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Transforming short break services
The term ‘transformation of short breaks services’ is one that is continually used in the Short Breaks Implementation Guidance. The Guidance states:
The Government is concerned that the significant investment made in short breaks results in changes that not only transform the volume of provision available, but also transforms the quality, appropriateness, range and capacity of provision to meet the needs of those eligible children and young people who are commonly unable to access provision. (page 14)
A number of case studies will be featured on the website to illustrate the creative and innovative thinking and practice of local areas attempting to transform their services rather than merely adding on to what already exists.
Gloucestershire have built on their experience of piloting a budget holding lead professional in children’s disability services to transform access to short break services into a new, simpler and more family-controlled model Link
Kirklees have developed an emergency care service for families of disabled children Link
North Yorkshire have developed a contract carer service by commissioning a number of providers in order to provide a range of options across a large rural county Link
Bolton has commissioned a school holiday scheme from an organisation set up by a female championship wrestler! Throught the short breaks programme, the organisation has developed a specific scheme to provide holiday activities for disabled children aged 13-18 Link
Direct Payments
Direct payments are not a separate type of short break service, but rather a means of arranging a short break service. Within children’s services a person with parental responsibility (usually a parent) of a disabled child /young person or a young disabled person (aged 16 / 17 years) is given money to purchase their own service instead of the local authority arranging that service on their behalf. A direct payment is given INSTEAD of a service and the giving is based on an assessment of need and eligibility criteria in the same way as direct services. A direct payment may be given to purchase equipment.
Many local areas are hoping to increase the take-up of direct payments as one of the ways to meet the Full Service Offer.
One area has queried whether of not direct payments can be given to families assessed using the Common Assessment Framework (CAF) by a team other than the social work / disabled children team. Link
There is an increasingly number of new terms being introduced into this area which are causing some confusion – personalisation, individual budgets, personal budgets, self-directed support. A useful diagram was developed as part of a CSIP presentation and can be accessed via the following link (it is slide 5):
http://networks.csip.org.uk/_library/resources/Personalisation/Personalisation_advice/Self-directed_Support_Strategy_workshop.ppt
The presentation was aimed at an ‘adult services’ audience.
A number of local areas are considering setting up ‘pools of personal assistants’ or contracting an external agency to do this. One of the issues which needs to be resolved is whether or not the agency setting up that service should register as a Domiciliary Care Agency. This will depend on whether the service is involved in ‘recommending’ or ‘employing’ the individuals who will provide personal care. The CSCI has produced guidance on this issue
http://www.csci.org.uk/professional/default.aspx?page=7341&key=
Accessing mainstream services.
Building capacity into mainstream services to increase access is part of the Aiming High programme. Mainstream services will need to change and adapt in order to become more inclusive and funding through the Aiming High programme may be used to achieve this, if it is spent in a way that builds up an inclusive infra-structure which changes the service – training of all staff rather than appointing one ‘disability worker’. The funding should not be used to meet the requirements of the DDA for greater access. The concept of ‘transformation’ is important in this respect as the change in a service needs to be long term.
Whilst some disabled children will be able to access mainstream services without support, other will require one-to-one support to access inclusive services and it is an accepted part of the Aiming High programme that providing more sessional workers, befrienders or support workers through direct payments will increase short break provision.
Examples of Good Practice:
Leicester City Council and Leicester City NHS offer a new service called TAP (The Access Point) which offers advice, information and support to access short breaks and activities. TAP is a single point of contact for diacbled children and young people, parents and carers, professionals. For further information click both TAP icons above.
North Yorkshire – Springboard project promotes the access of disabled children and young people in mainstream clubs and groups by providing support and preparation through a group work programme.
Wigan - Leisure for All offers a team of trained and experienced staff and volunteers to support disabled children and young people access a with range of leisure activities Link
Gloucestershire – examples of creative one-to-one support to access activities and some inclusive group activities in the area Link
Children and young people with ASD and additional impairments such as severe learning disabilities or behaviour that is challenging.
