Whole Family Wellbeing Funding (WFWF) Programme - year 2: process and impact evaluation - full report

6 Outcomes and contributing factors: children, young people and families at the centre of service design

This section explores the extent of achievement of the outcomes intended by the WFWF component involving children, young people and families at the centre of service design. This component emphasises the importance of family services that are designed based on the needs and rights of local families, are co-designed with families, and that involve integrated support pathways that are easy for families to navigate.

Key findings

• Family services managers and practitioners developed skills in family engagement and co-design for individual services. Enabling factors included staff training, dedicated roles for family engagement feedback collection, and integrating family consultation into service frameworks.
• CSPPs demonstrated ongoing family engagement, using feedback to improve individual family support and services. Enabling factors included multiple feedback channels, lived experience representation on advisory groups, practitioners embedding feedback conversations into daily practice and leveraging families’ relationships for collecting feedback.
• There was limited evidence of family engagement and co-design being used to inform broader service design (beyond individual services). Families also felt their feedback directly influenced their own support but were less aware of its impact on broader family support service design in their area. More work was needed to ‘close the feedback loop’ ensuring families see how their input shapes available support.
• Children, young people, and families who were interviewed through the evaluation and had accessed WFWF support, appreciated the non-judgmental, stigma-free support they received. However, there was a lack of secondary data to corroborate their views and show that CSPPs were also actively monitoring services being stigma-free. CSPPs may need help with monitoring perceptions of stigma. Enabling factors included third sector delivery of support, rebranding service names and descriptions, and practitioners’ empathy and adaptability.

Outcomes: Family services managers and frontline practitioners develop engagement, feedback collection and co-design skills, and collate and analyse service design feedback

There was insufficient evidence to draw a confident conclusion about the achievement of this outcome, based on interviews with family services managers and frontline practitioners, and WFWF annual reports.

Family services managers and frontline practitioners shared lots of evidence of developing engagement and collection systems to gather feedback from families on individual services they used. Information collected was typically about what was working well and less well, and suggestions for improvement. CSPPs provided limited evidence of analysing and using feedback on system-wide family support (beyond individual services) to inform service design. This was partly due to challenges with CSPP analytical capacity and capability, as discussed in Section 8. However, many CSPPs were developing initiatives aimed at improving the collection, analysis, and use of feedback across family support.

Most CSPPs used questionnaires, feedback forms, focus groups and one-to-one discussions, and drop-in feedback sessions with frontline practitioners, to engage families in the design of individual services. Depending on the nature of the support or the families being consulted, this was undertaken by local authority or third sector practitioners already known to the families, or by practitioners involved in delivering the support. Examples included:

• East Lothian’s library support staff used drop-in participation sessions to gather young people’s feedback on their use of the library, and how they want to use it.
• East Ayrshire’s The Promise Team facilitated a ‘Hackathon’ as a means to engage young people with involvement in the justice system and provide the opportunity for practitioners to ask about young people’s experiences with being in mainstream education, having secure housing and being connected with their community.
• South Lanarkshire staff used mind mapping in its teen group to capture feedback from young people on what activities and support they would value most.

Strategic leads and managers often described efforts to train staff in co-design with families, recognising the importance of giving children, young people, and families a voice. For instance, a third sector partner in Fife was developing an accessible co-design process, which was being evaluated by an independent reviewer. This process was being used to address issues with disconnected services and families' difficulty in accessing them.

"We're quite hopeful that this will lead to a different relationship between service users and service provider, you know, and people will feel as if they have a role in the service that they then ultimately end up consuming and not just that things are done to them... we're hopeful that the independent evaluation will give us really powerful learning that we will be able to roll out across services."

Strategic Lead

Factors enabling the outcome

Three factors enabled this outcome: staff training, hiring staff dedicated to family feedback collection, and including family consultation in quality assurance or service operating frameworks.

The first factor enabling this was that some CSPPs used their WFWF allocation to deliver training on family engagement, consultation and co-design to frontline practitioners. This was commonly delivered by third sector partners.

The second factor related to recruitment was that CSPPs created posts or hired more staff into posts dedicated to engaging families in providing feedback and to use that feedback to improve the support relevance. East Lothian created the Community Officer role, with the responsibility to review services, including capturing feedback from families throughout their support journey. Their role led to changes in service design, including an increased number of families attending drop-in support at a local library, and revising the service ethos to be less judgemental. Fife created the Homemaker role, discussed in the Spotlight below.

