Category 7. Delivering together with health services

This category includes examples of practice that are developing effective integrated working practices between local authorities and health organisations.

Sponsored by the Children’s Social Care Practice Leaders

Introduction to the submissions in this category

This category saw excellent submissions, reflecting therapeutic, child-centred and preventative approaches, working in partnership to co-produce and deliver truly integrated services to children. young people and their families.

Therapeutic models featured prominently within the category particularly through Barking and Dagenham’s submissions; the Culturally Sensitive Therapy Project, embedding cultural awareness and therapist–family matching, the North East London Sunrise hub demonstrates the impact of a holistic, child-centred, and integrated approach that is supporting the recovery of children and their families who have been affected by sexual abuse.

Greenwich’s well-established integrated working between Local Authorities and health organisations demonstrated how effective multi-agency partnership working helps children and their families receive the right support at the right time. Merton’s Family Hub outlines how careful planning, navigation and engagement across a wide stakeholder landscape enabled co-production and a shared vision for a place-based delivery model with ‘Access, Connections and Relationships’ at the heart.

Delivering together with health in their pre-post birth service, Redbridge are ambitious to build on their established strategic and operational multi-agency partnerships and expand, the service. with health colleagues fully embedded within the team.

Sustainability and innovation on a smaller scale enabled Tower Hamlets to break the cycle of recurring removals of infants from their parents by providing the support necessary for parents to improve their lives and future parenting prospects through effective multi-agency partnership working.

London Borough of Barking & Dagenham – The culturally sensitive therapy project

Summary of project: To enhance therapeutic services, ensuring culture, race, and ethnicity are consistently and constantly at the core of therapy sessions and professional thinking spaces to ensure practice and experience of therapy is culturally appropriate and sensitive.

Key Contact: Andrea Clare, Head of Service, Specialist Intervention Service

andrea.clare@lbbd.gov.uk

Read more about this project

Team: Specialist Intervention Service Therapy Team

Partners: Children’s Social Care, Foster carers, Young people, Parents, Social workers, Therapy Team

Main Submission:

Despite being the 7th smallest London borough, LBBD faces significant economic challenges, high child poverty, significant health inequalities, and elevated mental health issues with 1 in 5 young people ages 8-25 having a probable mental health disorder. According to the 2021 Census by the ONS, 44.9% of LBBD residents identify as White, making it the dominant cultural identity in the area (ONS, 2021). The remaining residents identify as Asian (25.9%), Black (21.4%), mixed or multiple ethnic groups (4.3%), and other ethnic groups (3.6%).

The aim of the project was to place a cultural lens on Play and Creative Arts therapy practise in a children’s social care setting in order to create incisive thoughtfulness around cultural attunement and sensitivity to ensure that therapists engaged with and were committed to considering painful unconscious bias and developing greater understanding of joining with children and young people around the understanding of culture in every therapy session. The therapy manager determined to increase and optimise the cultural and ethnical diversity of therapy staff, to sustainably affect the service and continuously attend to both personal and systemic racism. The project was also designed to theorise and conceptualise reflection, supervision, and practice. Three new staff members were specifically employed via grant funding. The results from the project showed a profound increase in cultural consideration and an expediential change in hopefulness with the children and adolescence as their cultural richness and complexity was explored.

The team were able to theorise and conceptualise around practises within play and creative arts therapy, to consider stereotypes, reduce play therapy practise bias, consider optimum cultural engagement with child, young person and parent and become more culturally inclusive. The project aimed to enhancem therapeutic services for children and young people in care and on the edge of care, by providing tailored interventions that considered the unique cultural needs of each individual. The therapy manager determined to increase and optimise cultural and ethnical diversity of therapy staff, to sustainably affect the service and continuously attend to both personal and systemic racism. ‘The culturally sensitive therapy project’ was designed to theorise and conceptualise reflection, supervision, and practice, and 3 new staff members were specifically employed via funding.

Between December 2023 and August 2024, 21 children and young people were referred for Play and Creative Arts therapy. 9 of those were offered a culturally connected therapy intervention with a culturally matched therapist. Extensive academic and clinical research was conducted alongside the interventions to ensure they aligned with current theories, neurodevelopment, multicultural thoughts, and clinical practices. The bond and trust building was exponentially increased as a result of cultural matching and ensuring attention was paid to race, culture and identity in every session. The project resulted in a psychoanalytically informed report which incorporated play and creative therapy techniques, strategies, and quotes from the children and young people involved. The pre and post therapy scores of the young people in relation to being culturally understood were considered. It focused on race as a concept, developing a culturally sensitive therapy space, considering the impact of culture and gender in relation to identity, the therapists engagement with culture and trauma, the importance of placing a cultural lens on systems and organisations, creating emotional awareness and shift in racist thoughts in the therapist and therapeutic space, considering cultural competency in relation to de-colonising of play therapy methods, dismantling internalised racial oppression, benevolent neutrality and the notion of cultural matching.

Two siblings accessed a group therapy intervention and said that “having had this safe space has helped us to understand our Pakistani cultural challenges and not feel judged. We can also now see our mother’s point of view since she has moved away from our faith beliefs, but we are now able to accept we can bear to see her again. We could not have done this without the therapy.” One young person said “I feel empowered in my therapy sessions because my therapist understands my position as someone who is a non-White British with the pressures of having to balance my parents’ expectations and be an ordinary teenager. I feel connected to my therapist as she is also Asian like me”.

9 young people were helped to navigate living in high-cost care placements, their internal emotional turmoil, and adverse external events. These factors destabilised their emotional maturation and capacity to understand their lives and explore new possibilities. They were considered holistically regarding physical, psychological, and neurological changes within their social and cultural context. Identity and culture were recurring themes in therapy sessions, as the young people sought to make sense of their traumatic lived experiences and the impact these had on their sense of self. Psychoeducation, as needed, helped children and young people understand their actions, provided theoretical context for their behaviours, and help them makes sense of their cultural identity.

