By Naomi Russell and Lorraine Mighty

Waiting for a social care assessment is becoming increasingly common across the UK, causing frustration and distress to people with care and support needs and having a demoralising impact on frontline staff and managers.

In September 2023,  IMPACT, the UK centre for implementing evidence in adult social care, and East Midlands Association of Directors of Social Services (EMADASS) began a year-long project to co-produce resources that would help staff, carers and people who draw on care and support negotiate some of the challenges associated with waiting lists.

Understanding the impact of waiting

The proposed outcomes for the project included:

• better understanding of the impact of waiting lists on people, carers and staff;
• agreeing a regional approach to managing waiting lists;
• increased satisfaction for people who draw on care and support and carers;
• development of co-production expertise across the region.

Using surveys, online meetings and face to face workshops, the views of around 104 people with lived experience and 140 staff from across the East Midlands were gathered. These insights were analysed alongside an evidence review of relevant literature to identify common themes.

Frustration for people with lived experience and staff

People who responded highlighted staffing resources, lack of consistency, over-complicated systems and increasing demands as factors that contributed to waiting times.

People with lived experience cited stress and frustration, a deterioration in mental health and decreased independence as some of the impacts of waiting for an assessment.  Staff told us they experienced stress and frustration, low morale and feeling they were not doing a good job.

What needed to change

Based on this feedback, the following themes were used in workshops across the region to generate discussion about what needed to change:

1. Use of resources
2. Communication
3. Systems and processes
4. Working with other organisations

The workshop notes were carefully analysed by the Co-production Steering Group, which was established as part of project governance arrangements, and by EMADASS. This identified the need to develop guidance for staff, and an information and advice pack for citizens, on “waiting well”.

From April to July 2024, task and finish groups comprising staff from East Midlands local authorities, third sector organisations and IMPACT worked alongside people with lived experience to develop the recommendations. Work progressed well and the products were finalised in August 2024.

Guidance for staff and advice for citizens

The guidance for staff is designed to support and equip them to provide a consistently good response to people and carers across the East Midlands. This includes information and advice for staff on where to seek support if they are struggling with managing waiting lists.

The waiting well pack for citizens is designed to provide helpful information and advice about services that can be accessed prior to an assessment/conversation. It also explains how to contact the local authority if you think you need an assessment/conversation, and what will happen when you do.

Co-production in practice

Both IMPACT and EMADASS were committed to co-producing this project. The project team benefited from good practice around co-production across the East Midlands, and with support from social care staff in each of the ten local authorities, people with lived experience were identified to join the project steering group.

The regional workshops were well attended by carers and people who draw on care and support, who co-produced recommendations about what changes are needed.

Formal and informal contact was maintained with workshop attendees to establish good relationships.  As a result, the task and finish groups had a good balance of staff and people with lived experience.  People with lived experience became leading voices and strongly influenced the finished products.

Next steps

All ten local authorities have committed to using the regional templates for staff and citizens.

EMADASS invested additional funding beyond the IMPACT project to commission a consultancy to develop an implementation readiness tool. This enabled local authority project leads to assess and access the support needed for effective implementation of the products.

Each local authority is updating the templates with relevant community information and co-ordinating distribution.

The distribution of the waiting well pack will be monitored and evaluated by each local authority to gain an understanding of the impact of the information and advice for recipients. This data will be collated by the EMADASS improvement team to understand the regional impact of this project.

Developing expertise in co-production

Whilst it will take time to understand the outcomes from the distribution of the waiting well pack for citizens and the staff guidance, a key project outcome that has already been felt is the development of regional co-production expertise.

By demonstrating good practice across the region, this project has renewed confidence in incorporating co-production in strategic improvement work and has set expectations for future projects.

Naomi Russell is deputy demonstrator lead and Lorraine Mighty senior strategic improvement coach at IMPACT; they were project leads for the waiting lists project. IMPACT works across all four UK nations, drawing on insights from research, lived experience and practice knowledge, to make a difference to frontline services and the lives of those drawing on care and support and of carers.

