Evaluation of the South East Framework for Integrated Care (Community) Vanguard Programmes
Task
Past research has demonstrated that there is a cohort of children and young people between the ages of 0-18 ‘in complex situations’, who are perceived as particularly vulnerable and who experience some of the highest levels of health inequality. Their needs are considered to be ‘complex’ when they are: multiple, persistent, severe, and/or framed by family and social contexts. Often services across multiple sectors collectively struggle to meet the needs of these children and young people. Similarly, many of these children and young people find it difficult to access, respond to, and maintain progress with the community-based support and interventions that are typically offered. This can result in the child or young person’s underlying needs not being met by services, which in turn can reinforce vulnerability and high risk behaviours.
The Framework for Integrated Care (FfIC: community) has been designed by NHS England, using evidence-informed best practice, to support the development of an integrated system that intervenes earlier in a child’s life, to successfully support them and ensure their needs are met. The aim is to enable children to thrive and to prevent them from progressing into the criminal justice, secure, inpatient mental health, and looked after children systems.
The six key principles of the FfIC (community) are:
Every interaction matters, with an initial focus on building and supporting positive collaborative relationships.
Children and young people and the relationships they experience are at the centre of all care they receive through genuine co-production.
Those spending most time with the young people are the primary facilitators of change.
Positively influencing the day-to-day care is the basis of any intervention and the primary focus of support.
All behaviour is understandable in context; there is a focus on developing an understanding of each child’s behaviours and needs based on their story (formulation).
There is a commitment by all to build and sustain trauma-informed organisations.
NHS England commissioned TONIC to undertake an independent and comprehensive process evaluation of the two South East FfIC (community) vanguards: the Thames Valley Link Programme and the Building Belonging Programme in Surrey. In addition, the evaluation also incorporated learning from two small-scale complex needs projects, which delivered services to a similar cohort of children and young people in Portsmouth – Children and Families Team: CAFT, and Southampton – Majestic Project. The aim of the evaluation was to identify learning on the outcomes and impact of each vanguard. The overarching purpose was to contribute to regional and national learning regarding further development and implementation of the FfIC (community) and service model design.
Our Approach
The evaluation utilised a mixed-methods formative process evaluation design, delivered through three distinct phases of fieldwork, to obtain quantitative and qualitative data, using the following approaches:
Semi-structured in-depth interviews with children and young people, parents/carers, and professionals working within the vanguard delivery teams and external to the programmes
Short online surveys
Feedback from programme staff during reflection sessions structured around the GROW framework [Goal, Reality, Options, Way Forward]
Diamond Nine activity to explore achievement of outcomes
Ethnographic observations of delivery group sessions, steering group meetings, annual reviews, share and learn events, and conferences.
The total number of qualitative engagements for this evaluation was over 350. TONIC conducted 137 in-depth qualitative semi-structured interviews: 85 for the Thames Valley Link Programme, 45 about the Building Belonging Programme, three for the Children and Families Team and four focused on the Majestic Project. Additionally, TONIC received a total of 203 responses to the online survey: 144 regarding the Thames Valley Link Programme and 59 providing feedback on the Building Belonging Programme.
To analyse the qualitative data, TONIC researchers used thematic analysis as well as undertaking SWOT analyses [strengths, weaknesses, opportunities, and threats] to evaluate delivery of the programmes. Additionally, descriptive statistics were produced to provide an overview of referral and engagement levels and summarise the cohorts who have engaged with each vanguard programme, as well as analysing recorded outcomes and impact as per service activity and outcome data collated by the respective programmes.
Outcome
TONIC produced a detailed written report that presented the findings of the evaluation, alongside a short executive summary. The findings chapter was divided by programme-specific outcomes and overarching reflections on how well each of the programmes adhered to and achieved each of the FfIC (community) principles. Findings explored strengths, opportunities for improvement and perceived impacts. Important regional lessons emerged, offering valuable insights for future service design and delivery, especially for any intervention striving to adhere to the FfIC (community) principles, these were framed as eight key recommendations for future service providers and commissioners to consider.