Theoretical and therapeutic insights were shared with parents, carers, social workers, and decision makers, which enhanced the effectiveness of partnership working. This ensured the views, hopes, and experiences of the children were conveyed and understood by all, leading to better outcomes, increased stability, and lower risk levels, as the child’s needs were being met effectively and appropriately.

One case example is that of F 14-year-old trans adolescent of mixed ethnicity, who was offered 13 sessions of Play and Creative Arts Therapy. She was culturally matched with her therapist and together they explored her sense of identity and the intersectionality between culture, gender, sexuality, and race. By the end of the intervention, a CORE- outcome measure showed a 42% reduction is psychological distress. Alongside her therapy sessions, her mother also received therapy to explore her world and understanding of her child’s. By the end of the intervention, F said “I feel like I know myself for the first time. Having an Asian therapist who shares our cultural experiences makes it easier for us to open up, she gets where we are coming from. We feel like we can be ourselves in therapy as she has created a safe place for us to discuss our cultural challenges. I would like to thank my therapist whose Asian background gives us a special connection. It’s comforting to talk to her because she understands our background and values which makes it easier to discuss these really shameful and sensitive things”. Her mother said “the environment is like a normal therapy room, she has let me lead and gently speak.

I am so lucky to have had this support. We now spend time together. I am no longer overwhelmed, and I can see my children for who they are and can let them grow.” As a result of this project, bi-monthly systemic team meetings with a cultural lens had been implemented to discuss all casework with a cultural lens. This is a model which could and should be replicated across all local authorities to ensure that good culturally appropriate practice is consistently considered. By doing so, we can reduce racial disparities and tackle organisational and systemic racism in the workforce.

Case study vignette for Culturally Sensitive Project

Offering creative therapy to two young teenage full sibling sisters from British Bangladeshi background. The aim of the work at the outset was to create improved emotional relationships between the girls and their mother from whom they were separated with. The therapy manager immediately identified a culturally appropriate therapist who could negotiate the nuances of culture and relationship with the girls their father and potentially their mother. This led to the girls engaging avidly in therapy exploring their suffering and finding their voices. The focus of the therapy was deeply nuanced by the intersectionality and complexity between culture, faith, family structures, language and dialect, gender, and societal integration. They explored views in relation to values, beliefs and behaviours in relation to appearance feelings and actions. The sisters considered their sense of gender, of being female and the dissonance in this respect between themselves and their mother. The therapists worked with the powerful projections and splitting processes which were live and particularly focused around derogatory perspectives and language in relation to female, culture and faith.

The outcomes of the work were that the therapist became the culturally humble and sensitive advocate who was able to devise a therapy intervention which created the space for the girl’s self-reflection processes regarding their own values beliefs and understandings. At the same time the therapist was committed to self-reflection around their own values beliefs and biases, acquiring a deep understanding and emotional appreciation for the girls and the oppressive experiences they were subjected to. The therapist task was to consider cultural bias and avoid alienating the girls and their family. The therapist’s role was to forge new pathways within the family system and to help diminish fear and anxiety and promote advocacy.

The therapist task was to engage with each person’s trauma, hold the therapy space and have an understanding of the adolescent position of each sister. To notice the importance of language and the intricacy of cultural belief-based concepts. Without the therapist’s cultural attunement, consideration and humility, the girls would NOT have been so engaged in the therapy process, and there would NOT have been such observational and detail knowledge and precision within the therapy space.

After only one session of culturally attuned sensitive and humble therapy practise, they girls were utterly engaged and keen to both learn, reflect and develop. The therapy intervention actually with the mother only required two sessions, because likewise the culturally attuned sensitive and humble therapist immediately placed themselves in the core of the parent’s cultural material, reflection was enhanced and time expediently used. The girls and the parent only needed one session together to then realign them in a way that they could continue in relationship with each other well. Empowerment and advocacy: In all of the young people who engaged with the culturally sensitive therapy service offer, first and foremost, identity was addressed, all were empowered to know and speak about their position and develop new insights. Being alongside the culturally sensitive therapist, and even more poignantly, a cultural representative, there was a sense that they were not isolated in the experience nor experiencing hostility or disempowerment.

Cultural knowledge: In every session family structures and hierarchies where thought about within the context of socio-cultural familial and community systems, in terms of generational perspectives and the need for this to be explored with cultural sensitivity and generational realism. Therefore the importance of the play therapist in researching a child or young person’s family culture and religion before coming to the therapy was critical, to ensure some knowledge and understanding. We considered a young Albanian adolescent with whom connection was gained using music to consider cultural identity and roots We considered the nuances within cultural and ethnic groups, and the need to ensure that the therapist can somehow walk beside their cultural shoes. The therapist, engagement with culture and trauma: We considered thoughts around service capacity and offering an ability to consider choosing cultural suitability of the therapist to the child young person or family. It was clear that as an informed worker of a different cultural position and particularly of a white position, there was much more material to be carefully traversed. Whilst trauma is something that all therapists work with skill and knowledge, the unconscious material and perceptions that exist between therapist and the child or family member of different ethnicity and cultural context creates internal tensions, that require careful psychological knowledge, honesty and nuanced adjustments in order to create real therapeutic space and availability.