There is strong evidence that parenting support services improve outcomes for children and adults in families experiencing adversity, councils have been told.

The latest government-commissioned practice guide to what works in children’s social care said interventions for parents of children aged 0-10 could improve parenting practices and child behaviour, lessen levels of stress and support adults mental health.

It also highlighted the vital importance of practitioners’ skills in building trusting relationships with, and in empowering, parents, and also the value placed by staff and parents alike on interventions that recognised the interconnections between parents’ and children’s needs.

Case for prioritising parenting support ‘has never been stronger’

Sector what works body Foundations, which published the guide today, said it was based on the first major review of UK and international evidence on parenting support for families experiencing adversity, including adult mental health problems, substance misuse or domestic abuse.

On the back of the guide, Foundations’ deputy chief executive, Donna Molloy said: “As councils struggle to cope with the costs of children’s social care, our evidence shows that proven models of parenting support can help to keep children safe with their families, improve their outcomes and alleviate pressure on an already overstretched system.

“The case for prioritising proven parenting interventions has never been stronger.”

Evidence to meet government social care outcomes

The practice guide is the second of a series of Department for Education-commissioned resources from Foundations designed to provide senior leaders in councils and partner agencies with the strongest available evidence to deliver on the outcomes in the children’s social care national framework.

The DfE-issued statutory guidance, published in 2023 under the previous government’s children’s social care reforms, sets four overarching objectives for the sector and three key enablers for achieving them:

• Outcome 1: children, young people and families stay together and get the help they need.
• Outcome 2: children and young people are supported by their family network.
• Outcome 3: children and young people are safe in and outside of their homes.
• Outcome 4: children in care and care leavers have stable, loving homes.
• Enabler 1: multi-agency working is prioritised and effective.
• Enabler 2: leaders drive conditions for effective practice.
• Enabler 3: the workforce is equipped and effective.

The first guide, on kinship care, was published in October last year, and the one on parenting through adversity for parents of babies and children aged 0-10 is the first of four on parenting support. The others will cover support for families in adversity with children aged 11-19, parents or carers of children with disabilities or severe mental illness and adoptive and foster parents.

Rising parental mental health needs ahead of family help reforms

The parenting through adversity guide comes amid a growth in the numbers of children in need assessments identifying parental mental health or substance misuse problems, which directors of children’s services have warned is increasing risks to the youngest children.

At the same time, councils are set to implement significant reforms to the way they support families, through the rollout of the family help model in 2025-26.

This involves the merger of targeted early help and child in need services into multidisciplinary teams, designed to provide families experiencing adversity with early, non-stigmatising help, =to resolve issues and prevent them escalating into child protection concerns.

Though the government is providing a £270m grant to implement the changes, the reforms come with councils under significant financial strain.

Guide ‘will help councils focus resources on what works’

Foundations’ head of practice guides, social worker Nimal Jude, said the latest guide would enable authorities to determine where to invest their resources.

“We are acutely aware of some of the workforce pressures and the wider financial situations that local areas are in,” she said. 

“It feels like this guide has come at such a crucial time during this transformation to family help, because you can really make some decisions about what things that you might want to scale back and what things that you might want to focus attention on, not least because you can now focus your attention with the full confidence that this is actually the best available evidence.”

The evidence base

The guide is based on two systematic reviews of the evidence around parenting support for families with multiple and complex needs.

The first, carried out by the Centre for Evidence and Implementation (CEI), in partnership with the universities of Oxford, Amsterdam and Monash, examined which interventions relevant to the UK, had the strongest evidence for reducing child maltreatment or improving child outcomes, along with what practice and delivery approaches contributed to success.

It examined 95 randomised controlled trials – where participants are randomly allocated into a group that receives the intervention and a control group – of 50 parenting interventions, finding:

• Small to moderate statistically significant effects on children’s emotional and behavioural problems, child wellbeing and parent-child relationships.
• Small to moderate statistically significant effects on promoting positive parenting (for example, appropriate disciplining, praise, warmth, and nurturing behaviours) and reducing negative parenting (for example, hostile parenting or laxness).
• Small statistically significant effects on parental mental health and reducing parental stress.
• Small but non-significant effects on reducing parental maltreatment and child abuse risk.

