Access and Inclusion

Every family should be able to get the support they need, when they need it, regardless of lived experience but this is not the case for all families. Promoting family wellbeing is most effective when families receive help early and at a level according to their needs – the right help at the right time, in the right place, with the right person. In 2016, the Early Intervention Foundation (EIF) estimated that the national cost of ‘late intervention’ (the acute, statutory and essential benefits and services that are required when children and young people experience significant difficulties in life that might have been prevented) was £16.6 billion. This highlights the economic and societal cost of ineffective access and inclusion to early support (EIF, 2020). These barriers are not felt equally across the population, and some groups will experience more than others. It is not untypical for children and families from minoritised ethnic groups to experience racism and discrimination when interacting with support providers and these impressions overshadow the overall experience of seeking or receiving support from a service (EIF, 2022). 

The coronavirus pandemic has accelerated the mobilisation of virtual and digital platforms for support provision, removing geographical barriers experienced by some families. But lockdown restrictions have also interacted with existing divides by income, age, disability, gender and ethnicity, in many cases exacerbating existing inequalities among groups already less likely or less able to access support services (Blundell et al., 2020).  

Reducing inequalities requires action across organisations: action to  prevent harmful experiences and to intervene early when problems arise. In order to reduce the impact of difficulties faced by individuals, actions are needed at an individual, family, community and societal level to create environments where all can thrive. There needs to be a combination of universal provision and targeted support for families. This enables families with higher needs not to feel negatively targeted, but also encourages them to have access to focused support where they feel equal participants. 

In the UK, there are a range of inequalities in outcomes for families from different socio-economic backgrounds. Many outcomes are affected but two examples are health (see  Public Health England, 2017) and education (see Education Endowment Foundation, 2017). Although there have been many steps towards a more equitable system. 

The family hub model offers an opportunity to improve access and promote inclusion by removing some of the barriers experienced by families when receiving support, moving between services or during transitional periods. Building relationships is a cornerstone of a family hub model. Continued dialogue (including ongoing one-to-one contact and both formal and informal communication where staff are solution-focused, open, reflective, and responsive) is one of the most effective ways of encouraging participation (EIF, 2020).  

The barriers experienced by families are multi-layered and interrelated – some services aim to work with the intersection of an individual or family need interventions aiming to engage families should therefore seek to address more than one type of barrier. 

A review by EIF found that the family hubs that have successfully engaged families are those which have understood access not as a one-off event, but as a sustained ‘continuum of access’ – a relationship rather than a transaction. This process includes: 

1. awareness by family hubs of their population’s needs, with relationships built through continuous formal and informal consultation and outreach; and ensuring parents are aware of where and what provision is available. 
2. first contact with the service, centred on promoting the value of available services and ensuring ease of access, particularly at first use. 
3. sustained engagement, ensuring that families are more confident and proactive in taking up services, including providing volunteer opportunities. 
4. promotion of the family hub to a wider group of stakeholders, using community ambassadors, supporting take-up of other services beyond children’s centres (such as GPs and hospitals), and helping families to overcome a range of barriers to access. 

Relationships are key, but it takes time to build trust and confidence, especially for parents and carers who may have limited expectations, anxiety about the opinions of others, and apprehension about what happens in the family hub. Families are often very proactive when seeking support, but don’t always feel supported if practitioners lack the skills to build a trusting relationship. Lack of confidence and distrust or fear of services are major factors in parents’ reluctance to attend a centre, therefore it is vital that family hubs build a workforce that different types of families will recognise and trust. 

We recommend that you consider using the AMBIT approach to support the development of your family hub model in helping particularly excluded and underserved families, who may have little confidence or trust in the possibility of ‘help’ being helpful in their lives. Link to integration and relational practice module.  

Family hubs offer universal access to services for children, young people, children and families. However, families may be ‘referred’ to family hubs by other professionals, for example social workers. It is important in the development process to think about this language and how it may feel to be ‘referred’ for someone who may struggle to access services. In some authorities, families are ‘connected’ and ‘introduced’ to family hubs.  

All families should provide their consent to data sharing and working with family hubs. This should be informed consent, where families understand what happens to their data, how it is recorded and shared. The benefit to families will be a reduction in how many times they tell their story and may make services more accessible.

When designing family hubs, it is important to consider the journey for the family before they decide to visit a hub or website and throughout their involvement with services. The journey planning should be conducted multiple times with different population groups held in mind and with input from families. This exercise can help to identify facilitators and barriers for different groups and highlight areas requiring more attention to improve access and inclusion.  