This evidence considers problems in associating with attending to culture and ethnicity whilst working with trauma in a trauma focused approach, and argues for therapeutic culturally oriented interventions, to attend to the material between a child of black, brown or of a different ethnic group origin than the therapist. Whilst emotionality can be encapsulated in the therapist’s experience, the cultural component is better understood by an informed and attuned therapist, but profound engagement occurred when a therapist offered something of lived cultural experience. This also meant that the culturally sensitive and potentially even matched therapists created explicitly intense bonds with the child or family member than normally takes place because of the depth of their understanding of culture, language, nuances and what they represent to the child or family member.

We considered how experienced therapists all used trauma and relational best strength approaches to practice, specifically deepening understanding around joining and embracing culture, gender, religion, ethnicity, sexuality, and ableness. (every aspect of identity). However powerful feelings such as disempowerment, anger, despair, can be elicited and triggered by the fact that the therapist is perceived not to have cultural awareness, knowledge or sensitivity.

With regards to children who have had to flee their families’, communities and countries of birth, it is important that their perspective of their experience is deeply considered in terms of extreme trauma and cultural. ethnic and religious persecution. Once again, the more safely ‘matched the therapist is perceived to be creates expedient sense of being known Culturally sensitive systems: We considered how parents and families understand and can be helped to be empowered to understand the systems that they are having to be engaged within. This includes the associated policies procedures and legal processes. We considered the use of specifically trained volunteer mentors from a bank of cultural positions to support families within cultural communities who need to access therapy services within social care. We felt that it was deeply important that the family has the space to be listened to as they discuss their perspectives and how service systems work.

Creating emotional awareness and shift in racist thought in both therapist and therapy space: Listening to narratives is central and critical in order that further racist assumptions do not perpetuate. We considered the impact of noticing and spotting microaggressions in the therapy space. Such as derogatory moments that can sometimes be foiled as compliments or as humour or even misguided support. This came from those who themselves considered themselves to be impacted upon by socio economic factors and thus disempowered and disenfranchised, holding to and projecting inherent unconscious and conscious bias and racism on those of other ethnic backgrounds. We considered this must always be challenged whilst offering, where possible, emotional containment to create reflectiveness and hence shift racist thought. We noticed how therapy interventions needed to be actively devised to address racist material with both adults and children in all therapy spaces.

We consider the sociopolitical history that particularly is affiliated to cultural groups. Is also importantly thought about within the historical knowledge of the therapists about their own particular personal and family experiences and material. This is to ensure that we understand each person’s journey in relation to racism. We considered aspects of social justice human rights and power relationships which can be addressed in the therapy space but requires a commitment by the therapists to escalate within the systems on behalf of and as advocates for the child or young person or family. This also requires the therapist to consider their own relationship with power and privilege.

Being Known. Klein, Bion and Winnicott psychoanalytic theorist’s evidence that there is something so important about being known by the other and known in relation to how you are perceived in their eye and felt by them. The connection sits in the intricacy of nuance held between those in the dyadic position together. This is how bond and trust builds, and engagement takes place, followed by shift in any thought processes that require adjustment. There are situations where cultural matching of a therapist to a child young person or family member might actually create tension and struggle if they feel that somehow a similar ethnically based professional might take a biassed position in terms of cultural judgement in relation to what has happened to them and their family. This is also the case if there is a sense of cultural collusion between a family member and an interpreter, where the element of familiarisation and familiarity becomes something collusive that the child or other person does not feel safe with. Careful consideration it therefore needs to be given to the projections which are conscious and unconscious between the child and young person and other family members or the child young person other families and interpreter.

The therapist needs to pay exceptional heat and have a culturally aware lens on the psychic material that exists in the space between the child and their family. We considered the importance of How other professionals consider race culture and ethnicity particularly in relationship to behaviour of children. Consider professional bias and the triggers and roots of such unconscious and conscious material, often around appearance and assumptions.

A cultural competence to address racism approach through Play therapy. We considered the decolonizing of play therapy methods. Whereby if the non-directive client centred play therapist gives the child from a collectivist culture an unstructured space to play and create freely and expects them then to engage in the activity independently, they may unwittingly force the child to violate cultural norms. The child from a collectivist culture may respond passively due to the strongly held expectation that the therapist will take an active role in leading the session. This approach may put the child at risk of being labelled as nonresponsive, resistant, or highly defended in a western play therapy model.

Dismantling internalised racial oppression. Children are susceptible to internalising the negative societal definitions about who they are. Therapists are required to understand the power of negative societal messages on children’s development of self-concept, and self-esteem. Play therapy is a powerful opportunity to influence the developing consciousness of the child, and potentially reprogram negative societal messages. Play therapy is a creative environment for enacting Vygotsky’s (1978) concept of the ‘zone of proximal development’, this is the distance between what a child can do without help, and their potential developmental level with the assistance of someone with the knowledge or skill to do so.

In understanding the impact of biculturalism for immigrant children, play therapists must develop a sensitivity to and a curiosity about the linguistic and transnational experiences of immigrant children and their families. The play therapist must integrate traditional western approaches to play therapy and develop creative strategies to address the lived and internalised impact of traumatic moves separations and cultures from family members, relating to fear deportation and exploitation et cetera.

The processing of ‘race-based stress’ and racial trauma for children and young people from black, brown and mixed minority ethnic cultural groups, resulting from the direct experience of viewing traumatic events related to racism against them creates a susceptibility to racial trauma. Therefore, play therapists should consider specific interventions for addressing race-based stress and racial trauma for children and adolescents of colour.

The therapist’s role is to bear the unpleasant and painful feelings of stress that are located in the child young person or family member, to hold, to know, to name and to validate the reality of the experience for the person with whom they are working.

Benevolent neutrality. This is linked with empathy fuelled by reparative and parental drives, and a consistent attention by the therapist to the damaged object of the therapist’s own unconscious fantasy. This must be considered noticed and addressed. Where western cultures view their theories and interventions as the collective that are asserted, but in so doing may equally lead to discrimination.

