Bairns' Hoose Pathfinder Phase – Research Report

12. Recovery

This chapter examines progress towards Standard 9: Therapeutic recovery services, ensuring CYP and families receive timely and accessible therapeutic support.

Progress

There was a wide range in reported progress towards the provision of recovery support through Bairns’ Hoose. All partnerships except one had commissioned third sector recovery support through the Bairns’ Hoose in some form, with some having commissioned support specifically for sexual abuse. The partnership who had not yet commissioned at the time of fieldwork had dedicated time to mapping out all available supports before taking steps to streamline those services.

The third sector support services were viewed to have worked well to provide support beyond the statutory requirements of government agencies and improve the capacity for recovery support through the Bairns’ Hoose. In addition to commissioning third sector services, partnerships also made progress towards developing clear referral pathways to Child and Adolescent Mental Health Service (CAMHS). However, gaps remained in the type and scope of recovery support available to CYP and families across partnerships.

Once recovery provision was in place, support was well received by CYP and families. One partnership collected feedback from CYP and families accessing recovery support through a third sector organisation and found that all who provided feedback reported feeling “safer, better heard and having stronger relationships” (Pathfinder fund report). Areas with support provisions, without a formal feedback mechanism, also noted the high level of demand for support services and the positive reception from families and frontline professionals.

“We're actually struggling a bit for space at times, which is just kind of testament to how well the element of support has been adopted and accepted by the referring social workers and by the families.”

Partnerships described high standards of training and having highly qualified staff to deliver these services. Third sector support workers had received training in trauma-informed practice. In one partnership, the third sector partner had also received training through Speech and Language services to improve support for CYP with communication needs. In another instance, the third sector partner helped identify additional workforce training needs. CAMHS staff and specialist social workers were trained in trauma-informed therapeutic approaches. Another partnership held core training workshops on topics such as working with siblings and CYP that have been removed from homes.

Challenges

Limited capacity

Due to limited funding for commissioning third sector recovery support, the capacity to deliver support was constrained. In some cases, this materialised as limits on the length of time a CYP or family could be supported. In other cases, it was seen in waiting lists for services or limited follow up support for children and families who initially decline support.

“We'd have to get more money to run a general [recovery] service to be able to meet the needs of the people coming from [the Bairns’ Hoose]. So actually what we've done, […] we are providing a family approach which lasts for six sessions.”

This strain on service capacity was discussed as being potentially exacerbated by the delays in presenting CYP’s cases in court, which prolonged recovery timelines for CYP and families.

Third sector partners were also limited in the scope of support they could provide based on the organisations’ existing remits. For example, organisations may have focused their support on therapeutic support, family support, or specific recovery support for those who had experienced sexual abuse. Some organisations provided support to CYP, not adults, and sometimes support was restricted to particular age groups (e.g. CYP aged 12 and above). If an organisation secured funding to expand the scope of delivery, any change would need to be approved by the board of trustees. Due to these challenges, the provision of recovery support in some areas had gaps for CYP and families.

For rural partnerships, a further strain on capacity for recovery support was the need to travel long distances to provide support. Support workers sometimes spent several hours travelling to deliver one hour of face-to-face recovery support. Provision in rural areas also relied on recovery workers having reliable transportation and an appropriate location to conduct the session. These challenges limited support workers’ ability to manage a large caseload.

Recovery provided in the Bairns’ Hoose

Partnerships raised concerns that Bairns’ Hoose sites may not be best suited for ongoing recovery work. Regardless of how trauma-informed the interview process was, it was felt that there was a risk of re-traumatisation for CYP going back to the space in which they gave evidence and, in some cases, also had a forensic medical examination.

“It is pretty tricky to come back and do some therapeutic work in that same environment. […] Actually, the [Bairns’ Hoose] might not be the right place to bring a child back to. […] However trauma-informed you are, it’s still quite traumatic to go through any abuse and actually give evidence […] and so on.”

“Because that has been one of our big discussions right from the beginning, really, I think, about whether the therapeutic part is located within the same physical building or whether that is something that's offered elsewhere and outwith. And what's the impact on a young person or child coming back to the building where, you know, they've had an examination.”

Furthermore, accessing recovery support in the Bairns’ Hoose may not always have been practical for CYP and families in remote or rural areas who needed to travel long distances for recurring visits. Partners felt that the barrier that travel posed may have discouraged some CYP and families from accessing the support they needed. This challenge was also raised by urban partnerships, where travel may have been complicated or time-consuming, particularly for families without access to a car.

Timing of recovery support

One risk identified was that some CYP may not have been offered recovery support depending on when the need for recovery support was assessed. For example, if need was only assessed after an interview, CYP and families who did not require a child protection response, but who may still have benefited from recovery support, would have been missed. Alternatively, if the need for recovery was assessed at the point of the interagency referral discussion, even CYP and families who it was determined did not require an interview, could still have been provided with links to any recovery support they needed. As they were shaping their recovery offer, partnerships were taking into consideration what it would look like for support to be offered at the earliest possible stage, to the widest range of people.

