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

4 Outcomes and contributing factors: availability and access

This section explores the extent of achievement of the outcomes intended by the availability and access component of WFWF. The focus of this component is on ensuring that families can easily and fairly access the support they need, where and when they need it. This component addresses barriers to service access and aims to make family services more available, timely, and responsive to the diverse needs of families across Scotland.

Key findings

• Within WFWF-related activities, families typically knew how to access relevant family support when they had already accessed or been referred to other children’s services. Families’ awareness of available WFWF support was low if they had not previously accessed non-WFWF support.
• Some factors contributed to increased awareness of and access to family support offered through activities related to WFWF included: prior awareness or experience of the support; advice from a trusted source sharing their experience or recommendation of the support; information sharing about locally available support (for example, new digital and online platforms and new promotional materials); and having a dedicated support worker to signpost to other services and provide tailored support.
• Barriers limiting awareness of and access to family support included: practitioners describing services in a way which led to some families choosing not to access services; waiting list times for some services; limited staff capacity to provide or refer to the right services; and case management system functionality.
• Many CSPPs had initiatives in development or implemented to offer support to families at an early stage, to avoid crises. CSPPs improved their focus on early intervention by: identifying gaps in service provision through self-evaluation and service mapping; developing joined up ways of working between key partners to identify family needs and offer the right support earlier; and delivering dedicated support to groups of families or individuals with specific needs (for example, neurodiversity) to prevent needs escalating.
• Families interviewed and who had received WFWF support, expressed satisfaction with the support they accessed, a key factor in their perceptions about the availability and access of support. Satisfaction was underpinned by feeling listened to, trusting the practitioners who supported them, and benefitting from the support received.
• Whole family access to support was enabled by interventions that targeted the needs of each family member (where necessary); a dedicated and trusted support worker with a holistic view of family needs; a single point of access for family support; and tailored and tracked approaches for family care supported by new data sharing systems.
• Perceptions of CSPP staff captured in case studies and from secondary analysis suggests more families, and more diverse families, accessed family support than in Year 1.

Outcome: Children, young people and families are aware of how to access relevant family support services

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

Families typically knew how to access relevant family support when they had already accessed or been referred to other children’s services. This was because practitioners signposted or referred families to other types of support, and because families had named contacts to inquire about other available support. In contrast, families without previous support experience were less likely to be aware of services or how to access them.

“Referrals from practitioners or services are most effective because it means staff can approach families known to them, wheel them in (to the service), can explain the offer and [start] building up relationships and trust from the start."

Practitioner

“I didn’t know the support was there until we were in a state, and really needed [it]. It was the first time I was offered this.”

Foster Carer

Once offered or accessed some type of support, families typically knew how to access further support when and where they needed it.

"If I needed it now and there was an urgent need, I know I could get hold of it and so could they [my children]. So, if they are having a bad day or whatever, they do feel they can do that, like they've got her [dedicated support worker]."

Parent

Factors enabling the outcomes

Four factors enabled family awareness of how to access relevant family support services.

The first factor was word of mouth from a trusted source. Many families accessed support following advice from friends and other families who had used the service and recommended it. Hearing from a trusted source that the support was beneficial raised awareness of what was on offer and encouraged families to seek it out themselves.

The second factor was having a dedicated support worker who signposted to other types of support which families could access. For example, frontline practitioners and managers in South Lanarkshire said that families involved with FGDM were more likely to know and access support as their support worker would signpost them to it and this helped simplify access. In East Lothian, practitioners felt families’ awareness of services had improved since the CSPP used WFWF to establish the Family Outreach Worker role. It was felt that having a dedicated family support worker helped them provide tailored family support as they understood the whole families’ needs, which increased satisfaction and encouraged further take up through word of mouth.

The third factor was improved information sharing about the local support available, made possible by developing online and digital platforms. In some CSPP areas, partners developed websites that collated information about all the services available to families in their local area as a one-stop place for them to find support.