Children and young people in this group are those most likely to be found on lists of unmet needs in local areas. Both practice and research evidence since the early 1990’s has shown them to be one of the most challenging groups of children to adequately cater for. The Full Service Offer aims to change this and ensure that this group of children have a range of day time and overnight service options from which to choose in every local area.
Currently, the choice in many areas for children with ASD who receive an overnight service is limited to a residential setting, with no family based options through either short break or contract care fostering being available. As well as ensuring that the full range of overnight service provision can provide positive experiences for children with ASD and behaviour that is challenging, local areas also need to develop a range of creative, individualised options which meet the very different needs of this group of children and young people. Local areas also need to consider developing or increasing early intervention programmes and early support for parents around their child’s behaviour, in order to prevent children with ASD starting a “career” of residential provision from an early age.
For a very small number of children an intensive support programme maybe needed to assist families through the summer holidays and to ensure that children remain at home. Halton provided individual support for 2 young people with autism and 'challenging behaviour' during the summer holidays Link
Poole – has arranged a programme of cultural and leisure/ sports opportunities for disabled children who might otherwise find it difficult to access mainstream provision Link
Nottinghamshire include time in their residential short break services to train new contract carers to offer placements to children with more complex needs Link
Staffordshire - has a successful initiative to provide free training on Autism Spectrum Disorder (ASD) within the community Link
Services for disabled children and young people with multiple impairments and/or complex health needs.
Disabled children and young people with multiple impairments and/ or complex health needs fall into one of the priorities groups within the AHDC short breaks programme. This group is made up of disabled children and young people with complex health needs including those with disability and life limiting conditions, and/or those who require palliative care and/or those with associated impairments such as cognitive or sensory impairments and/or have moving / handling needs and/or require special equipment / adaptations. These children may be referred to as having ‘multiple impairments’ or ‘profound and multiple disabilities (PMLD).
In the past children and young people in this group were likely to be found on lists of unmet needs in local areas. For many of these children their choice of short break services was limited to specialist residential settings. The Full Service Offer aims to change this and ensure that this group of children have a range of day time and overnight service options from which to choose in every local area.
Nottinghamshire include time in their residential short break services to train new contract carers to offer placements to children with more complex needs Link
Suffolk has developed the use of technology to support large care packages both in the child’s own home as well as in placements with family-based short break carers Link
Dorset has collated the views of children who do not use language as part of a service review Link
Nottinghamshire - Scoping Report for Children and Young People. This report details a scoping exercise undertaken by NHS Nottinghamshire County into services currently commissioned by the Primary Care Trust for children with complex health care needs. The aim of this report is to assess current provision, identify gaps and make recommendations for future provision of services. It also includes an action plan Link
Engaging with parents and children
Within the Aiming High programme there are many examples of useful information leaflets, parent-led conferences, family consultation days, surveys, and focus groups. The website will assist local areas by featuring examples of engaging with parents who are ‘harder’ to reach.
Involving parents at all levels should be an integral part of service planning, commissioning and delivery. It should be embedded in our practice and in the way we deliver services. It is by adopting these approaches that we will be more likely to engage with parents who do not come to ‘group events’, who do not have English as their first language and who are perhaps not articulate or literate.
Examples of practice:
Nottinghamshire - leaflet sharing the views and experiences of disabled children, young people and their families using support services for children and young people with complex medical conditions and/or life limiting illnesses Link
East Riding of Yorkshire – information leaflet for families on short breaks link
Suffolk – questionnaire to ascertain the needs of families Link
Hackney - have devised a questionnaire to go out to parents to either be completed by them or to be completed with the help from a small team of parent consultants employed by them. This is part of an ongoing consultation process. Questionnaire Link and leaflet Link
Brighton and Hove – The Compass Link The Compass is a service run by a local charity which acts as a one-stop shop for parents. In exchange for parents providing information about the needs of their child and family, families receive a leisure card which offers a range of leisure activities.