Cultural matching. Whilst each child and family is unique in terms of perception, caution exists around the notion of cultural matching. The debate highlights that a general policy we may only be circumventing tensions and dilemmas. Professionals must always be thinking and addressing how race and cultural processes enter clinical encounters. The process of cultural matching policies made positively, offers choice to children, parents and families from minority ethnic group backgrounds, where they have less access to generic services. Clear evidence has emerged that partial matching of race, culture or ethnicity of the clinician produces a better outcome.

Action Points

A good practise template which considers culturally appropriate curiosity.

A focus group with professionals to consider data around cohorts of families using therapy and themes in relation to culture race and ethnicity. Creating listening spaces to think about experience in terms of racism and cultural nuances and identity.

Practise exercises and strategies to consider cultural attunement IE clothes, fasting, celebrations, music, Bodily behaviours nonverbal communications et cetera et cetera Considering the background of therapy and therefore the style and mediums that the therapist brings to the space.

Consider the impact of social class religious orientations gender and sexual orientations, racial social and geographical histories which all play their part in the cultural narratives and dynamics, contributing to themes that inadvertently play out in therapy. Achievement offers leverage to enable the therapist and child or family member to work expediently together in relation to cultural understanding and effectively working with the presenting problem in therapy.

We considered always thinking about whether the child, young person or family member could or would need to choose between therapists, and when and whether this would be within the gift of service delivery. Having laminated cards with each therapist’s face and some details about their identity offered for the service users to consider. Ensuring there is an avid selection of books and children’s literature around racism and also around positive cultural identity.

Considering pictorial and narrative role models and psycho-educative texts for all developmental positions and ages. Ensuring there is an array of equipment and language appropriate books to offer insightful and intentional engagement with racism. To ensure that attention is paid to racism and identity and is encapsulated in both the supervisory processes and the therapy spaces.

Building a process map, poster fashion to address emotional intelligence and racism. Developing a process map around pathways towards cultural and racially attuned and sensitive play therapy…. Exploring and honouring names, repeating and saying names, considering names and identity Etcetera. Considering pronouns and exploring gender sexuality and culture in relation to identity in an open and curious way. Considering foods and scent in an explorative and curious way.

Constantly checking cultural blind spots and the turning of a blind eye to avoid or deny bias racism and ensure that staff and service users are informed and knowing around culture race and ethnicity.

System cultural lens team practice meetings: The creation of a systemic approach in the team space, places a culturally sensitive lens on practice to explore race, culture and ethnicity. . The team will come together once every two months for systemic supervision where the lens will be specifically on cultural sensitivity. In this space each therapist will take a turn to bring a child family or case and explore their culture, their biases, and pain in relation to self and the work. These meetings will be facilitated by the team manager who will create a thinking space where the aims are to consider the passions aroused by the subject of race ethnicity and culturing relation to the child and their systems (Family and organisations etc). The manager’s role will be to contain feelings of individuals and of the group, understanding the location of material, and how tolerable it is for each to bear it. Each person will be required to be reflective and consider their own material which can be taken into personal and private supervision.

The therapy team manager and independent consultant therapist will chair and oversee these meetings, To create regularity and safety in the space.

Supervision: The development of a space within clinical supervision to consider nuances around race culture and racism. The importance of considering unwavering cultural humility and sensitivity to be thought about in each piece of work. In this way we are attending to the therapist’s own internal values.

London Borough of Barking & Dagenham – The sunrise hub in partnership

Summary of project: The North East London Sunrise hub is a holistic, child-centred, and integrated approach to supporting the recovery of children and their families who have been affected by sexual abuse.

Key Contact: Kelly Bromfield, SA Improvement lead/ Service Manager, Family Support and Safeguarding

kelly.bromfield@lbbd.gov.uk

Read more about this project

Team: Sunrise Hub: The Northeast London Child Sexual Abuse hub (CSA Hub) and LBBD CSA Practice Leads.

Partners: Barts Health NHS Trust, Barnardo’s

Main Submission:

Introduction to the Initiative and Motivations for Action
The North-East London (NEL) Child Sexual Abuse (CSA) Hub, also known as the Sunrise Hub, is a holistic, child-centred, and integrated approach to supporting recovery of children and their families affected by sexual abuse. This initiative was commissioned by Newham CCG and involves multiple partners, including Barnardo’s TIGER services, Barts NHS Health Trust, and a Social Care Liaison officer (SCLO) employed by LB Barking & Dagenham (LBBD).

The Hub has expanded to become a comprehensive wellbeing Hub for all North-East London. The Initiative’s motivation stems from statistics that 1-in-20 children and young people experience child sexual abuse, costing the UK £3.2bn annually. In NEL alone, there were over 700 cases of non-acute CSA reported in 2018/19, with Newham having the second highest rate of reporting in London. The challenge was the lack of tailored emotional support for these children, which led to the development of the TIGER service (Trauma Informed Growth and Empowered Recovery).