Figure 11 CSPP Spotlight: Fife

Fife’s Homemaker role empowers families to feedback, then coordinates adaptations to their support.

The Homemaker role within Fife’s Family Support Service was a small pilot of a practical, hands-on position that focuses on providing direct assistance to families who are facing challenges in maintaining a stable and supportive home environment. The responsibilities include practical home, life skills, parenting support, emotional support and crisis prevention. A key responsibility was collaboration with other services, through weekly multi-agency meetings, to ensure the changing needs of families are understood and quickly responded to by the most appropriate service. It was this feature of the role that supports family support staff to engage with families and to use that to inform relevant support. Key skills for staff included active listening and emotional validation, confidence with flexibly adapting support to the changing needs of families, and multi-agency communication:

“Homemakers can be put in difficult positions when families are discontent with the care provision being provided. They need to be seen to be listening and acknowledging the frustrations as well as feeding that information up.”

Frontline practitioner

Practitioners discussed the role of the Homemaker to enable families to feedback.

“This family in particular said [that they] never really had a voice. They were scared of professionals but the Homemaker coming on board started that train whereby they felt respected and listened to and became very open in their communications...She absolutely is supported to feedback and as the weeks went on they were able to do that more and more, which was nice to see.”

Frontline practitioner

The learning from this pilot will support service redesign, with a view that family support workers continue to provide this type of support for families.

The third enabling factor was that CSPPs were looking to embed family consultation and co-design into their quality assurance and service operational frameworks. For example, including family consultation as criteria in a framework, and detailing the standards and procedures for family consultation. Strategic leads interviewed expected this to contribute to more consistent family engagement across services, that informed service design.

“We're building that into our core quality assurance stuff that we’re doing as a partnership…it is very much about interviewing staff, about understanding that data and what that’s telling us, but it’s also very much that tripartite approach in terms of what are we hearing from the people we are delivering services to.”

Strategic Lead

Factors limiting the outcome

Limited evidence was available for factors limiting this outcome. A factor cited by managers and practitioners was staff capacity to engage in training and guidance, and to put it into practice.

Outcome: Children, young people and families are actively, regularly and meaningfully engaged in service design

This outcome was assessed as being partly achieved, based on strong and consistent evidence from interviews with frontline practitioners, and children, young people and families, and WFWF annual reports.

While CSPPs evidenced ongoing family engagement and using this to inform both individual families’ support and individual service improvement, limited evidence was available of CSPPs using this feedback to inform system-level service design (beyond individual services).

Across all CSPPs, children, young people and families were supported to feedback on their experiences of individual support they were involved in. This was primarily through informal conversations with practitioners that supported them, and they often preferred this over other formal feedback methods like filling in a form or survey.

"She [practitioner] tries new things and then you kind of chat about how that's working and if it doesn't work then you try something else, and if it is working then great."

Child

Factors enabling the outcome

Four factors enabled families to engage in service design: multiple feedback channels and being asked at multiple time points in a family’s support journey; including lived experience representation on advisory and leadership groups; encouraging practitioners to embed conversations with families about their support experience into day-to-day practice; and leveraging existing relationships with families to collect feedback.

The first factor related to how CSPPs support diverse families, with different communication styles. CSPPs that used multiple communication channels across multiple time points in families’ support journeys captured better quality information more regularly.

"They've got opportunities to feedback, whether it's at the start and it's around design and the support that they receive or it's throughout with their worker or it's at the end with a kind of participation officer and recognise the available support."

Strategic Lead

The second factor was lived experience representation on advisory and leadership groups also supported regular family engagement, especially where those people had responsibilities for peer consultation. This was described as the ‘See One, Do One, Teach One’^[14] approach, which helped to expand the capacity of the CSPP to regularly engage families in feedback.

“They’re lived experience [members] going to be going out and doing area mapping and consultation with their peers as part of that."

Manager

The third factor that enabled this outcome was that practitioners regularly captured family feedback by embedding conversations with families about their experience of support into their day-to-day practice.

"He [family practitioner] does sometimes evaluate things with me. He'll say was that helpful, do you think we could do something differently next time."

Child

"It wasn't only about the [feedback] forms - they [practitioners] were asking even when we had the cycling; we had like half an hour going outside on the cycling and they were like, how do you feel, are you OK, do you need anything? They were really supportive."

Parent

The fourth factor related to how CSPPs were better able to regularly engage families in feedback by leveraging families’ existing relationships in the community. For example, practitioners known to families sent requests for feedback, through surveys or forms, which improved response rates.