CSPPs also used community events or spaces to share information with families in a comfortable and casual setting. For example, in Aberdeen, community development, youth and support workers held community events in the park, wearing bright coloured jumpers to make themselves more visible to the public. East Ayrshire developed a mobile barbering service, which linked multiple services (for example, mental health or financial support) to address difficulties experienced in rural communities. East Lothian used ‘roadshows’ featuring multiple agencies and organisations to bring diverse drop-in support to rural communities. Taking support to where families already were was particularly important for engaging families living in rural areas or families more likely to be isolated.

“One way that partners are trying to get around that [rural issue] has come through the whole family wellbeing subgroup of the CSPP...So, there'll be health visitors, there will be speech and language, there'll be family support, there'll be a youth worker connected communities, colleagues, there'll be East Lothian Works which offer employability, so coming together and offering a Roadshow drop-in.”

Practitioner

CSPPs also used promotional materials to raise awareness among families of the local support available. For example, posters and flyers with quick-response (QR) codes were disseminated to cafes, local libraries and community spaces to encourage families to self-refer to support.

CSPPs also used practitioners embedded within schools to improve information sharing about the local support available. Many CSPPs had or had plans to embed family services practitioners in schools. The Spotlight below discusses how East Lothian used Education Outreach Workers to work with schools.

Figure 4 CSPP Spotlight: East Lothian

Focussing on school-based support to better meet the needs of families, earlier. East Lothian analysed the profile of referrals into family services and found a third of referrals were related to school-based issues, such as non-attendance, and anxiety linked to the Covid pandemic. In response, they used WFWF allocation to establish Education Outreach Workers who will work with schools to resolve school-based issues, earlier, and to identify if other family members require support, such as with routines or boundaries with their child. They hope these Workers will support schools who lack capacity to refer, to support earlier referrals, before children are in crisis, and to improve the appropriateness of referrals for neurodivergent children. Early evidence suggests a shift in referral sources: "We've seen a massive increase in children [that/who] can be refer[ed] in through schools, whereas initially it was very much health visitors who were the main referrer by quite a big margin."

Strategic Lead

Alongside the referral analysis, East Lothian strategic leads and managers reviewed existing support offered to understand how current resources could be better used to increase earlier access to support by groups with unmet needs. For example, a review was undertaken of the teacher mentoring scheme for care experienced young people, which was designed to help them develop numeracy and literacy skills. It was found that this support was not having the desired impact, which resulted in funds being repurposed to deliver support for children with neurodiverse needs (as this was a gap identified in current provision).

“That's one of our other biggest challenges… that there's very little support for children and young people who are neurodiverse.”

Manager

Factors limiting the outcome

Three factors limited family awareness of how to access relevant family support services.

The first factor was families with no prior experience of family support typically lacked awareness of what was available. Managers and strategic leads thought the support had lower visibility within communities in comparison to statutory services, which were more established and had a greater profile. For example, Aberdeen’s practitioners described how one of their services faced challenges with visibility and relied heavily on word-of-mouth referrals between families to raise their profile amongst families they had not worked with before.

“[Service name] has always been rubbish in how visible it is...so often, we are relying on those receiving the services to be able to share with others who could need the services to do it for us.”

Manager

The second factor was how practitioners framed the relevant support when signposting families to it. For example, a parent described how one of their children declined support, even though the child’s sibling was already accessing this. The mother felt the practitioner could have reframed the description of what the support involved to encourage the child to engage. In this case, to get a hot drink and go for a walk to talk, rather than to do formal activities such as in school.

The third factor was funding. Parents, carers and practitioners shared their belief that limited funds for supporting certain groups of families, such as those with children with additional needs, meant challenges with providing relevant family support services. An example of this was a lack of appropriate summer holiday activities for children with additional support needs.

The fourth factor was the shifting landscape of family needs and available support. Strategic leads and practitioners interviewed described how the landscape of family needs and available support changed frequently. For example, they noted that family needs had become more complex due to the Covid pandemic, and that the support available changed regularly which was hard to keep abreast of. This challenged family services’ ability to connect families with the most relevant support.