Strengthening parent-child relationships 

Based on the CEI’s systematic review, Foundations said there was “strong evidence” for the benefits of providing parenting interventions to strengthen parent-child relationships, and that councils should make these available to families with children aged 0-3.

It said these should be based on, and delivered by practitioners well-trained in, attachment and/or social learning theory (which posits that children learn through observation, including parental modelling). These staff should be able to observe and reflect on how parents respond to children’s cues and explore parents’ own attachment experiences.

The guide also said there was “strong evidence” for councils commissioning interventions to improve child behaviours, reduce negative parenting practices and improve positive practices.

Improving child behaviour and parenting practices

In relation to behaviour, key features shared by effective interventions were supporting parents in setting clear expectations and boundaries and promoting child-led interactions.

Promoting positive parenting can include practitioners taking on a coaching role, which requires them being skilled in coaching techniques and being able to build long-lasting, trusting relationships with parents.

The guide also said there was “strong evidence” that parenting interventions can reduce parental stress and improve mental health for those with mild-to-moderate problems.

Improving mental health

It said practitioners should be skilled in understanding the impacts of stress on parents experiencing adversity and should be given time to develop relationships with them, to enable parents to learn new skills and make use of feedback.

While the guide stressed that that parenting interventions were not sufficient to achieve significant changes to mental health, it said there was evidence they could improve parenting skills, even in adults with clinical levels of illness.

It said these programmes should involve practitioners offering guidance on child development and supporting parents’ abilities to manage their emotions.

Evidence ‘promising’ in relation to reducing harm

On reducing the risk of harm to children, Foundations said the level of evidence for parenting interventions was “promising”.

It said programmes that involved a fixed and structured series of sessions tended to be more effective in this area than those that were flexible.

The guide added that local leaders should examine the need to invest in these services for families with children on the edge of care and in the rollout of family help.

Vital importance of practitioners’ interpersonal skills

Alongside the CEI review, Foundations carried out its own systematic review of studies on the barriers and enablers to successful implementation of parenting interventions for families in adversity and on parents’ views, experiences and preferences in relation to these. This drew upon 33 studies.

Among two findings that had “high” certainty, based on the strength of the evidence, was that practitioner interpersonal behaviours were “essential to building trusting relationships and empowering parents”.

The review said parents valued practitioner characteristics such as openness, non-judgmentalism and encouragement, which facilitated the development of the trust that was “essential” in promoting change.

Building trust was supported by an initial home visit, communication outside of scheduled sessions, regular attendance from the parent and a consistent workforce, with parents highlighting the challenges of doing so when workers changed.

Recognising that parents’ and children’s needs are ‘intertwined’

The other finding that was deemed to be of high certainty was that both parents and practitioners value interventions that recognise “the intertwined relationship between parents’ practical and psychological needs and the needs of their children”.

Practitioners appreciated that supporting the parent, by focusing on their practical, social and emotional needs, was often the best way to help the child, with this approach welcomed by parents, the review said.

Based on its review, Foundations identified 12 principles for working with families in delivering parenting interventions:

1. Tailoring parenting support to ages and stages of child development.
2. Using strengths-based approaches to engage parents and offering parenting support across the system.
3. Ensuring that parents from minoritised ethnic backgrounds have equitable access to effective parenting interventions and that these are delivered in a way that fully meets
   their needs.
4. Understanding that parenting interventions work well for families where the parent has poor mental health, and, when delivered successfully, support parents to improve parent and child outcomes.
5. Prioritising face-to-face delivery of support.
6. Implementing both fixed and flexible delivery models to support a mixed local offer and prioritising more structured interventions to effectively reduce the risk of serious harm to children, directing resources where they are most needed.
7. Tailoring local programmes to meet the specific needs of families, offering both group and individual options to support engagement and provide parents with choice.
8. Focusing on careful implementation, effective delivery, and ongoing quality assurance to ensure the success of interventions.
9. That a strong local offer should start with a robust population needs analysis and involve place-based system leadership to develop a multi-agency offer.
10. That local areas should have effective referral routes into parenting interventions from a range of local services.
11. That effective parenting support requires a skilled and integrated workforce to deliver effective interventions.
12. Parenting support should form part of a wider system of support that strengthens the resources available to parents.