“What we learned is that you have to use your local networks that you have so linking in with the family outreach workers and then to contact families directly through colleagues that have a good personal relationship because actually just to send a link out through an e-mail ...is a very tricky way to get feedback I think for particularly for vulnerable families that are maybe really busy or just maybe wouldn't normally engage in things like that.”

Practitioner

Factors limiting the outcome

Factors limiting regular family feedback in service design included families feeling their input was not necessary, timing of feedback requests, and cases where practitioners had no direct contact with the families, they were trying to get feedback from.

The first factor limiting regular feedback was that some children, young people, parents and carers felt their views were not needed or valued, especially when they have not been consulted on their views before.

"One of the traditional barriers is that the families we work with would not traditionally see themselves as the type who would be part of this [feedback] process, particularly with young people. They expect a certain cohort of young people to participate in consultation events, or even to be asked their opinion to be honestly. So, it's still a learning process for them to understand the value in their voice and how they can actually use it."

Manager

The second factor was that capturing feedback at certain times can limit the volume and detail of the feedback, such as when families are experiencing crisis.

"In periods of crisis, it is harder to get feedback from families because there is not time for this, and priorities are to respond to the crisis and de-escalate this." Practitioner

The third factor related to the challenges of capturing feedback in situations where it was not mandatory or where practitioners had limited contact with families. For example, collecting parental feedback on school-based support can be difficult if the service does not have direct communication with the parents or carers.

"The school-based Pathfinder is mostly with young people, and we get their feedback, but we are not getting feedback from parents. There are general discussions, but the convo doesn’t get recorded anywhere. It needs to be recorded."

Practitioner

Outcome: Children, young people and families say that services are designed to be: free of stigma; rights-led; and to meet their specific needs

This outcome was assessed as being partly achieved, based on strong and consistent evidence from interviews with frontline practitioners, and children, young people and families. There was less clear evidence of services being stigma-free and that CSPPs were monitoring this from the secondary data. While CSPPs said this monitoring was happening, they did not share sufficient supporting evidence. This suggests CSPPs may need support with monitoring and reporting on perceptions of being stigma-free in their delivery.

Children, young people and families interviewed were positive about the lack of stigma and the non-judgemental approach in the support they received.

“You feel really comfortable to kind of say anything…like you're not going to get judged by either [practitioner name] or the other worker there, or by the people around you.”

Young Person

Children, young people and families across case study CSPPs felt that services were designed to meet their needs. For example, a child supported in South Lanarkshire felt the practitioner “kind of just knows what to do," for example walking him to class when he needed it.

In South Lanarkshire, a parent also felt that the support adapted well to the changing family dynamics, which may have been missed if a whole family approach was not used.

"I think that's why it being family support is quite important because dynamics change in a family, everyone has different needs at different times...I only asked for help for one specific thing so if they had just kept to that route, they wouldn't have been able to identify all the other things for other people."

Parent

Factors enabling the outcome

There were four factors enabling this outcome: third sector involvement reducing the stigma associated with social work; changes to names of support; increasing the appeal of the physical space that support was provided in; and practitioners’ knowledge and experience.

The first enabling factor reported was that support delivered by third sector organisations helped families to shift their views of family support away from social work associations. For example, in Aberdeen, practitioners described families being more willing to engage in support because they were less worried about being stigmatised for having social work involvement, or worried about what might happen more formally if children’s services were involved.

“Families are not engaged in social work or addiction social workers because they're terrified, they're going to lose their bairns. They engage much better with [organisation name], who are a third sector organisation. The stigma's not there.”

Service Manager

Figure 12 CSPP Spotlight: Aberdeen City

Third sector partners (Children First, Barnardo’s and Sports Aberdeen) deliver support and remove the association with social work intervention.

Third sector organisations like Children First, Barnardo's, and Sports Aberdeen are playing a critical role in supporting children, young people and families by providing therapeutic services and reducing the stigma associated with social work intervention. By building trust with families and connecting them to relevant services, these organisations ensure that support was both accessible and timely, while removing the fear of being judged or labelled.

Frontline practitioners have noted the impact of these third sector partners in empowering families to access necessary resources with less hesitation. This approach has fostered trust and increased awareness of available resources (amongst children, young people and families, as well as staff members), leading to a more comprehensive support provision and ensuring families feel empowered to seek help.

The second factor was that changes to services’ names and support descriptions also helped to destigmatise family support access. For example, referring to ‘family support’ instead of ‘family services’ and describing support as ‘hubs’ or ‘centres in the community’ were less imposing to families.

