Developing services for adults

[Intro] 

This is a Research in Practice podcast, supporting evidence-involved practice with children and families, young people and adults.  

Leading a Family and Group Conference Service.  

In this podcast, Tim Fisher of Relational Activism speaks to Kat Hartnett, Manager at the Camden Family and Group Conference Service about their experiences of Family and Group Conferences and its strengths as an approach. 

Tim: Maybe an opening question is, I mean, you've worked in social work for a long time, Kat. 

Kat: I have, yes.

Tim: Yes, what do you think is different about family group conferencing? 

Kat: I think what is different is it can shift the relationship with the professional and hopefully make the person feel, who's been invited to have an FGC [Family and Group Conference], that professionals see that they have resources within their network and resources within themselves. That could feel very different then when you have professionals or a system saying that, 'Actually, we know better about your situation and we're the experts.' So, that's the shift that I notice within it and also, you see that from the people attending the FGCs, leaving feeling like they are more skilled-up, that they do have more strengths than they'll recognise and feeling empowered.

[How a Family and Group Conferencing works as a strengths-based approach in adult social care] 

Tim: You mention strengths. Is adult and family group conferencing a strength-based practice? 

Kat: It is absolutely strength-based, it completely focuses on what strengths are that an adult has within them and within their network. Sometimes, if there's a network coming together and saying, 'We're able to offer this level of support and we're able to do this for the adult at the centre of the FGC but actually, we'd benefit from support in this area,' and then the professionals can be looked to… to see if they are able to provide that support. So, it's very much saying to the adults and their networks, 'What are you able to do and how can we support to do it?'

[The process and practicalities of running a Family and Group Conferencing service] 

Tim: How do family group conferences start and what does it look like? 

Kat: So, we receive referrals from lots of different places. 50% of our referrals are not from the council, so they may be from the NHS or the memory service, doctors, lots of health professionals referring into adult FGC, and then the other part is the social workers referring for adults to have family group conferences. So, it's really split and we do a lot of work with the local community and our healthcare professionals to promote family group conferencing.

Tim: What kind of work is that you do when you're promoting then, Kat? 

Kat: So, we attend the borough multidisciplinary team meeting, which looks at the best way of supporting people, where there's frailty and complex needs, and that is attended by lots of different professionals and is a really good forum for thinking about alternative ways of supporting people, alongside their health and social care plans. We also reach out to local community services and arrange to meet with them, meet with their teams to promote the service, providing examples for workers about when an adult been supported in that space and what it looked like for them and what the positive outcomes were. A lot of it is about demonstrating the strengths-based approach and demonstrating the positive outcomes for the individual.

Tim: How is received by professionals, in your experience?

Kat: Professionals are usually very open to family group conferencing, and then it takes some effort and persistence for the interest to turn into referrals from services, and that tends to be because professionals want to see how that is going to work for them, as a professional, and the impact it's going to have on the individual. What we do find is that, when people refer to family group conferencing, they then keep referring because they can see the benefit of the process and the difference it makes from other processes that someone would typically have in the local authority.

Tim: Sticking with this process and what you need to do in respect of referrals and setting up your family group conference offer, who organises the family group conferences where you are or what are the other elements of it? 

Kat: So, we have a number of independent coordinators who work independently from the council and that is also a real strength of the service. So, when they're receiving a referral and they're meeting with the professional and they're meeting with the adult at the centre of the FGC, they're coming at it without knowing absolutely everything there is to know about them, and that can feel really important to people, to start a fresh sometimes.

Tim: So, you've got this group of coordinators, you've got the referrals and the professionals that you've spoken to. From your point of view, as a manager managing the process, you get the referral in, then how do you initiate it and get it going? 

Kat: So, once we have the referral in, we will allocate to the independent coordinator, once we, kind of, check some information, if there's information missing or we need something clarifying, we have quite a lot of safeguarding family group conferences. So, often, before the point of allocating to a coordinator, I would contact the professional, just to ensure that all the relevant information is available, to ensure that it's a safe FGC happening. The coordinator will then make contact with the professional to introduce themselves and have a planning meeting where they start to put together an agenda for the FGC. That agenda is then shared with the adult at the centre of the family group conference and that provides an opportunity for them to add things to it or remove questions or remove information if they feel that doesn't work for them at this time. It's completely driven by an adult's consent. If they don't want information to be in that FGC, then it isn't going to be in it because it needs to work for the person who's having the meeting.