Councils have been handed a guide to what works in supporting kinship families, according to the current evidence base.

They have been urged to offer carers specialist support in navigating services and financial allowances, to help support permanency and reduce placement disruption, along with providing parenting programmes to support the wellbeing of carers and children.

The practice guide, from what works body Foundations, is the first in a series of Department for Education-commissioned publications designed to provide councils with evidence-informed guidance on meeting the outcomes in the DfE’s children’s social care national framework (see box).

The kinship carer guide was based on a systematic review of the evidence of what works in improving outcomes for kinship carers and children in the UK and similar countries, and of what UK carers value in the support they receive.

‘Limited but growing evidence base’

The Centre for Evidence and Implementation (CEI), which conducted the review, found that the evidence base around how best to support kinship carers was “limited but continuing to grow”.

Photo: Fotolia/aquarious83men

The research was strongest in relation to so-called kinship navigator programmes, which provide carers with specialist practitioners and information to help them access the support to which they and the children they care for are entitled. These are widespread in the US but have not been formally introduced in the UK, though the Kinship Connected programme, run by the charity Kinship, is similar, said the CEI.

The US studies analysed suggested that navigator programmes had small but significant impacts on the likelihood of children being placed in kinship care where a decision was made to remove them from the family home, and also on reducing the likelihood of placement disruption thereafter.

There was also some evidence, from two studies, of navigator programmes helping children to move into permanency, whether through reunification with their parents, adoption or guardianship.

Evidence for navigator programmes improving child safety and carers’ wellbeing, parenting skills and knowledge of services was more limited.

Navigator programmes ‘should be rolled out in UK’

The CEI concluded that the navigator programmes approach “holds promise” and should be rolled out and evaluated in the UK.

Based on this, Foundations’ practice guide says councils should “offer kinship carers specialist support to learn about, navigate and access the support that they are entitled to”, on the basis there was “good evidence” that this worked.

The CEI also found a small but statistically significant impact on permanence from providing financial subsidies to kinship carers who take on guardianship for children, based on five papers across three US studies.

However, it said the small number of studies meant this finding should be interpreted with caution, stressed the different context for permanence in the UK, compared with the US, and argued that more evidence was needed to examine stability and child wellbeing outcomes, along with legal permanency.

Call for councils to offer financial allowances

Based on this, the practice guide says there is “promising evidence” for councils to offer a financial allowance to kinship carers “to increase placement permanency, reduce the likelihood of placement disruption and improve the likelihood of permanent guardianship”.

Photo: Gourmet Photography/Fotolia

Currently, in England, the only kinship carers entitled to a financial allowance are family and friends foster carers. Those caring for a child under a special guardianship order (SGO) or child arrangements order (CAO) may receive a means-tested payment, though this is discretionary, while no specific provision from children’s services exists for informal kinship carers.

In its kinship care strategy, published in December 2023, the previous Conservative government announced it would pilot providing special guardians of former looked-after children with allowances equivalent to those received by foster carers, in eight areas from 2024-28, backed by £16m in 2024-25. The Labour government is yet to confirm whether it will take this forward.

Impact of parenting programmes

The systematic review also found positive impacts from parenting programmes for kinship carers on their wellbeing and that of the children they were caring for, along with on the children’s behaviour. However, the CEI urged caution based on the fact these findings were based on small sample sizes, while it found no evidence of impact on carers’ parenting and their relationships with children.

The CEI called for more “rigorous evaluations to be able to understand the efficacy of these programmes and other approaches for kinship carers and the children in their care, especially within the UK”.

In the light of this, Foundations recommends that councils offer parenting support to kinship carers when a child or young person is demonstrating behaviours that challenge their carer on a frequent basis, based on “promising evidence”.

