Child poverty pathfinders - early implementation process: evaluation

Chapter 5: Delivery of the Pathfinders

This chapter begins by discussing the progress made toward systems change. Section 5.2 then discusses the barriers and facilitators that partners and stakeholders describe in relation to creating and maintaining a 'joined-up system'. It then discusses the new access routes that have been created via the Pathfinders. Within these two sections (section 5.2 and 5.3), the strengths and weaknesses of delivery at a local level are explored, and insights are provided in terms of what is considered to be working well, and what could be improved. Section 5.4 then discusses perspectives on the sustainability, replicability and future scalability of the Pathfinders.

Chapter summary: Delivery of the Pathfinders

What progress is considered to have been made toward systems change?

The pace of change has differed between Pathfinder sites at the very beginning of early implementation. In Dundee pressure from an initial 'rush to action' created early barriers to partnership working and systems change, although this is reducing over time. In Glasgow initial action on system change has been slower, with more time given on planning project aims and governance arrangements.

In both Pathfinder sites, there is a sense now that systems change is becoming embedded. Activities have begun to align and there was a sense that this collaborative approach was helping to reduce the barriers parents/carers were facing when seeking support. Where these ways of partnership working and partnership alignment were ocurring organisational culture change was seen as important in embedding system change outcomes in the longer term.

What changes have been made to facilitate the alignment of services, and how has this created new access routes?

Although the approaches taken in each Pathfinder differed, both approaches appeared to be underpinned by a triage and navigation approach where holistic conversations and signposting ar ekey to enabling person centeed support.

In both Pathfinders, the continuity of support is seen as important in the alignment of services. This supports a person-centred approach where families have a key contact and do not need to keep repeating their story or go looking in lots of different places for support. This approach enables better alignment between services and faster access to support for service users.

What are some of the barriers and facilitators to creating a 'joined up' system?

Many of the barriers faced to creating a 'joined up' system relate to partnership working, which is discussed further in chapter 4. Key barriers included defensiveness from partners and stakeholders about their own role; overcoming silos; having the space to test new ways of working; a rush to action without adequate time for planning; and apprehension about the scale of the task within such a complex child poverty system.

Factors which enabled better joined-up working included creating opportunities for people from other organisations to build relationships, enhanced awareness of the different support offered, development of clear aims and communications strategy and the development of clear workflows, processes and activities.

What are partner and stakeholder's perspectives in relation to the future of the Pathfinders?

All partners and stakeholders felt that it was too soon in the implementation process to know whether the Pathfinder would be sustainable in the longer term, and whether it would be able to be scaled and replicated in other areas.

Key barriers to sustainability were felt to be around continued funding challenges and having robust monitoring and evaluation in place to be able to evidence impact. It was felt that decisions on continued funding needed to be based around an understanding that systems change is a long term process and it will take a while for any outcomes to be fully realised and evidenced. Scaling up any approaches was also seen as requiring significant additional investment.

While there has been progress toward creating a more joined-up system, much of the change to date appears to have been reliant on the development of enhanced partnership working. While developments to date have been positive, this raises some concern about whether change can be sustained via informal agreements or whether there may be a need for more formal structural change to sustain benefits gained to date.

When asked whether the Pathfinders could be replicated in other areas, several partners and stakeholders mentioned that it was the concept of working together across organisations to deliver person-centred support that would be replicable, where the model itself would need to be adapted to suit the locality.

5.1 Progress made toward systems change

This section explores the extent to which partners and stakeholders felt that systems change was beginning to be achieved during the early development of the Pathfinders.

In both sites, partners and stakeholders conveyed that some progress was being made toward systems change. A few felt that the pace of change had been slow, as it had taken time to build effective partnerships between services and organisations. One partner held the view that some of the barriers to achieving change arose from departments within large councils still tending to work in silos, and so some of the early work of the Pathfinder had been about trying to get multiple council departments to work together. Multiple partners and stakeholders, in both sites, stated that the process of embedding change had been a difficult one so far, as there was a tendency for organisations and individuals to want to do versions of what they had always done. Despite these challenges (outlined in more detail in chapters 4 and 5), most partners and stakeholders were of the view that there were early signs that systems change was beginning to occur. Much of this related to new ways of working, such as the keyworker approach that had begun to be established in both Glasgow and Dundee, where the first person to triage a family (either by telephone or face-to-face) would assess wider needs and remain alongside the family until they had begun to engage fully in support, or until their needs were met, depending on the circumstances. These new ways of working are described further in section 5.2. The shift from operating as a single organisation to being part of a multi-agency team, working towards a shared aim hints towards the beginnings of change in working behaviours and relationships, which many partners and stakeholders felt would be the foundation for lasting systems change.