Tim: Once the process has got going, what, from your perspective, is happening and how do you support that? 

Kat: So, there's a huge amount of work that happens before the family group conference and a lot of this is often, kind of, overlooked, that the coordinators will spend a great deal of time going out and meeting the individual. Sometimes they'll need to spend time developing a relationship with them, so that there's an element of trust there and they're able to progress with the family group conference and feel it's something that could be helpful to them. Sometimes, in lots of situations, the adult may have family members that are in conflict. There may be a significant history of difficulties in those relationships, and actually, there needs to be some support from the coordinator to unravel some of that and put support in place to enable them to all come together on the day of the family group conference. It needs to be that everybody attending on that day feels that they're able to really work together and make a plan in the best interests of that adult, and for that to happen, sometimes there's a need for there to be elements of mediation and support for the relationships involved.

Tim: Your coordinators are organising the family group conferences on the day and what's your take on the… Because I understand, and we're talking to some coordinators, that you've got the sharing of information at the beginning and then the private family time and then the agreeing the plan on the day of the meeting. Is that how the meetings work from your perspective as well?  

Kat: Yes, that is how the meetings work. I think what is important is that there is that professional input at the beginning of the meeting. So, another part of the coordinator's role would be to ensure that professionals have shared their information when it is needed. So, for example, if someone was having an issue around housing or the suitability of their accommodation, it's really important that we have the voice of the housing association or housing services in that meeting. So, it's very much a collaborative effort, with the professionals there at the beginning to share that information, then leaving to allow the adult and their network to make their plan and share food and feel able to do that, and coming back together to listen to what that plan is going to be, with an expectation that, where it's needed, the professionals are still supporting that.

[How the benefits of a Family and Group Conferencing are evaluated] 

Tim: What do you hear afterwards, Kat, as the manager? So, the family group conferences are happening and then what do you hear afterwards and what do you want to know about the meeting after the fact?

Kat: So, often, if someone hasn't had a family group conference before, as in a social worker has one, there feedback will be that that wasn't what they expected to happen and they might give that feedback after the next one as well because they all look so different. They are very much developed around the person who's at the centre of them, which means they'll be taking place in lots of different places. There'll be sharing of lots of different foods, and it really should be a unique experience to that person. So, not two family conferences are really the same, and that is often reflected in some of the professional feedback that we get. Feedback that we have from the adult at the centre and their network is that, 'We didn't think that was going to work. We didn't think that was going to be possible, to come together and actually make a plan that looks workable,' and often, people will comment afterwards or contact the service to say, 'It's caused a shift in a relationship. We haven't been able to communicate about this issue or communicate much at all for such a long time, and now we see there's some change there and that's because of this process and that's become of this meeting and the coordinator support to develop it,' which is great feedback because it's great for people to be reconnecting and being able to support each other.

Tim: Do you record outcomes from the family group conferences that your service organises? 

Kat: Yes, so we do record outcomes when a family group conference has happened but also when a family hasn't taken place because lots of the work to prepare for the family group conference can create that change.

Tim: Thinking about outcomes, why do you need those and how do you utilise those, as a manager of the service? 

Kat: So, for example, if there was a family where there's an adult caring for their parents and there's a breakdown in that relationship and it seems unlikely they're going to be able to continue in that role, as a carer, and we do have family group conferences like this. The family group conference could create a shift in that relationship and put the resources around the carer, to enable them to continue in that role, with putting respite in place and additional support from family members to manage what can feel like a lot for them to do. Then we can see that actually, if that hadn't have happened, we can see where that may have ended up, with the care not being provided and then needing to look for it elsewhere, which, again, would not be in their interest and would be costly as well. So, we record the outcomes from the meetings that happen and we also record the outcomes when there's significant work from the coordinator but no meeting because sometimes the change occurs in that area of work and families and individuals may say, 'We don't feel we need the meeting now because we've achieved what we wanted to.'