In response to this challenge, South Lanarkshire increased the frequency with which they conducted a gap analysis of family profiles (based on type of need, demographics and personal circumstances) accessing and not accessing their support, from once a year to a few times a year. To identify unmet need, Fife worked with their co-production panel to explore needs of all families, and they planned to conduct a similar gap analysis to South Lanarkshire.

"Services change all the time and actually we find it quite difficult to keep up with what's out there for people to access. But I would like to think that...if people are saying a particular need is not being met, we would know people to be able to refer the family to.”

Practitioner

CSPPs recognised that more needed to be done to increase the awareness of and access to relevant family support services. These barriers were already being addressed by some of the activities contributing to the achievement of this outcome (for example, community events and promotional materials, described above).

Outcomes: Focus on prevention and early intervention, and children, young people and families say family support is accessible and provides early help and support where and when it suits them

This outcome was assessed as being partly achieved, based on strong and consistent evidence from interviews with strategic leads, managers and practitioners, and WFWF annual reports.

Prevention and early intervention activities were either planned or in the early stages of delivery across CSPPs. Therefore, evidence of the impact of these specific initiatives was limited or not yet available. There was also greater evidence of CSPPs focussing on early intervention support, but less evidence available for prevention initiatives.

All case study strategic leads and managers recognised the importance of both prevention and early intervention, for improving family outcomes and ensuring a financially sustainable family service.

"If we don't get that right at its earliest point, you're going to have these families in crisis which is going to cost... and at that point families don't want to work with you really. So, we are really focussed on the early intervention, building those relationships and getting in there early and hopefully that will prevent referrals to social work."

Manager

Many CSPPs had initiatives in development or implemented to offer early support to families, to avoid crises. Initiatives shared common features to prevent escalation of needs: community-based, early identification of needs, integrated and collaborative services, and person-centred approaches. Examples of early intervention initiatives included:

• Fife’s ‘No wrong door’ model aimed to help families access support through any avenue, with joined up services linking families to the most relevant type of support. Its Emergency Support Team (EST) was another example, detailed in the Spotlight below.
• South Lanarkshire’s Family Support Hubs are community-based centres that provided support in community locations across the area, encouraging families to self-refer and engage in support early. Strategic leads reported that early performance data shows the Hubs have reduced the number of referrals for children being escalated to social services. See the Spotlight below for more information.
• Aberdeen’s ‘Fit Like? (sic) Family Wellbeing Hubs’ also offer a wide range of services and support, including health, education, social care, and other community services, in one accessible community location.
• East Ayrshire's HEART model (Help Everyone At the Right Time) is a family support approach aimed at providing early, integrated, and community-based assistance to children, young people, and their families.
• East Lothian’s new support groups, like library groups and mum’s groups, and Collaborative Support through Element 2 enabled the CSPP to set-up a dedicated, multi-agency team to deliver early intervention services.

CSPPs hoped that increasing the visibility and access of support would diversify referral routes, particularly from self-referrals. In South Lanarkshire, the Family Support Hubs experienced an increase in self-referrals, detailed in the Spotlight (Figure 6) below.

Figure 5 CSPP Spotlight: Fife

Preventing foster placement breakdown through Emergency Support Team (EST) created with WFWF allocation.

Fife’s priority was to support placement stability for children in care. They used WFWF allocation to enhance the EST with Emergency Support Workers to minimise disruption for young people transitioning between foster placements, through behaviour management.

Support Workers visited families daily and discussed how the families could manage their child’s behaviour and respond to any other challenges the carers were facing.