“We know we need to look at and develop further Standard 9 and the therapeutic recovery services and what that can look like for our children, not just the children who go into the child protection process, but also some of the families and children where they don't. Are we actually meeting their needs where we've identified there is a need to be met? They might not require a response under child protection but still might need support with trauma and recovery.”

Commissioning third sector services

The process of commissioning a third sector organisation was raised as a challenge due to the lengthy timelines needed to complete the procurement process.

“I think one of the directions that we've taken has been around the support and although it took us ages to get that up and running, people don't really understand how long it takes to actually get these things in place. You can't just go out and say, ‘I'm going to give you X amount. Can you do A, B, C and D?’. There's a whole commission process, it's all legal, it's all very kind of T's crossed and I's dotted”

Procurement was made more difficult due to the funding for Bairns’ Hoose being annual. For example, one partnership decided not to proceed with a potential partnership with a third sector organisation after a long period of consultation. Due to the annual funding structure and lengthy procurement timelines, they did not have time to find a new partner during the financial year and had to wait until the following year to start the process again.

Additionally, it was a challenge to commission support services as a multi-agency collaboration. Partner agencies had to pool resources across several agencies to commission a third sector provider, even though a single agency did the actual commissioning.

Facilitators

Role of third sector organisations

Despite these challenges, third sector recovery support was described as working well alongside support provided by government agencies because the provision could go beyond the legal remit. While CAMHS and social work may have been limited to providing support that met the legal requirements due to funding and capacity restrictions, third sector organisations could complement the provision with long term and additional support.

“It's fast paced, you don't have lots of downtime in between referrals and you're moving on to the next child. But what [third sector organisation] have done is they've offered a wraparound service so that, while we are doing our bit, which can feel quite clinical, quite cold, quite process driven, [third sector organisation] can do the nurturing, supportive role around the family that we might not be able to offer or we want to offer but maybe don't have capacity to do so.”

Family support

One partnership found that the provision of family support, in addition to therapeutic support, gave families a point of entry to services that felt more accessible. They found that families who were not ready to take up therapeutic support were more willing to accept family support. This was particularly true when the support provision was independent and separate from social work, which had a statutory role.

“Our experience is that families are not often ready to pick up therapeutic support. […] There's a whole process to get their heads around and sometimes these families or children, are not ready for a very long time. […] So even if we think we need to be involved and we know that, if support doesn't go in there, they're coming back to us in two months’ time or three months’ time, there's not much we can do because we have no legal remit. And so we thought, ‘Well, okay, let's try family support. A support that's not social work, that's independent, it's what families want’.”

Coordination of support

Partnerships took several different approaches to coordinating the provision of recovery support services among partner agencies and third sector organisations. One approach was to employ a Bairns’ Hoose coordinator whose role was to help coordinate referrals to third sector partners. In one case, this coordinator was positioned within the third sector organisation providing recovery support. The Bairns’ Hoose coordinator attended interagency referral discussions, allowing for insight from an early stage into which CYP may have needed further recovery support. However, since the coordinator was based in a third sector organisation, attendance at the discussions and information-sharing protocols were not automatic and needed to be created.

Coordination across agencies was also developed by creating a recovery subgroup which improved multi-agency collaboration. Another strategy was to improve the coordination with the SCIM team by co-locating recovery support workers at the Bairns’ Hoose (see Chapter 6).

When coordinating support for CYP and families, three partnerships sought to create a single point of contact for families to access recovery support and advocacy. This ensured CYP and families knew who to contact for questions and support. It also ensured a professional was responsible for following up with CYP and families to make sure they received the support they needed even in long-lasting cases. In cases where families didn’t already have a designated social worker, third sector Advocacy, Rights, and Recovery workers became their single point of contact. However, more work needed to be done to formalise the process of appointing a lead professional as a single point of contact and to clarify the expectations and requirements for the lead professional.

Another strategy to make sure CYP and families did not get ‘lost’ after initial contact was to create a booking system with scheduled follow-up touch points. One partnership created a booking system with touch points three to six months and 12 months after accessing the Bairns’ Hoose. At the time of completing StART2, this system had not yet been tested.

Finally, while concerns were raised about timing of recovery support, there were some positive learnings around this too. When recovery support was considered at the interagency referral discussion, families could be given another option for support from the earliest stage of involvement in Bairns’ Hoose.

“And my team have said to me quite directly is that for the first time ever, they feel like they've got something different to offer families at the IRD [interagency referral discussion] stage.”

Participants raised the importance of considering the timing and location of recovery support from the start of creating a Bairns’ Hoose. By mapping out recovery services and understanding families’ needs, recovery support could be designed to suit families’ best interests, rather than operating as an afterthought following an interview.