Details of Actions, Activities, and Initiatives
The Sunrise Hub has implemented several best practices, combining traditional psycho-educational work with coaching and trauma-informed practice, helping children find strength to lead their recovery. The service operates across NEL and Northwest London Integrated Care Systems (ICSs) and supports victims of both intra-familial and extra-familial abuse. Key actions include:

  • Young Person Research-Based Evaluation: In 2022, MOPAC, along with NEL and NWL, funded a research project focusing on how London CSA services can be improved. Peer researchers undertook surveys with over 300 current and historical CSA service users and their parents.
  • Flexible Service Delivery: Emotional wellbeing services are delivered in locations chosen by the child.
  • Partnership and Collaboration: Weekly intake and partnership meetings between Barnardo’s, the health team, and the SCLO ensure ongoing collaboration. Partnership with Local Authorities
  • SCLO: This is a LBBD employed role, supporting 7 NE London boroughs. It offers advice and liaison between social care professionals and the Sunrise Hub. As a result of this role and the CSA improvement work undertaken in LBBD, the borough has submitted the highest number of referrals in NEL to the Sunrise Hub for CSA medical assessments as well as TIGER referrals for children. In addition to this, LBBD have set up a CSA Think Space consultation which is run by the SCLO and CSA Practice Leads who offer a reflective space to consider and drive best practice. Sunrise Hub attended 61 strategy meetings in LBBD between April ‘24 and December ‘24 in contrast to 28 during the same 2023 period. This has resulted in children and their families receiving timely coordinated services.
  • Promotion and Referral: Local authorities, particularly GPs and children’s social care directorates, actively promote, signpost, and refer children to the Sunrise Hub.
  • Awareness Training: The Sunrise Hub, in collaboration with local authorities, conducts training on trauma-informed conversations with children, parents, and carers, as well as support for lower-risk children
  • Statutory Safeguarding Processes: The partnership ensures that statutory safeguarding processes are followed, reducing the need for children to repeatedly recount their experiences.
  • Service Expansion and Development: The local authority has developed work within schools to raise awareness about healthy relationships, consent, and the use of pornography.
  • Feedback and Improvement: Local authorities alongside the Sunrise Hub gather feedback from children, young people, and families for service improvement.

Evidence of Impact

  • Improved Emotional Wellbeing: The TIGER service has helped children and young people improve their emotional wellbeing, rediscover their sense of self, and learn to self-regulate.
  • Increased Referrals and Access: The CSA health assessment clinics have seen an increase in referrals since 2020, and Barnardo’s has received 388 referrals from April 2020 to March 2023, with 95% being accepted and offered support.
  • Sustainability and Clinical Practice: The creation of a network of paediatric CSA expertise with contracting/funding processes ensure the sustainability of the hub.

Voice of the Child
The Tiger Talks evaluation project recruited peer researchers to undertake surveys and oneto-one interviews with children and young people. Key findings include:

  • Safe Space for Exploration, Validation and Support: Children and young people reported that the support services provided them with a safe space to explore their emotions and talk freely.
    • “It has been good having sessions, and I have learnt a lot, and my TIGER practitioner has listened to me and not judged me. My confidence has
      gotten better, and I go out more with friends. I get on better with my mum as I can be more opened when speaking with her. Thank you”
    • “It has been good to speak about what happened to me. I have never felt judged. – It has been easy to open up to you about my feelings/moods
      and my emotional well-being. I have found our discussions good.”
    • “I was able to talk about my feelings and problems. I understand what abuse is and I recognise when someone is taking advantage of me. I felt happy working with my practitioner, and I felt safe”.
    • “The sessions with my TIGER practitioner benefited me and helped me process hard thoughts. Helped with my derealisation. Made me realise I have a voice and am heard. And empowered.”
  • Comments were made regarding the professionalism, attentiveness and friendliness of both doctors and play specialists. Parents/carers felt that their child’s choices were respected throughout and would recommend the hub to others
  • 2 Parents stated that information and videos before the appointments were helpful to manage expectations
  • older kids commented on the fact that they liked the pace of the appointment and the fact that staff took time to explain everything before it was done.

In summary, the North-East London Sunrise Hub exemplifies best practice in supporting children and young people affected by sexual abuse. Its holistic, child-centred approach, combined with strong partnerships and innovative practices, has made a significant difference in the lives of many. This model of multi-disciplinary working lends itself to being better placed to respond to the recommendations set out in the National Review into child sexual abuse within the family environment

Supporting Information:

CSPRP_-_I_wanted_them_all_to_notice
Royal Borough of Greenwich – Integrated working between Local Authorities and health organisations

Summary of project: Royal Greenwich has well-established integrated working between Local Authorities and health organisations across both children’s and adult services. This relates to the direct delivery of services to children and their families, as well as our commissioning functions.  

Key Contact: Karl Mittelstadt, Assistant Director Children’s Services

Karl.Mittelstadt@royalgreenwich.gov.uk

Read more about this project

Partners: South East London ICB, Public Health Team

Main Submission:

Commissioning  

Our commissioning work has long been delivered in partnership with our ICB and Public Health Teams and there is a long-standing commitment to sharing resources where this supports the effective delivery of effective services to children and their families. Two jointly funded integrated Commissioning Director posts, one for adults and one for children, were established in 2021 with responsibility for overseeing commissioning activity across the Local Authority and South East London Integrated Care Board. 

The integration at senior leadership level was further built on through the development of a fully integrated staffing structure over 2022-23, which was implemented from 1 April 2024. These jointly funded teams now oversee the commissioning of services across all aspects of children’s – from CAMHS and placements for children in care to detached youth work and maternity services.  

This has helped strengthen the focus on join-up in our commissioning, including supporting the development of examples below.  

Direct and Commissioned Services  

As part of working together across the LA, ICB and our provider Trust (Oxleas NHS Foundation Trust), we have established a new integrated Clinical Team.  The team is employed by Oxleas and co-located in Children’s Services. The team delivers direct services to children and families with emerging mental health needs (child or adult). It also supports practitioners by offering clinical consultation and supervision. The service accepts referrals for children open to any part of children’s services (including youth justice services, education welfare services as well as social care). Building on this team it has recently expanded to include two specialist mental health workers for Care Leavers (fully funded by the ICB) who are also clinically supervised by Oxleas adult mental health services. 

These arrangements have recently been strengthened by the introduction of family network co-ordinator (funded by Public Health) to improve the emotional well-being of care leavers and reconnect Care Leavers with their networks.  