"It was hugely valued because they [service name] were here as often as we [daughter and mother] were…People are busy and we need somebody to focus on us, and that's what they did." Parent

“There was a lot of pressure on the household and stress, and it was difficult to keep everyone safe, so we spoke with our social worker who suggested that [service name] was the first place to start...The social worker said that [service name] would provide any support we needed, including techniques for how to do things differently.” Parent

Figure 6 CSPP Spotlight: South Lanarkshire

Family Support Hubs take a ‘no wrong door’ approach to improve early intervention and support for families in four localities in South Lanarkshire. South Lanarkshire opened Family Support Hubs in four localities to promote a ‘no wrong door’ approach for families to access family support. The design of the Hubs sought to encourage early help and to overcome stigma families may face in accessing family support by allowing walk-ins, encouraging self-referrals and by making the physical space casual and comfortable through its design and furnishings. "What we are seeing is actually this is bringing families and young people and children all together to look at 'this is a building we could potentially use in the future', but also how can we make this warm and comfortable...so it's that change and perception of the community as well of what the building actually does." Manager The Hubs helped to provide early help and support, as evidenced by increases in self-referrals. "What we didn't expect is the second highest referral rate now is the families themselves and that’s not what we predicted. So, that’s given us an early indication that this is working, the families are actually referring themselves for that support.” Strategic Lead Work was underway to strengthen third sector and universal pathways through the Hubs to diversify the sources of referral. This work included sharing information on the work of the Hubs and referral pathways with third sector colleagues, so they were aware of how to make referrals. The Hubs operated with a whole-family support model, and so work was underway to help social workers in the Hubs to manage the increased time pressures that come with regular visits and support to wider family members.

The main activity noted around prevention was training staff on restorative and preventative approaches. For example, East Ayrshire trained frontline practitioners to be accredited coordinators for FGDM.

Factors enabling the outcome

Three factors enabled early intervention.

Identifying gaps in early intervention provision through self-evaluation and service mapping allowed CSPPs to understand the landscape of support (i.e., what was already available) and then identify gaps in support access and barriers to earlier access.

“When we did our self-evaluation around family support, we noticed that it wasn't very joined up... [and identified a gap in early intervention provision, so] we are seeking to commission in the space of early intervention at this stage and hoping over time that will move into preventative and universal. We need them all.”

Strategic Lead

The second factor was more joined up ways of working across CSPP and targeted support. More joined up working between multi-agency organisations helped to address family needs early, and before they escalated. An example of an activity co-designed and developed by multi-agency organisations was in Aberdeen, where a range of organisations work together in their new ‘Fit Like? Family Wellbeing Hubs’ to support children and young people’s mental wellbeing. This included using the WFWF allocation to introduce reflective spaces in the Hubs, so that education and health colleagues can work together to support children and young people’s emotional and mental wellbeing.

Strategic leads suggested that this collaborative work de-escalated family needs, thereby reducing rates of meeting the threshold for social work intervention and reducing the number of children and young people in crisis. A strategic lead explained how support mapping revealed a main referral source was housing, prompting more joined up working between family support and housing support:

“(We) mapped out the user experience so when families have an issue, they know what the process looks like. Also identified ways we can improve the process. Joined up services should mean families don't have 'to keep going over the same ground to get the work done’.”

Strategic Lead

Improvements to joined up working facilitated earlier multi-agency discussions about new and changing needs of families receiving support, and helped to put in place plans earlier, to address these through universal services.

The third factor was providing dedicated early intervention support to specific groups of families. The aim being to ensure early intervention support was easily accessible and relevant for families with unmet needs. For example, South Lanarkshire created a school-based family project called Pathfinders, which delivers targeted support to children, young people and their families (for example, neurodivergent young people or young people on the edges of care) to support their transition from school into adulthood, and to families from pre-birth to when their children are 24 months old.

Factors limiting the outcome

Three factors limited early intervention.

To address the misalignment of different services’ goals, CSPPs worked on refining local commissioning processes to align local support to WFWF goals, including early intervention. Where existing support delivered by the third sector did not yet prioritise early intervention, this was viewed by CSPP strategic lead as limiting the potential benefits to families who could be better supported by early intervention. Further detail about the barriers and enablers of transforming local commissioning and procurement processes can be found in Section 7.