Providing CBT, peer support groups and self-care training

The practice guide makes three further recommendations for authorities, also based on promising evidence.

Picture posed by models: Photo: Nullplus/Fotolia

It says authorities should make cognitive behavioural therapy available to kinship carers assessed as in need of therapeutic support due to, for example, the child displaying behaviours that challenge the carer, in order to reduce these behaviours.

This was based on a single study, which found a positive impact of CBT for carers on children’s behaviours. While this had a “fairly large” sample and low risk of bias, the CEI said further research was needed to replicate the finding.

The practice guide also calls for councils to provide cares with access to peer support in order to improve their wellbeing. The two relevant papers in the systematic review suggested a positive impact on carer wellbeing, but one had some concerns for risk of bias and used a fairly small sample and the other did not report effect sizes, said the CEI.

The practice guide also recommends offering kinship carers training in self-care to support their emotional health and wellbeing. This was based on three papers, for which the CEI found “some evidence of
promise”. However, it did not report high confidence in the findings because the strength and significance of the results varied significantly across the studies.

What kinship carers want in their support

The systematic review also looked at UK carers’ perspectives on the support they needed. While it said there was a limited research base for this in the UK, it found the messages for practice were clear and distilled  them into 10 statements, five of which it had “high confidence” in:

1. An intervention’s distinction from statutory services is perceived to facilitate engagement, favourable experiences and positive outcomes. The CEI found kinship carers felt more positively about support from non-statutory services due to prior negative experiences with statutory provision, including “a closed-door approach” and “sporadic and unreliable” from social workers.
2. Providing carers with access to a network of peers enhances an intervention’s acceptability and usefulness. Carers reported finding solace, understanding and practical support within these groups.
3. Carers value specialised support due to their unmet needs and the gaps in statutory services. Carers reported that social care and other services frequently underestimated the severity of their needs, lacked appropriate services to address them, or imposed eligibility criteria that families found challenging to meet. They expressed a strong preference for interventions tailored specifically to address the unique challenges faced by kinship families.
4. Carers value recipient-centred programmes. The studies found that carers appreciated support that was collaboratively designed, tailored and flexible.
5. Targeted interventions for kinship families were perceived as beneficial by both carers and practitioners. They reported that this benefited carers’ wellbeing and parenting skills.

Good practice principles

Based on the statements, Foundations’ practice guide sets out three key principles for working with kinship families:

• Support for kinship carers should take into account the specific needs and strengths of kinship carers.
• One-to-one relationships and high-quality casework should be at the heart of support for kinship families.
• Kinship families need to be made aware of the support they are entitled to, and local authorities should actively work to address barriers to accessing support.

Implementing the guidance

Alongside the practice guide, Foundations published a reflective tool, to help local authorities implement it. This advises councils to assess their current level of provision for kinship families, identify gaps and support and make plans to fill these, act on these plans and then review the impact.

In a blog post, the DfE’s chief social worker for children and families, Isabelle Trowler, said that Foundations would be working with a small number of local authorities to embed the guide’s recommendations and generate learning that can be shared more widely.

The guide also follows last week’s publication by the DfE of statutory guidance for councils on kinship care, which is an update of 2011 guidance on family and friends care.

The statutory guidance calls on councils to provide kinship families with a “local offer”, which “should be based on evidence of what works”, drawing on the practice guide.

Financial offer to carers

The local offer should set out the eligibility criteria for financial carers, the process for applying for this and circumstances in which means-testing will apply, while councils should draw up written agreements setting out the level and duration of any support given.

In response to this, Association of Directors of Children’s Services president Andy Smith said: “The guidance provides for each local area to design its own financial support offer. ADCS has advocated for these payments to be made via the benefits system to reduce our involvement in family life where there are no ongoing concerns or needs.”

National ambassador role

The publication of the practice guide and updated statutory guidance also follows the appointment of adultification bias expert Jahnine Davis as England’s first national kinship care ambassador.

National kinship care ambassador Jahnine Davis

One of her roles is to support and challenge councils to improve practice, which Trowler highlighted in her blog post about the new practice guide.