Our partnership with health also enables us to have strong joined up continuing care and social care decision making and commissioning arrangements in place. A joint panel co-chaired by the ICB and LA oversees the assessments for Continuing Care and provision under the Chronically Sick and Disabled Persons Act.  Although our continuing care budget is overspent, leaders across the partnership understand the volume and complexity of need and work together to alleviate pressure and provide the best support for children and their families.  

The successful commissioning and delivery of services is based on governance and oversight arrangements that are characterised by high trust and integrity. Our DCS has regular 1:1 meetings with the Director of Children and Young People in the Community Health Trust. These meetings are complemented by regular joint leadership meetings between Children’s Services, the Community Trust and ICB.  Most recently these have been extended to Heads of Service. These arrangements strengthen cohesion by fostering sustainable and high-trust relationships.  

Our health partners play a strong role in statutory safeguarding arrangements and co-chair three of our five sub-groups (Quality Assurance and Audit, Learning, Training and Policy as well as the Serious Care Review Group).  

All of our recent inspection activity has highlighted the strength of partnership working in Greenwich.  

HMIP (March 2023): ‘There is an extensive health offer to the children working with the YJS, including a family intervention and clinical health lead (consultant clinical psychologist with CAMHS), YJS nurse, substance misuse service workers, a speech and language therapist, and a liaison and diversion specialist. These personnel are co-located with the YJS team and we saw good evidence of speedy access to services in our case’ inspection. The health team supports accelerated access to specialist mental health services, where this is required. 

Local Areas SEND Inspection (May 2023): ‘Leaders in Greenwich are determined that every child or young person with SEND should have their needs identified accurately and met consistently. The local area partnership in Greenwich is mature and fully integrated. Jointly commissioned services are well established. Leaders across education, health and care know exactly what is working well, and which aspects of work could be even better’. 

ILACS (June 2024):  

  • Highly effective partnership working with housing colleagues, schools, youth services and children’s centres, as well as mental and physical health services, helps children and their families receive the right support at the right time. Collaborative multiagency working is making a difference to children and young people’s lives and helps to limit the demand for more intensive statutory provision. 
  • There is a strong focus on supporting care leavers to maintain their physical and emotional health. Intelligent and effective joint work with the mental health early intervention team provides timely and effective support to care leavers experiencing mental health difficulties. 
London Borough of Merton – Co-production of Merton’s ‘Our Merton Family Hub’

Summary of project: collaborative exercise involving consultation with young people, parents, local community groups, commissioned service and statutory partners to develop a shared vision of how Family Hubs in Merton will be experienced by those who use or work with them.

Key Contact: Allison Jones, Head of Early Years, Family Wellbeing and Early Help

allison.jones@merton.gov.uk

Read more about this project

Team: Family Hub Transformation team.

Partners: Merton Connected, Keystone Marketing, KidsFirst (parent/carer forum)

Main Submission:

In late 2021, Merton applied for transformation funding to support borough wide implementation of the DfE Family Hub programme. Since November 2022 Merton has, alongside 12 other successful LA’s worked diligently to initiate and embed widescale change in the way that Early Help services are accessed and experienced by babies, children, young people and their families.

Moving to a place-based delivery model with strong focus on ‘Access, Connections and Relationships’ has been achieved with careful planning, navigation and engagement across a wide stakeholder landscape. The need to talk with, hear and respond to the views of local families has remained front and centre of early development work. Embedding the ‘Family Hub’ brand and a shared understanding of the concept has taken time. The evolution of ‘Our Merton Family Hub’ was driven by a need to develop simple language and messaging about how Family Hub services would be experienced by those who use and deliver them.

The development of ‘Our Merton Family Hub’ (or visual pledge as it is often referred) was an iterative process, drawing initially, from insights and feedback gained through engagement and consultation activity. This included:

1) Discussions with parents who had joined ‘Merton Family Voice’ (a parent/carer forum where feedback on various aspects of transformation has been sought).

2) Conversations with young people and families who attended the Family Hub launch event in August 2023.

3) Feedback shared by VCFSE partners in a series of workshops aimed to build relationships with third sector organisations (many of whom represent the views/experiences of lesser groups within our local communities).

4) Structured activity held during a Partner Engagement Day (19.01.24) where views were sought on the shaping of a visual pledge.

A visual illustrator was drafted in to translate words into pictures. This was considered important to ensure that the messaging about Merton Family Hubs is understood and accessible to a diverse audience, including younger children, families with SEND, people with learning needs and those with English as an additional language. Young people also told us that any information needed to be easy to both read and understand.

Five versions of ‘Our Merton Family Hub’ were drafted before landing a final product. Each draft was consulted on, and feedback drawn from several sources (including the audiences has allowed Merton to be fully assured that the inception of ‘Our Merton Family Hub’ is truly informed by co-production and collaborative working, supporting a sense of borough wide ‘ownership’ regarding the programme and its aspirations.

This mode of engagement and consultative approach has enabled families and delivery partners to contribute to the shaping of Merton’s Early Help/Family Hub offer. We recognise that for many families, the support provided through Our Merton Family Hub has made a huge difference when managing very challenging circumstances and whilst waiting for specialist health interventions. This has been of particular significance to parents of children with SEND, who have told us how Family Hub services have really helped them to better care for their children when they become dysregulated. The interface with ‘Kids

First’ has helpfully shaped the framing of Merton’s approach to better reflect and respond to the lived experience of families with SEND and work towards improving outcomes through an effective support offer.