Another barrier to early intervention was that some pilot initiatives of early interventions had ended or were scaled back because of the short-term nature of funding for the posts delivering the initiatives. Managers explained how some of these staff left to seek secure employment.

Finally, perceptions of the importance of early intervention. A shift to prevention and early intervention in a CSPP requires all staff, including support functions, to be onboard with prioritising this activity. A strategic lead explained this:

“I still feel accountants on the council in particular viewed early intervention work as non-statutory, and I would like this to shift in perception. A concern for me going forward is that it’s not seen as the low hanging fruit of early intervention, that it’s actually statutory work and we need to keep reinforcing that with people.”

Strategic Lead

Outcome: Children, young people and families say they feel positive and trusting of services

This outcome was assessed as being partly achieved, based on strong and consistent evidence from children, young people and families and frontline practitioners. This outcome is included under this core component as families’ views on the support may influence their perceptions of both the ‘availability’ and ‘accessibility’ of it and whether they continued to access it.

Families interviewed and who had accessed WFWF support were positive and expressed satisfaction with the support they accessed. Positivity was underpinned by feeling listened to, trusting the practitioners who supported them, and benefitting from the support received.

Children and young people positively described the practitioners they worked with as ‘supportive’, ‘open’, ‘fun’, ‘helpful’, ‘chatty’, and ‘safe’. Adults interviewed described developing a trusting relationship with practitioners had helped them to feel supported.

"Trust is so important. We are open to a lot of criticism as kinship carers. We have to be doubly cautious...I could trust [support worker], yes, and the kinship worker before who has been off sick."

Kinship Carer

Families interviewed who had accessed WFWF support described the different ways they benefitted from the support. A mum described the benefit to her younger child by comparing it to her older child who did not receive the same support.

“I’ve had an older child through the system and there wasn’t that service there, and I feel that probably would have been good then. The younger one coming through school has had access to it from day dot, which means he’s had that support and interaction to help him through those difficult times that [older child] didn’t have right from the start…They don’t like school but the younger one particularly is able to manage a bit better because he’s had that support right from the start.”

Parent

A common message from families interviewed was feeling the support they received exceeded their expectations. A mum who recently migrated to Scotland discussed how she found the culture change difficult for raising her daughter and how she felt about the parenting support she accessed:

"They've been giving me the kind of support that I did not know that I needed."

Parent

Outcome: More children, young people and families receive whole family support through referrals or self-referrals

There was insufficient evidence to draw a confident conclusion about the achievement of this outcome, based on interviews with parents, carers, strategic leads, managers and practitioners, and WFWF annual reports.

Levels of access varied within and between CSPPs, and families, but generally more families – and more diverse families – were reported to have accessed family support. For example, Fife’s third sector-delivered projects, Gingerbread and Clued Up, supported 50 families with children on the edge of care, in crisis and experiencing family breakdown, and Inverclyde’s new intensive support workers supported 49 children to remain at home. East Dunbartonshire saw a consistent uptake of additional play scheme support as part of their ‘Creatovators’ programme. The programme was a Scottish social enterprise that provides support and services for autistic individuals and their families. In North Ayrshire, analysis was undertaken to understand the types of families accessing support and their needs to help ensure a diverse range of families were engaging with WFWF activity.

However, there was limited evidence to suggest that entire families took up support when this was available. Some family members choosing not to access services, lengthy waiting list times for some services, limited staff capacity to provide or refer to the right services, and case management system functionality limited the take-up of support by whole families.

Factors enabling the outcome

Five factors helped more families to receive whole family support.

The first factor was an increase in the provision of whole-family focused interventions. For example, many CSPPs had increased their use of FGDM to connect the whole family to family services, and to encourage whole family engagement in ongoing support. The Spotlight below describes this in more detail.

