planning guidance for ICSP requires authorities to take account of diversity and equalities issues in developing and delivering services. Similarly, the Children Scotland Act, and Additional Support and Learning Act require equal opportunities and equality issues to be appropriately dealt with. Joint service inspections will include analyses of provision for minority groups and equality issues.
DATA ISSUES
A4.155 The principle source of data for monitoring progress towards this Target is the Quality Improvement Framework ( QIF) developed by the Scottish Executive for ICSPs (March 2006) 18. This framework includes a suite of 43 performance indicators organised into seven broader 'outcomes' which will be reported in ICSP annual updates. The majority of indicators are outcome-focussed, although 13 refer to processes or outputs. It is likely that the first plans to include data from QIF performance indicators will be those prepared for 2008-2011, following delays,in receiving the initial submissions, consequent delays in the Scottish Executive providing feedback to agencies on these and policy developments. 19.
A4.156 The Executive describes QIF indicators as a starting-point for agencies' self-evaluation and intended to complement local improvement objectives, targets and progress indicators. The Executive has not set any prescribed format for ICSPs, although it has reviewed plans and provided feedback. In the interim, the Scottish Executive has committed itself to monitor integrated care provision in two key areas: (i) ensuring that all children appearing at Children's Hearings have an action plan based on their individual needs; (ii) by autumn 2007, evaluating implementation of the Additional Support for Learning legislation, which requires authorities to provide the additional support children need to tackle identified barriers to learning
A4.157 Following the passing of the Joint Inspection of Children's Services and Inspection of Social Work Services Act, 2006, from 2008, self-evaluated performance based in the QIF indicators will be monitored and validated through multi-agency inspections of children's services, led by a Children's Services Unit based within Her Majesty's Inspectorate of Education ( HMIE). Joint inspections of child protection services are already being rolled out and this approach is to be extended to all children's services from 2008.
A4.158 The Target also operates in a responsive and demand-led policy area: the number of personalised care plans and consequent actions will depend in the number of children in need of care, which cannot be specified in advance (although, based on past trends, it may be possible to estimate future demand).
A4.159 In theory this Target could be met 'successfully' by having personalised care plans in place, irrespective of any outcome or benefit which children may derive from them. However, the Scottish Executive proposes to measure the benefits of integrated packages through examining updates to ICSP and QIF information. Furthermore joint Inspection reports will contribute to monitoring progress in line with Target priorities, and a fuller evaluation of outcomes from Getting it right is proposed.
A4.160 As local authorities and partner agencies will record all ICSPs that they create, and possess information within these on the circumstances and characteristics of the children they have been created for, it would be possible in principle to collate this data at an aggregate level and analyse any distribution to provide a national picture of children receiving integrated care. However, the Scottish Executive is seeking to reduce the number of performance indicators for children's services from the current level of about 140 to the 43 in the QIF, and to develop more high-level outcome agreements in place of detailed statistical returns. It might be possible for analysts within the Scottish Executive itself to examine all 32 annual ICSP updates and seek to extract some aggregate information. However, as the Executive has not required ICSP updates to be completed in a standardised format, it may be that the necessary data will not be contained in every submission.
A4.161 The QIF indicators make use of existing data sources ( e.g.Scottish Social Attitudes Survey, Growing Up In Scotland Survey) which are already analysed at a national level within the Scottish Executive departments responsible for these respective policy areas. However, while these data provide a national picture of specific indicators, they are not suitable to analyse the integrated element of children's service provision, which is the defining feature of this Target. It therefore appears that an understanding of the overall outcomes from this Target will be best achieved by period systematic analyses of ICS Plans, annual updates and joint inspection reports.
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