Much of the systems change described by partners and stakeholders related to a growing awareness of other organisations, and the people working within them. Many partners and stakeholders felt that it was relationships between people that was contributing to systems change. A few partners expressed concern about relying on the goodwill and motivation of individual people to bring about systems change, since people move to other roles from time to time and connections can be lost. Others, however, felt that working more closely with people from other organisations as colleagues and partners had led to new ways of working that over time, with support, could contribute to broader cultural changes within workplaces and organisations. Some partners and stakeholders felt that now that they could see the benefits of working in this partnership-based way to share resources and create new access routes for people, they could not see themselves returning to previous ways of working. For the stakeholder below, there was the sense that the partnerships formed via the Pathfinder would contribute to systems change.

"When we first came in, we all worked separately. Now we are a partnership, we do what needs to be done. People are working out of their comfort zone. The sense of team has overtaken job titles now. I'm so pleased it's like that – I've never seen it before... proper partnership working." (Dundee stakeholder)

This quote also speaks to the increased job satisfaction that several stakeholders described having come from 'proper partnership working' and seeing the difference this could make in the lives of those seeking support. In the Dundee drop-in hub, co-location of staff from multiple organisations seemed to be helping with this sense of having achieved lasting systems change. The motivation to maintain effective partnerships and an improved system seemed to be increased by the in-person nature of interactions, where the same families would visit regularly, enabling staff to build up relationships, continuity and a sense of contributing something positive to the community. In both sites, however, the journey toward systems change was described as being a process that was still ongoing. A Glasgow Pathfinder partner describes this in the quote below.

"I'm comfortable with where things are at the moment… A couple of months ago we had lots of opportunities, and we were missing them – now we can pick these up and that's because we now have a team in place and we are clear on the roles and their remits." (Glasgow Partner).

The above partner went on to say that being clearer on each other's roles and remits had strengthened partnership working, which was beginning to contribute to systems change. This appeared to have been further strengthened by the appointment of a dedicated project manager, who had developed a clearer strategy, work flows and workstreams.

5.2 New access routes

In both Pathfinders, partners and stakeholders told us that improving access to services was a key focus of all Pathfinder activity, and core to the aim of joining up the system as part of the overall aim of reducing child poverty.

Partners and stakeholders told us that the Pathfinder had meant that support could be accessed through a growing number of organisations, who were joining together to offer new routes and pathways. For example, people may present themselves through an early learning establishment, Jobcentre Plus, council locations, a healthcare service, or direct and would be given support to access a broad array of services to meet their individual needs.

In both Pathfinders, partners and stakeholders discussed efforts being made to provide new access routes by triaging people and providing keyworker support to navigate systems to reduce the barriers people were facing to accessing and receiving support. We refer to this in the current section as a 'triage and navigation approach'. What we mean by this is that the initial staff member who meets with the family assesses their needs, and stays involved until these needs are either addressed, or until another service begins working with the family. In both sites, partners and stakeholders described the challenges posed by this new way of working. The challenges of providing new access routes were discussed in two ways. First, stakeholders discussed the need to work out what the needs of parents/carers were, to ensure that they made the right referrals. Many described feeling motivated to make a difference in the lives of individuals by being able to connect people quickly and effectively to the right services, developing new access routes based upon each staff member's developing network of local contacts.

The qualitative findings suggest that a key aim of the Glasgow Pathfinder is to ensure that the citizens of Glasgow are offered a holistic needs assessment to gather the support their family needs. Several participants told us that if a family does not want or need ongoing support, they will focus on the immediate support they require and the families will have the option to come back to the service at any time.

One service provider in Glasgow described the 'Glasgow Helps' phoneline, which was considered to be a good example of the 'no wrong door' approach that Pathfinder partners were trying to establish across the city. The stakeholder quoted below noted that their service had received less referrals than they had initially expected after learning of efforts being made to create new access routes. They queried whether the skill-mix of staff answering phones at the Glasgow Pathfinder was sufficient to identify the needs of families, and identify the most appropriate services to help them.