Tim: Your service has been really successful and the referrals, as I understand it, are growing. How are you encouraging that and is there anything that you could tell people that might be looking to set up an FGC service or they're running one at the moment and they want to keep it going and keeping it successful? Anything else that you want to add to what you've told us about the way you manage your service? 

Kat: I think it's really important to be working alongside a range of different teams and having the family group conferencing model integrated into that work. So, for example, there's been the recent training with our safeguarding about family group conferencing, which has resulted in a significant increase in safeguarding family group conference referrals coming into the service, and then we're able to have a look at what's happening. We can look at the safeguarding work and the outcome being an FGC referral or the safeguarding remaining open and the FGC work running alongside to support it. So, it's very much aligning with colleagues in different parts of the organisation and working out how best to support the people within that service.

[Outro] 

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Being really clear about what family group conference is. Because what can happen is when you talk to people about family group conference, uh, several things can happen, they can think it's a therapy, when actually it's a really clear model and process. And if you follow the model and the process, even if somebody halfway through says, this really isn't for me, the first half of that process will have been very valuable. 

So it's about having a valuable process and model. So it's being clear, and being able to explain it in such a way that it is a process and model, it isn't therapy. So when you're-when you're selling it and when I've spoken to commissioners, and other groups, they would so often say things like...it sounds like family therapy to me. And I go no-no it's not family therapy. And then, the other-the other one which is probably more recent in the last 5 - 10 years, it's very similar to open dialogue. Ah, well there are some similarities but it's not open dialogue - so yeah - it's being really clear. 

So this is the offer, and also I'll-how I do that is by, is that probably multifaceted, is looking at using case studies, perhaps, uh, working with people with lived experience to come and talk about their experience because I think that-they're more powerful, than, than me talking about it. They talk about the process, and they can also talk about, the difference, how it is different, how it is different from normal day-to-day service intervention. 

It is something that is time limited, and that's really important when you're engaging with commissioners and um, teams, so they understand, this is time limited, it's not going to go on necessarily for years. When you're not going to say ‘Ok, well we'll see them for two years then refer them back.’ It's-it's-and it's not that somebody can say, oh well okay well we'll refer them to you and that's fine, because actually the person, the service they're working with is part of the family group conference going forward, and that's really important.  

The other thing that has been successful, there's two, two things, is making sure you're linking it to the policy framework and the policy landscape. At the moment there's lots of talk within the new government policies about the left shift, the left shift community. Community provision, uh, personal health budgets, personal recovery, people managing their own illness, all of that framework fits, has always fitted, but it fits in different guides so you've got to use the right language. 

So family group conference fits with that, that can deliver that in a relatively short space of time. And the other area that-that, is important when you're selling the-the service or want to get services expanded, is the cost.  

So how much does it cost? So you uh-I-I-I've worked out different costs of FGC, this is what it's like, its cost, this is like the cost of the review. And then if you-if you compare that to, somebody who, has complex mental health problems is maybe, could be engaging, could be not engaging, maybe engaging with the system, as a whole but not in a very positive way, an example of that is, somebody feeling that they're out of control, especially at night calling the ambulance on  
re-repeatedly time-repeat times, um, everybody in the system getting fed up with the individual.  

And you are saying, well okay so this is what this costs, at the moment, this is what FGC costs and let's see what the result is at the end of it. And it's important to track the result. So the result is, is there a cost reduction? And often there is, there may be initially a cost increase because someone engages with services that they haven't engaged with properly with.  

And the other thing also is to get the evaluation, so have a-have feedback, so how did it work for the family. So you're not just also engaging with one person you are invo-engaging with the system. So therefore the system itself, you know you haven't got a carer who's becoming so stressed that they begin to need services with their own. You're providing carers assessments, you're working with what-what does that part of the family need? What do they-that individual need to make themselves feel better going forward. And the family itself begins to feel empowered and can manage themselves going forward. 