Using the strapline ‘Our Merton Family Hub’ and displaying this widely across buildings, promotional material, websites, presentations and communications has also promoted a sense of collection and belonging. Families told us that they wanted Family Hubs to be somewhere with more opportunities to ‘drop in to’ and meet other parents when the opportunity arises. This is reflected in various ways within both the visual pledge and through the developing Family Hub service offer. As a direct result of feedback, we have increased drop-in sessions across our Family Information and Support Hubs, Open Garden Sessions, MIASS and delivered more open access ‘on off’ events for Families to attend. This has been well received with over 100 family members attending a recent open garden session at one of our Family Hub network delivery locations.

Children young people and parents each contributed to the shaping of this work. Parents of children with SEND shared helpful feedback on use of colours and imaging to support greater full accessibility. Whilst efforts were made to reduce the amount of text within the visual for ‘Our Merton Family Hub’ some parents shared that the visual had too many images and not enough information. Based on this feedback, a decision was taken to develop a separate booklet for parents which explains Family Hub services and the support available. These have been shared at various engagement events with parents reporting that the information contained within these booklets has been a useful source of reference.

We are planning to revisit the effectiveness of our FH brand (including our visual pledge) as part of ongoing review and evaluation activity. This will involve the development of a practitioner resource tool kit which partners will be invited to use in their engagement with families and young people to gauge feedback on perception and experience of support through Merton Family Hub.

Supporting Information:

London Borough of Redbridge – Pre-post birth service

Summary of project: This submission reflects on the success of the existing pre-birth service delivered alongside Health colleagues and the plans for further expansion with health colleagues fully embedded within the team.

Key Contact: Catherine Worboyes, Assistant Director, Children’s Social Care

catherine.worboyes@redbridge.gov.uk

Read more about this project

Team: Family Help: pre- & post-birth

Partners: ICB, NELFT, Public Health, Midwifery

Main Submission:

Delivering together with health in response to the recommendations from Born into Care and to the increasing numbers of post-birth care proceedings, Redbridge Children’s services established a multi-agency pre-birth service in 2021 focused on vulnerable pregnant women where there was a hight risk of post-birth care proceedings.

Redbridge’s data showed that those most at risk were:

  • Care experienced young people/children & young people in care
  • Parents who had experienced the removal of previous children
  • Young parents
    The introduction of this new pre-birth service led to signification reductions in the number of
    child protection investigations and post-birth care proceedings. In 2023/2024, even though the
    number of referrals leading to the assessment of unborn babies increased by 65%. the pre-birth
    service outcomes showed:
  • 22% reduction in child protection investigations
  • 19% reduction in pre-birth child protection conferences
  • 18% reduction in pre-birth child protection conferences leading to a child protection plan
  • 30% reduction in the issuing of post-birth care proceedings

Building on the success of this service

Redbridge is now developing a multi-agency pre-& post-birth service with Health Partners as part of its new Family Help service.

Strategic and operational partnerships with Health colleagues are already in place through the Multi-Agency Safeguarding Hub (MASH) including weekly meetings with the hospital midwifery team to discuss and plan for known high risk pregnancies. A range of other health partners also attend these meetings including perinatal services, health visiting and the specialist midwife for teenage pregnancies.

The new Family Help – pre-& post birth service will build on these established relationships, draw on the learning from the successful Family Nurse Partnership in Redbridge and on the achievements of the existing pre-birth service.

The new Family Help – pre-& post birth service will increase the capacity of our multi-agency team enabling them to expand the number of families they work with in the earliest stage of pregnancy, undertaking intensive, preventative family-centred work, including families where babies have previously been taken into care.

The new service aims to support many more vulnerable mothers and families both pre- and postnatally by providing earlier targeted intervention and support to first time parents, particularly those identified as high risk. A key challenge was designing and implementing the right structure to meet the needs and demands of the families requiring support from the pre- & post-birth service. Managed by Children’s services, the team is made up of a Team Manager, Practice Manager, a Senior Social Worker two Social Workers, four Family Support Workers.

Reduced caseloads provide social workers with the time to build relationships. Support will be tailored to the individual needs of the family.

The team will integrate key health professionals enabling Family Help to provide practical support to a much wider group of vulnerable families, giving them the confidence and help to look after their babies and keep them safe, ensuring families can thrive and that those who need it access perinatal mental health support. The service will expand to include five health professionals, co-located with the social care team.

These posts include:

  • A dual qualified Health Visitor and Midwife
  • A Health Visitor specialising in drug and alcohol use
  • A Health Visitor with a specialist interest in working with those who have experienced
    Adverse Childhood Experiences and previous children being removed
  • A Mental Health and Wellbeing Practitioner
  • A Nursery Nurse

The breadth of health and social care expertise within the team will enable it to provide intensive support, assessment and intervention to those parents most at risk. As outlined, operational links with midwifery services had been well established, with the service further building upon those relationships. Moving forward the service wants to mirror and embed the practice provided by the Family Nurse Partnership to provide consistent support across both social care and health services.

The service will run in tandem with the pre-birth panel which reviews all high-risk pregnancies in the pre-birth team, with particular attention given to those in care/are care leavers to Redbridge. As previously identified, care experienced young people were identified as being at a higher risk of post-birth separation from their child. The aim is for experienced managerial oversight to ensure early care planning and support is implemented to reduce the number of care proceedings, or to ensure that those at the highest risk are identified early.

Evidence that the best practice initiative is having an impact

We already know the impact of our small pre-birth team and we expect that the expansion of this team into a multi-agency service to support and deliver positive outcomes for a much larger number of families.

To reiterate, in 2023/2024, even with the number of referrals leading to the assessment of unborn babies increased by 65%. the pre-birth service outcomes showed:

  • 22% reduction in child protection investigations
  • 19% reduction in pre-birth child protection conferences
  • 18% reduction in pre-birth child protection conferences leading to a child protection plan
  • 30% reduction in the issuing of post-birth care proceedings
London Borough of Tower Hamlets – Diamond Project

Summary of project: The project was developed from the ground up as an innovative initiative funded by Tower Hamlets Council (LBTH) and the London Innovation and Improvement Alliance (LIIA). The cycle of infant removal perpetuates their exclusion from essential services, reinforcing patterns of crisis and instability. The Diamond Project was designed to break this cycle by providing the support necessary for parents to improve their lives and future parenting prospects.