"…it's about how much do you need to upskill your staff when it's a generalist service? They don't need to know everything, but they need to know something. They have to be able to get to the crux of the matter pretty quickly." (Glasgow stakeholder)

A keyworker approach was also being used in Dundee to create new ways of accessing services. The Dundee drop-in hub was considered by many stakeholders to be a good example of the new access routes being developed. The drop-in hub was considered to be an effective way of enhancing access to services because it was staffed by local people who were developing strong local networks because of their connection to the Pathfinder. Two formal keyworkers had been appointed in Dundee, who's role was to help families to access the services they needed. This was seen as being a new way that services could be accessed. The relationships that were developing through the Pathfinder and through the hub were also seen as strengthening the system, creating new and different access routes, in which people were using the relationships they had with staff in other services to act as informal keyworkers, supporting families to access other services.

Although a drop-in hub model had not been implemented in the same way in Glasgow, there were similarities in terms of the triage and navigation approach described. Several partners and stakeholders involved in the Glasgow Pathfinder noted that they were using a single point of contact approach where no matter what service or staff member received an initial request for support, the same person would stick with families until they had the support they needed. In both Pathfinders, one member of staff taking responsibility and remaining alongside the family as they navigated through the system was seen as being beneficial and a key part of the new approach to accessing services that was being established through the Pathfinders. Many partners and stakeholders in both sites asserted that this was important because it was providing continuity and avoiding the need for people to tell their stories to multiple different staff and organisations when seeking support. One stakeholder, however, expressed some concern about this new way of working and raised questions about whether frontline staff from different organisations would be knowledgeable enough to identify diverse needs, and whether they would be connected enough locally to know how and where to access the right support for people.

In the Glasgow Pathfinder interviews, participants who held senior strategic roles within the Pathfinder tended to focus on steps being taken within Glasgow City Council to enhance inter-agency, multi-professional referral pathways as part of a whole systems approach to reducing child poverty. When asked about the new access routes the Pathfinder was creating, stakeholders who were involved in local service delivery tended to discuss the Glasgow Helps model, and referred to this as a valuable example of how Pathfinder activity was being used to create a 'no wrong door' approach. Most partners and stakeholder interviews, however, reflected that Glasgow Helps was only one aspect of the Pathfinder.

When discussing the Glasgow Helps phone line in more detail, several stakeholders told us that the phone line was open to anyone with a Glasgow postcode. Despite this, most felt the service was successful in reaching many families experiencing child poverty, and reported that the majority of callers did have a child.

5.3 Barriers and facilitators to maintaining a 'joined-up' system

In this section, we discuss the barriers and facilitators that Pathfinder partners and stakeholders have experienced during the early implementation of the Pathfinders in both sites. As explored in previous sections, creating a 'joined-up' system was a key aim of both Pathfinders, and because of this, elements of this section have been touched upon in chapter 2 which discussed perspectives on Pathfinder aims, and in chapter 4 which presented the perspectives of partners and stakeholders in relation to partnership work. To avoid duplication of points made in previous chapters, the current section is brief, and provides key points to consider in relation to progress made in creating a 'joined-up' system.

The barriers to creating a joined-up system were considered to be:

• Defensiveness from partners and stakeholders about their own role, and the organisational role. As discussed previously, initially some partners had felt unable or unwilling to let go of parts of their own role and there was some initial reluctance to allow lines of responsibility to blur enough to come out of organisational silos and test new ways of doing things.
• A lack of scoping work during the initial phase in the Dundee Pathfinder, where there is a perception activity began before there was a full realization of the services already being provided in the area.
• Apprehension from some partners and stakeholders when faced with the scale of the challenge, with tackling child poverty seen as such a large task within a complex system.

Facilitators to maintaining, and building, a 'joined-up' system include:

• Developing collegiate relationships between people from different organisations.
• Enhanced awareness of what is available, where and how to access support.
• Development of clear aims and a clear communication strategy.
• Development of clear workflows, processes and activities.

The qualitative findings that relate to the above points are explored in greater depth in chapter 4, Section 4.5. We now contextualise these findings with a brief discussion on the partnership scorecard data. Approximately half of those who took part in the partnership scorecard agreed that there had been some success in joining-up actions and resources for greater impact. Some felt that there had been limited success to date. One felt that there had been substantial success in joining-up the system. As stated previously, however, the low scorecard response rate means that these findings cannot be read in isolation as they may not be representative of the views of many. Instead, these findings provide a snap shot that helps to contextualise the more detailed qualitative findings.