Figure 7 Thematic Spotlight: Family Group Decision Making

FGDM central to encouraging whole family involvement in support and connecting family members to wider support networks. FGDM offers a whole family approach to empowering family members to seek their own solutions to life challenges threatening the safety and/or wellbeing of children, young people or adults. East Ayrshire, East Lothian, and South Lanarkshire are among CSPPs either using or planning to use their WFWF allocation to increase provision of FGDM, typically delivering it through a third sector organisation in their area. "The biggest shift for me was realising it was more than just my child that they supported. And absolutely if I have any questions or if I'm struggling, even with food, or just worried about them (their child) in general...the absolute benefit of working with [FGDM practitioner] is I can send them a message, it doesn't matter what day or time of night it is, and they'll pick it up and get to us as soon as they can the following morning." Parent

The second factor was having a trusted support worker, as mentioned in the earlier outcome children young people and families say they feel positive and trusting of services. Young people, parents, and carers interviewed noted that ‘trust’ - feeling they can trust the practitioner - played a significant role in convincing their family members to engage in support. Interviewees described how practitioners provided opportunities for families to engage in activities together that helped build the relationship between parents, carers and children and with a wider network or peer support. It was also felt that having a trusted support worker resulted in engagement of a more diverse range of families, including those who otherwise would have been reluctant to access support.

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

Child

The third factor was practitioners targeting wider members of the family and offering support. This differs from interventions formally designed to work specifically with entire families (such as FGDM), because these were examples of individual practitioners, proactively offering additional support to wider family members. For example, in East Lothian a practitioner supported a young boy with his behavioural needs at home and at school. During home visits, they noticed the impact of the child’s behaviour on his sibling and offered additional support. They also supported families to develop behaviour management tools.

“The biggest shift for me was realising it was more than just the young person that they supported and absolutely if I have any questions or if I'm struggling, even with food, or just worried about [name of child] in general.”

Parent

The fourth factor was CSPPs providing a single point of access for family support. For example, South Lanarkshire’s Family Support Hubs include adult services which allows parents, carers and wider family members affected by substance use to access support at the same time their child was supported by other Hub teams.

The final factor was data sharing and case tracking systems that enabled practitioners to monitor the progress of a whole family. For example, Aberdeen’s continuum of care and request for assistance model sought to ensure family support was tailored and tracked for each member of the family. Data sharing systems were used to follow each family member’s and the whole families’ progress through support. Strategic leads and managers felt this had ensured whole families received the support they needed and that individual family members’ needs were not forgotten.

Factors limiting the outcome

Four factors limited whole families accessing support.

The first factor was some families choosing not to access services. Some family members did not take up the support offered by a practitioner. Feedback from practitioners and families suggested that this may have been because they were not interested or did not see it as relevant, did not know what was involved, or because they thought the practitioner should focus on the initial family member referred.

“I think it generally does go across the whole family, and it's offered at the point of assessment, but a lot of families will not take you up on that because the referrals are put in for one specific child.”

Frontline Practitioner

Discussions with practitioners suggest building trust with families they work with (see outcome above: Children, young people and families say they feel positive and trusting of services) was the most effective way to engage other families; the families they support then become advocates for the support to other families.

The second factor limiting achievement of this outcome was long waiting lists. This meant that not all family members could access support at the same time if they were referred to different services. Practitioners felt this risked the progress of other members of the family that had accessed support. Parents, carers and practitioners interviewed often cited physical and mental health services were most likely to have waiting lists.

The third factor was limited practitioner capacity to provide support to whole families. Holistic family support puts more pressure on practitioners’ time when one practitioner was also responsible for supporting the wider family. A parent noted how they do not see their practitioner as often as they would like as they have needed to take a step back to help other families who are in more need than them.

"Whole family support puts more pressure on their time and time management requirements because the practitioners visit extended family to see what support they can offer.”

Frontline Practitioner

The fourth factor was poor case management system functionality. Practitioners interviewed from different CSPPs highlighted that it was difficult to record when whole families had received support in the case management systems they used. They explained this was due to current recording systems restricting how much detail they can input because it was designed to focus only on the individual who had been referred. This meant that it was difficult to track progress of the whole family and practitioners were unsure that support was fully joined-up across the family (e.g. avoiding duplication or siloed working across different services).