For me, I think it is, there's two things. One is preparing the sys-the system, because there's an expectation that everyone in the system is gonna jump on board and say yes, this is brilliant and that always doesn't happen, because people don't like change. And, when you have a new service, people can, not always, but they can think oh hang on a minute, why are they-it's okay they've got money, we haven't got money for new workers in our team. So I think it's about, the team understanding, the system understanding the-the role of FGC and also the fact  
that-the-that FGC can support them. They can support them to deliver a really good effective service. So it's not just gonna benefit the families and individuals, it's gonna benefit the workers. 

So my name is Caoimhe McKenna, I'm the team manager of the Adult Early Help Link Worker Service and Family and Group Conferencing Service at Waltham Forest Council.  

Um, so this, service area sort of sits within our Stronger Communities directorate at the council so, that sits alongside adult social care, alongside housing, it's its own directorate, um, and we sit within that early health and prevention space so, we're not quite sitting within the statutory service. Um, and I oversee a bit of the link worker rules and then also the FGC which we'll talk a little bit more about today.  

For me personally, um, my connection to FGC, coming from Ireland, I've lived in England now for around 10 years but, within Ireland we, were very lucky that we always had quite strong networks, and community was always a real core part of my upbringing. When I go home now, it's still a really important aspect for me and, ever since moving to London, I very much felt like there was a l-a lack of community here, and you know, for people there was a-they d-they just didn't have that network.  

So it was a real passion for me that we were able to support people to either create a community, or, connect with the community that may have broken down. And I really felt like through the learning about FGC that-that was what that was doing. And in a very fast-paced way, you know, we're...FGC is a shorter intervention for us than we usually, would do so I felt "right, it's time to learn a bit more about this." This seems like it would really complement the work of the Link Worker Service, and how can we sort of, build this across the services both within statutory and within the prevention space. 

We accept referrals from everywhere else, so we are very connected within our volunteering community sector. We accept self-referrals, we have lots of people that contact our inbox or meet us at weekly community drop-in session, information sessions that we ho-hold weekly where residents can connect with us-us very quickly, and they don't need to go through a service or a front door to get to us. So, that was a core part of the work that I wanted to make sure our service could do and that we were sort of r-you know, reaching out a wide range of people. 

They come onto FGC, they will be connected with a family and group conferencing practitioner, they will then begin working with them over the next few weeks. So, they'll spend some time getting to know them and it's what we call within the FGC we're at that preparation period. So they're really getting to know the resident, they're getting to know, um, the different people that they may want at the session. 

But, a little area that we've added onto this to help us with our data tracking and our outcome tracking is we have, um, incorporated a new monitoring tool called Signal. So Signal, it's a survey essentially, and you sit down with the resident, and you-you do it together. So basically, it's a really, um...It's a-it's a very visually, you know, it's very easy for the resident to understand it. They go through a number of different questions and areas about their life.  

So, for example it may ask, it-different areas that it goes through is, things like you know, when was the last time you went to your GP? When was the last time you went to your doctor? Um, how do you feel about, you know, your money at the minute? Are you covering your rent? Are you cover-you know, do you have life insurance? All of these different areas broken down, and what the resident will do is they'll see three images on screen with these questions, and they'll choose either red - don't feel so great in that area, amber - they feel ok, or green - they feel great, there's nothing else they want to do in that. 

And what that essentially then showcases is a-is a life map, and then from that, that helps us build on the FGC because, the resident will have decided on a number of things that they want their FGC to focus on. So it might be, how do I stay safe in my community? How do I connect with others? Or any other areas that they have. But through completing this life map, we've actually found that they will then think of, "Oh, well, actually, I'd like to put in - connect them with my GP on there," or, "Actually, I'd like to, you know, I do need to book a dentist appointment, how would I go about doing that?" And we incorporate that in. And at the same time, we then complete that at the end, and ideally, you'd want to see some of those reds moving to amber or moving to green. 

So that then allows us to showcase the, you know, the-the outcomes of the service and how it is helping people to improve their lives. So, that's a little thing that we've just added in over the last month or so. We understand that with our adults, there's a lot of complexities, there's a lot of different needs. 