In the interviews, partners and stakeholders were asked to outline what factors had been successful in creating a 'joined-up' system. While generally partners and stakeholders in both sites felt that progress was being made, all felt that there was still a long way to go before the system of services and access routes could be considered 'joined-up'. Most felt, however, that there was the sense that Pathfinder aims and activities were beginning to align and this linked to an aforementioned theme where many expressed feeling a sense of hope, optimism and progress. In Glasgow, however, many respondents noted that the scale of child poverty was so large that it was not possible to envisage a day when it had been tackled in full. This points to a potential barrier around creating and maintaining motivation across partners and stakeholders delivering systems change at scale in the face of challenging external circumstances and perceived scale of the challenge. Joining up systems effectively, however, was seen as something that might be more achievable in time than the overarching aim of making meaningful change to the numbers of children living in poverty. This suggests that ensuring aims seem achievable and realistic to delivery partners and stakeholders in the shorter term is important in making progress towards the longer term strategic goal of reducing child poverty.

5.4 The future of the Pathfinders

This section explores the perspectives of partners and stakeholders concerning the potential scalability, replicability and sustainability of the Pathfinders.

When asked about the extent to which they considered the Pathfinders to be scalable and able to be replicated in other areas, all partners and stakeholders shared the view that it was too early in Pathfinder development to be able to answer this question fully.

Foremost in people's responses was the issue of funding commitments. Participants from both sites felt that the Pathfinders were expensive to deliver, and for replication or scale-up to be possible, the Pathfinders would need to be cost efficient. Most expressed that there was a need to ensure that monitoring data was being routinely collected to enable evaluations and to support cost-benefit analysis. Many felt that it would be necessary to examine long-term outcomes before it was possible to say whether the Pathfinders were delivering sufficient results to support a case for them to be sustained in the long-term.

One participant in Glasgow was of the view that a model like the Pathfinder would take a long time to establish, and that it should be given 5 to 7 years, to embed, before its long-term impacts could be evaluated. A few partners in Dundee also expressed their concerns over the timing of the current early process of implementation evaluation, as they felt that it was too soon to be able to identify impacts. This related to the view that for the Pathfinder(s) to be scalable, they would have to evidence being cost-efficient. Many felt that it was too early in the implementation process to be able to assess the costs, compared to the benefits achieved.

For the Pathfinders to be able to be replicated, many felt that there would need to be flexibility in terms of how it was implemented in different areas. Some felt that it was the principles and the vision that could be replicated, rather than the models used. Several partners and stakeholders mentioned that it was the concept of working together across organisations to deliver person-centred support that would be replicable, where the model itself would need to be adapted to suit the locality. Despite the current delivery models of a telephone line in Glasgow and a drop-in hub in Dundee, some partners and stakeholders expressed that a sparsely populated rural area might better suit a telephone service, while an urban area might prefer face-to-face services including drop-in hubs. As such, the actual execution would depend on local needs and resources, and this demonstrates the importance of the local context.

When partnership scorecard respondents were asked about sustainability there were mixed responses as to whether investment had been made in ensuring this across both sites. Six respondents agreed that some partners had made some investment in developing sustainable interventions that aim to reduce child poverty beyond the end of the Pathfinders. A lower number of respondents, four in total, felt that this was only the case for a few partners. Three respondents concurred that across the partnership most partners had made reasonable investment in developing sustainable interventions which aim to reduce child poverty beyond the end of the projects. These responses were mixed across the two Pathfinder sites.

An alternative view was provided by one Dundee Pathfinder partner who suggested that there would need to be formal structures in place to connect services and provide support, at scale. Current barriers and facilitators to the alignment of services in Dundee, in particular, were described as including being reliant on informal relationships between people working within services. While this was creating benefits, the partner expressed some concern about the extent to which this could be sustained via informal agreements, which they described as being 'workarounds' rather than formal structural, or systems, change. As explored in chapter 4, the establishment of relationships via the Pathfinders had taken a considerable amount of time, and it is likely that these relationships would require time to continue to develop and flourish. This has implications when considering scalability, and hints at a need to consider the financial resources and incentives that organisations may require to continue working in this way and avoid 'slippage' back to the way things were before. This suggests that providing person-centred support in this way, at scale, might be challenging.