Key Contact: Sam Nair, Principal Social Worker & Head of Learning Academy

sam.nair@towerhamlets.gov.uk

Read more about this project

Team: Edge of Care Team

Main Submission:

The challenge of recurring removals of infants from their parents is a particular issue for Tower Hamlets where 40% of care order applications involve parents who have previously lost custody of at least one infant.

These parents face complex and interwoven challenges. Their histories are often marked by childhood trauma, neglect, and repeated interactions with the care system, leaving them distrustful of professional services and hesitant to engage. Because their children are removed, these parents often become ineligible or untrusting of long-term support. The cycle of infant removal perpetuates their exclusion from essential services, reinforcing patterns of crisis and instability. The Diamond Project was designed to break this cycle by providing the support necessary for parents to improve their lives and future parenting prospects.

Consideration was given to using the Pause Programme, but this is a costly option and imposes some conditions upon the mothers. Tower Hamlets aimed to create a similar, cost-effective project within an established service, ensuring sustainability and innovation at a smaller scale. The Diamond Project was integrated into the existing multi-disciplinary Edge of Care Team which allowed the project to leverage pre-existing relationships and networks within Children’s Services.

The name of the project was chosen because diamonds are strong and unbreakable, qualities we wanted parents to see within themselves so that they felt empowered to make changes in their lives.

The project aims to help referred parents to achieve the following four objectives:

  1. Being a parent -Staying in contact with their children and contributing to their lives.
  2. Staying healthy – Improving their health, including mental health, self-regard, and safer sexual practices.
  3. Staying safe – Avoiding abusive relationships and building safer ones.
  4. Being in control – Building security, accommodation, income, employment, and self-confidence.

The project was developed from the ground up as an innovative initiative funded by Tower Hamlets Council (LBTH) and the London Innovation and Improvement Alliance (LIIA). This was in consultation with the East London Family Court and with support from local stakeholders (RESET/CGL, The East London NHS Foundation Trust, OCEAN Mental Health Service and Perinatal MH Service, EAFC Positive Change, Adult Services Community Learning Disability Service, Adoption London East, and Tower Hamlets Housing. Parents who themselves experienced the repeat removal of their children have been consulted to be active partners in the development of the offer.

The Manager for the Edge of Care Team led the project, which was integrated into her team. This setup facilitated trust and effective working relationships, ensuring that referrals were appropriate and timely. This allowed the practitioner to be part of the multi-disciplinary team, providing support and containment.

In the first year, the project faced challenges with limited capacity of one practitioner, but we resolved this by increasing staff and leveraging partnerships. The Better Together Framework provided a consistent language and approach, fostering collaboration and resource-sharing among diverse stakeholders and allowing the project to build a robust network of partner agencies, facilitating the development of our offer.

To date the project has received 23 referrals for support for parents, and we have worked with 16 of those mothers. Some referrals were not accepted as parent was living outside the borough, or they had older children living in their care, or were already pregnant and did not meet the criteria. Where we could, we sign posted them to other services.

In light of a positive evaluation, the project has been extended for a second year, with two workers. This extension provides enhanced stability, enabling more parents to benefit from the program. Additionally, the group offer has been implemented to support as requested by parents from gathered feedback. The group will provide peer support to parents, specifically focusing on addressing the loss they have experienced. This is planned to be a tri-borough initiative, coordinated with Ocean Mental Health NHS service, supported by a clinical psychologist.

Due to our project’s small scale and capacity, our support has primarily focused on mothers, though we recognise that fathers also face recurrent care proceedings. While some joint support has been extended to fathers, it has mostly involved activities like writing letters to their children or referrals to relevant services. Recently, we decided to trial working with a father who has agreed to receive support. This approach is not yet tested, but we hope that with a larger project in the future, we will be able to expand this support

In Year 1, the project worked with 10 parents who had a total of 39 children removed from their care. None of those has had any further care proceeding at this point two years on.

The pilot service achieved several positive outcomes for the 10 parents in the 12 months of the project. Some examples of our first-year impact taken from the evaluation are:

  • All 10 women are now registered with a GP
  • 2 women facing homelessness are now moved to permanent housing
  • 3 women were supported to rebuild family relationships
  • 4 women have received counselling or advice around drug and alcohol use
  • 7 women have had some advice and support intervention around partner violence

One woman was assisted in accessing the Adult Community Learning Disability Service (CLDS), where she was diagnosed with previously undetected learning difficulties. She now receives support from this service and has been working effectively with its staff, enabling us to conclude our involvement. One partner of a woman was referred for Autism assessment.

Feedback from parents was positive:

“The worker is lovely. She listens to me, and she visits me at home and gives me time. I wanted to understand why my children were taken away. I looked at my papers with her, she helped me to understand it better.”

“She helped me write letters to my children and attends appointments with me as I have learning difficulties.”

“She helped me to be in contact with my children. I didn’t have the letterbox contact but now with support I have the contact and up to date information.”

“If it wasn’t for the worker, I’d be on the streets now”

“My confidence was very low when my children were taken, I didn’t take very good care of myself. She just picked me up and helped me to get on with things.”

Partners have said:

“I cannot over emphasise the importance of having a social worker who is alongside and working for the mothers. She understands her clients’ needs and is able to advocate for them to access the right support.” – Clinical Lead

“This is a service that has been needed for a long time” – CLDS

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