We didn't feel it was going to be effective for us to just sort of walk away from there, so what we've put in place is a monthly, um, FGC drop-in, where residents and their network, um, can drop in on that Tues-first Tuesday of every month, they drop into the library, they talk about things that are going well. They talk about maybe issues that they're having, maybe things in the plan that aren't really working out, and it just helps that they don't have to wait until the review for that. So, these have actually been going quite well, and we've had a lot of people popping in, even just to say, ‘You know, the plan's really working, and things are going really well, we just wanted to let you know.’ So it's just nice, I think, that people don't feel like they're being left, but they still have that accountability that it's their plan and it's their actions.  

So, that is our process and then at the end, after the review, we will then complete the Signal, um, survey again so that we can see those outcomes, and see have we-what areas we've improved in. I would definitely-definitely say our accessibility is a huge strength for us. You know, that residents can connect, the service is well promoted, um, they can go into their library and get flyers on it, they can see it on the screens, and they can just drop us an email, or they can meet us at one of our community spaces if they, you know, don't have access to a laptop or don't have access to email. So, I feel as though we're not tied into just being within a statutory field that really is a huge benefit for us, and for the residents.  

Um, secondly I would say a huge strength for us is our partnerships. We've put a lot of work into our partnerships and I would say, you know, they are some of the key areas that any new services would need to focus on because...one, you need those partnerships for the referrals, you need people to understand your service but also when it comes to, bringing people into the FGCs so that, you know, different organisations and different partners can get involved. 

So for example, we have our-we've had our VAWG team - our Violence Against Women and Girls team attend. We've had, you know, um, some of our transition teams attend, we've had different community groups come and support where the resident maybe isn't sure that they want to connect with that service, but then somebody from the service will pop in and really sell it to them and, without those partnerships, I just don't feel like the FGCs would be as suc-successful as they are. So that's a huge strength for us but we've put a lot of work into it, and I think that's why they work so well.  

When you're starting the FGC service for me, it was a-it was definitely a, a time that I thought, "It-is it going to work? What will this look like?" But actually, when you start to see those outcomes and you really see those plans coming back together, you can see the amount of work that can be done in quite a short period of time. So I would definitely say invest in it where you can. You know, sell it to the different services that you work with. Don't limit yourself to just working with one team, really try and pilot it across different areas and see what works for you and for your council or for your local area. And yeah, hopefully it'll be a huge success. 

Central to the model is the independence of the coordinator who has responsibility for facilitating the process, not for what should go into the Plan. They should not normally have any other role in relation to the central person and their network (such as social worker or service provider) but can enable the implementation and review of the Plan.

Initial training for coordinators should be for a minimum of 10 days and should include:

• training on FGC values and principles

• training on communication and facilitation skills, cultural competence

• training on specialised knowledge of adult protection issues and community resources 

• opportunities for shadowing and co-working with experienced coordinators. 

They should also be shadowed while they undertake their first conferences.

Coordinators are trained and supported to stay with uncertainty and give space for the central person and their network to find their own solutions.

Guides in different formats should be created to give out to the central person and network members. These should break down the different stages of the FGC process (including preparation), so that everyone involved is aware of what it will be like and what will happen.

The process and format should be informal and flexible so as to best fit with people’s social and cultural preferences, support needs, or other factors – as long as all participants will have a voice.

Where the central person may have limited mental capacity or other vulnerabilities that may affect their participation, they should be offered an advocate, or an alternative mechanism whereby their views and preferences can be represented (e.g. by preparing a statement or personal plan in advance).

During the preparation phase, the coordinator should connect with the central person and each network member to explore their concerns, aspirations and preferred options – and how to include the widest relevant network.

On the basis of what people have said, a working document should be drawn up and shared with all participants ahead of the Conference. 

This should be written from the perspective of the central person (but may also need to reflect the perspectives of other participants where these may differ). The central person’s voice(s) may be reflected through the utilisation of ‘I’ statements or, on occasion, by them taking responsibility for writing the document.