“They're [families] all saying the same message: sometimes it's less stigmatising when we can get that support, and it doesn't feel like a social work intervention.”

Strategic Lead

The third factor was that the physical space in which families accessed support was important to families perceiving support as being stigma free. A relaxed, comfortable location, familiar to families, that did not elicit impressions of government services helped children, young people and families feel that support was not stigmatising. For example, South Lanarkshire’s Family Support Hubs are based in a building that was furnished to be comfortable and inviting, and Inverclyde used WFWF allocation to renovate a hospital to make it more welcoming to neurodiverse children. Providing support in the comfort of a family’s home also contributed to support feeling less stigmatising.

"If she [practitioner] wasn't in my own home environment, it'd be like another appointment, like something you have to do... it's probably quite oppressive. Whereas this feels like a friend is coming over, so you feel more relaxed and open to it."

Parent

The fourth factor was that children, young people and families interviewed cited practitioners’ listening and communication skills, and empathy, as reasons they felt the support they received was non-stigmatising.

“What was happening before accessing the support was more embarrassing, like being pulled into headteachers’ offices, arguing with people, that was more embarrassing than actually going into that office and being able to get support.”

Child

Practitioners’ knowledge and experience allowed them to adequately adapt support to meet families’ needs. Improved support capacity as a result of WFWF also allowed practitioners more time to develop closer relationships with families to help them meet needs. Work was also underway in areas to develop training and toolkits for delivering non-stigmatising service, such as Fife’s stigma-free toolkit; it was too early to assess the effectiveness of this pilot project.

"That relationship's [between practitioner and child] absolutely pivotal, being able to work with young people...The things they've managed to get him to do, I didn't think he would be able to do, and they've been able to work with him to support him.”

Parent

Factors limiting the outcome

Practitioners described how the framing of family support in a way that implies a deficit – in families’ skills, experiences, behaviours – perpetuates stigma. Practitioners interviewed felt the more embedded in a community family support is, the less this was a factor.

A small number of families interviews reported that some practitioners’ support styles were a factor limiting this outcome. This was particularly where it was perceived by families as ‘being done to’, ‘not listening’, and ‘sounding scripted’. A parent interviewed described her experience:

“The first practitioner [they received support from] was not so positive, as the practitioner was not really listening and just told me things I already knew... I felt that the practitioner was just reading things from a textbook rather than engaging with my situation and dealing with it.”

Parent

Outcome: Children, young people and families recognise available support is informed by them and feel their contributions influence service design

This outcome was assessed as being partly achieved, based on strong and consistent evidence from interviews with frontline practitioners, and children, young people and families.

Families interviewed recognised individual support they received was informed by them because support often adapted as their needs changed, as described earlier in this section. Yet, families were less aware of how wider services or support was informed by them. More work was needed to ‘close the feedback loop’, so that feedback provided by families informs service delivery, and that families recognise available support was influenced by their contributions.

Factors enabling the outcome

Limited evidence was available on the factors enabling this outcome. Evidence captured included CSPPs communicating to families over email or in-person, sharing what changes had been made based on family feedback. For example, sharing changes made to the timing, duration and structure of a coffee morning drop-in session for parents, to better suit parents’ preferences.

Aberlour’s Element 3 project, the Mother and Child Units, took a ‘you said, we did’ approach; the programme formally and regularly captured feedback, reviewed and acted on it, and communicated this back to residential families. For example, based on residents’ feedback, the programme adapted their mobile phone policy to enable women to remain connected to their older children. They also informed residents about the changes made in response to their feedback.

Factors limiting the outcome

Factors limiting this outcome related to the operational scale of family support. Practitioners interviewed described the need for service managers and leaders to inform them when and how decisions were made with family feedback, so practitioners could inform families.

“I suppose a challenge that I've found…it did feel for a long time we were feeding a lot of information upwards, the stuff from our focus groups [with families], and information that we've been gathering, but we didn't hear a lot back from decision makers.”

Practitioner

The diversity and number of organisations involved in family support indicated that it may take time for changes to use family feedback to inform wider family support delivery to embed throughout a CSPP. Practitioners noted this was slower with organisations or practitioners less open to practice and culture change.

“...on a systems level, it is still in progress...Inconsistencies across organisations that engage with children means that my role is to connect all the dots, get the right people in the rooms and child at centre of discussions... [there is a] stubbornness [among some of these organisations] towards wider system change.”

Practitioner