Dudley – involving families in commissioning services Link
Enfield – are using a small team of parent consultants to network and interview other parents on the Core Offer and their programme of short breaks Link
Kent - held two events in February 09 to find out what children and young people wanted from short Breaks, here is what they said Link
Bedfordshire Borough Council and Central Bedfordshire - have produced a report titled 'Report on Outcome of Participation and Involvement Exercise with Children and Young People' to feed back the results of a survey undertaken in January 2009 with young disabled people in Bedfordshire. During a two week period over 90 young people were able to give their views as to the future shape of short break services as part of the ‘Aiming High for Disabled Children’ programme. Link
Involving disabled children
Within the Aiming High Programme there a many examples of consultation events with disabled children – including Big Brother diary rooms / pods – events which focus on having fun and enjoyment. The website will feature these and other ways of engaging with children who do not use language and may therefore be less regularly consulted.
Research in the area of participation has concluded that participation should be an ongoing process rather than a one-off event. It should be embedded in practice and in the way services are delivered. By adopting alternative approaches disabled children who do not use language, who do not have the cognitive ability to make abstract choices or children on the Autistic spectrum who may use language in a different way will be enabled to participate in choosing their services.
Manchester - a programme of play-schemes and activities were commissioned over the summer period in and around Manchester. An evaluation report has been introduced which puts together whether the activity/scheme had a positive outcome and met the needs of parents and children Link
Derbyshire - the involvement of students from Peak School in creating their own school council Link
Sunderland – employment of a Participation Officer as part of the Aiming High programme Link
North Yorkshire – Flying High to See the Way – a steering group of young disabled adults set up to facilitate the involvement of disabled children and young people Link
Dorset – ascertaining the views of disabled children by using information already held in the children’s review system Link
Bolton - have funded a series of fun days to engage in a positive, enjoyable way with local families with disabled children Link
Commissioning services
Short break services can be strengthened and diversified through a robust and effective commissioning process by:
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understanding the needs of children and families in the local area;
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significantly increasing the volume and range of short breaks;
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improving the access to short breaks for families;
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increasing the number and quality of short breaks.
Joint planning and commissioning of short break services by the local authority and Primary Care Trust (PCT) facilitates integrated working. Joint planning should include joint governance arrangements, policies and procedures and aligned or pooled budgets. This process needs to be in partnership with parents to enable a step change by ensuring that the services commissioned are those that families need and will use.
Bromley - In May 2009, Bromley ran a ‘small grants’ commissioning programme which resulted in five providers being awarded funding for a range of ‘creative and innovate’ provision, specifically targeting Groups A & B. Link
Cornwall County Council has commissioned Sense, the national deafblind charity to run the “Get Out There” (GOT) Group for young people with a visual impairment and significant additional needs, including deafblindness Link
Sutton recommissioned their domiciliary care service through working jointly with providers and adopting an outcomes based model Link
Dudley involved parents in their commissioning process Link
Bolton worked to strengthen a local voluntary organisation in order to increase ‘local capacity’ Link
North Yorkshire have commissioned a range of providers for their contract carer service Link
Workforce
Workforce issues are seen as major challenges to the success of the short breaks programme. There is a need for a rapid expansion of the workforce on a number of levels – workforce responsible for implementing the programme, care providers and staff who support care providers and the children receiving services. In some areas, the additional funding represents more than a 100% increase in service and the need to transform the workforce should reflect this.
Enfield developed a joint training programme across disabled children’s services Link
North Tyneside developed a common training programme which allows staff to move around services without having to be ‘retrained’ by each service Link
Norfolk is working on a strategy to utilise the transient student population in their workforce Link
Kent – one of the largest local areas – has developed a workforce team to support the short breaks programme. One of the pieces of work developed by this team is a strategic process to capture workforce requirements and training needs and then action those requirements Link