There should be a discussion with the central person and their network as to where they would be most comfortable in hosting their FGC. They should be offered the choice of a neutral venue for the Conference, such as a library or community facility. However, they may elect to hold the Conference wherever feels most comfortable to them – including the place where they live.

During the preparation phase, the coordinator should connect with the referrer and relevant practitioners to clarify what they would wish to bring to the discussion.

In setting the tone for the conference, it should start in a way that brings people together on an informal basis and breaks down power hierarchies – such as the sharing of food.

The discussion with practitioners in the conference should be facilitated so that all participants are able to learn with and from each other, with a particular focus around what matters to the central person.

Central to the model is Private Time in which the central person and network members (and any advocate) work up their preferred Plan. In some instances, the central person and network members may invite the coordinator into the room to assist at particular points with their decision-making process.

It is essential that coordinators are able to offer follow-through to support the implementation of the Plan, and to convene one or more conversations with the central person and network members to review how the Plan is working and address any additional issues that may have arisen.

Standard 1: Independence of the coordinator

Central to the model is the independence of the coordinator who has responsibility for facilitating the process, not for what should go into the Plan. They should not normally have any other role in relation to the central person and their network (such as social worker or service provider) but can enable the implementation and review of the Plan.

Standard 2: Initial training 

Initial training for coordinators should be for a minimum of 10 days and should include:

• • training on FGC values and principles

  • training on communication and facilitation skills, cultural competence

  • training on specialised knowledge of adult protection issues and community resources 

  • opportunities for shadowing and co-working with experienced coordinators. 

They should also be shadowed while they undertake their first conferences.

Standard 3: Preparing for uncertainty

Coordinators are trained and supported to stay with uncertainty and give space for the central person and their network to find their own solutions.

Standard 4: Explaining the FGC process

Guides in different formats should be created to give out to the central person and network members. These should break down the different stages of the FGC process (including preparation), so that everyone involved is aware of what it will be like and what will happen.

Standard 5: Flexibility

The process and format should be informal and flexible so as to best fit with people’s social and cultural preferences, support needs, or other factors – as long as all participants will have a voice.

Standard 6: Offering an advocate

Where the central person may have limited mental capacity or other vulnerabilities that may affect their participation, they should be offered an advocate, or an alternative mechanism whereby their views and preferences can be represented (e.g. by preparing a statement or personal plan in advance).

Standard 7: Supporting participants to engage

During the preparation phase, the coordinator should connect with the central person and each network member to explore their concerns, aspirations and preferred options – and how to include the widest relevant network.

Standard 8: Supporting a person-centred working document

On the basis of what people have said, a working document should be drawn up and shared with all participants ahead of the Conference. 

This should be written from the perspective of the central person (but may also need to reflect the perspectives of other participants where these may differ). The central person’s voice(s) may be reflected through the utilisation of ‘I’ statements or, on occasion, by them taking responsibility for writing the document.

Standard 9: Venue preparation

There should be a discussion with the central person and their network as to where they would be most comfortable in hosting their FGC. They should be offered the choice of a neutral venue for the Conference, such as a library or community facility. However, they may elect to hold the Conference wherever feels most comfortable to them – including the place where they live.

Standard 10: Coordinator preparation

During the preparation phase, the coordinator should connect with the referrer and relevant practitioners to clarify what they would wish to bring to the discussion.

Standard 11: Setting the right tone

In setting the tone for the conference, it should start in a way that brings people together on an informal basis and breaks down power hierarchies – such as the sharing of food.

Standard 12: Listening as a professional

The discussion with practitioners in the conference should be facilitated so that all participants are able to learn with and from each other, with a particular focus around what matters to the central person.

Standard 13: Best use of Private Time

Central to the model is Private Time in which the central person and network members (and any advocate) work up their preferred Plan. In some instances, the central person and network members may invite the coordinator into the room to assist at particular points with their decision-making process.

Standard 14: Support after a conference 

It is essential that coordinators are able to offer follow-through to support the implementation of the Plan, and to convene one or more conversations with the central person and network members to review how the Plan is working and address any additional issues that may have arisen.