The interim evaluation by Ecorys reported that “the importance of hubs not solely delivering activities to ‘solve problems’ but also to create community spaces bringing families together. Hubs did this by running family friendly community events, such as Queen’s Platinum Jubilee parties with refreshments and activities or running community fridges and wardrobes to pick-up food or clothes without having to ask.” It may be as important to think about the purpose of the family hub universal offer as it is to design targeted services.  

Children, young people and families who need support may want specialist referrals to be made, but they also need to know what the service looks like and what will be offered to them. Services can be complex with tiered systems and thresholds that are difficult to understand to both professionals and families. It is important for the workforce to be knowledgeable about services and for them to be realistic when making referrals. Young people, parents and carers may need more than signposting and useful phone numbers, it important they have a named person whilst waiting for referrals to be made and to help explain the process. 

Good quality data is essential for providing insights that can drive improvements in tackling inequalities. Careful analysis of data can expose systematic inequalities that are having a significant impact on certain communities. See the family hub development process for more information on how to use data to inform implementation. 

Accurate community data provides important information on the relative population size of different population groups; raises awareness of smaller, ‘less visible’ groups; and supports more tailored responses that recognise diversity within and between groups. 

There are a range of key types of community data to give an assessment of population needs, including: 

1. the lived experiences of children, young people and families 
2. organisational data 
3. community data 
4. practitioner experience 
5. local evidence based on what works 
6. population needs and current demands on services 
7. joint strategic needs assessments 
8. publicly available data on child and maternal health (e.g. Fingertips) 
9. national data sets (including census data available from summer 2022). 

Community data should be considered alongside data measuring patterns of referral to, attendance of and engagement with services offered in family hubs, for example: 

1. footfall data from hubs 
2. membership access 
3. sustained engagement 
4. socio-demographic characteristics of those accessing support. 

Using these sources to pool accurate community and (non)attendance data will enable family hubs to tailor the support offered and ensure that families in priority groups, including those with protected characteristics, are accessing services and feel their needs are being met. 

The family hubs programme guide requires services to be made available to families: 

1. face-to-face at a family hub 
2. through the family hub but received elsewhere in the network (e.g., via outreach, at a youth centre, school, at a clinical setting such as a maternity hub, at a voluntary and community sector organisation or at a faith setting) 
3. virtually through the family hub, including static online information and/or interactive virtual services. 

Services that are universal and available to all families are critical for identifying families who need support. This is particularly important in areas where there is a high degree of population turnover. Open-access services are important for reducing stigma and for building trusted relationships. They also contribute to wider community cohesion by offering services such as cafes, libraries, IT facilities and outdoor spaces, especially in areas where community services have been reduced (EIF, 2020). 

Many barriers to accessing the right support at the right time have been compounded by the coronavirus pandemic. Lockdown restrictions have directly limited access to support for parents and carers, such as delayed or missed health visiting and GP appointments, and disrupted access to mental health services for children and young people. Virtual and digital delivery of support has circumvented some of the access restrictions experienced by families, but these also carry with them their own barriers for families experiencing economic disadvantage and socially excluded groups unable to access online services, due to digital poverty (e.g. limited skills, internet access or frequent change of email and phone number). 

An EIF review of virtual and digital delivery of interventions found that virtual delivery can be effective in improving outcomes for young people across a wide range of intervention types and outcome measures, comparable to face-to-face delivery. However, levels of participant drop-out are often high. Based on their findings, EIF promote the following recommendations when designing and delivering interventions virtually: 

1. Develop plans to address challenges such as issues of retention and children and young people to engage with services. 
2. Focus on the importance of contact between participants and practitioners, 
3. clearly identifying the core components of an intervention that must be maintained in any adaptation from face-to-face to virtual and digital delivery. 
4. Develop monitoring systems to identify quickly if interventions are struggling to reach their intended recipients or attrition rates are concerningly high. 
5. Work collaboratively to design evaluations which will improve the evidence base on effective approaches to virtual and digital delivery of interventions for children and young people beyond the immediate crisis.

Peer support, and improving mental health literacy and confidence, could be useful for groups that face some of the highest risks to their mental health, many of whom report finding professionally-led services ‘hard to reach’ or less relevant to their needs and lives for example, care leavers, children in care and young carers. Peer support offers the potential for children and young people to develop the resilience needed to reduce mental health needs and to recognise their wellbeing needs at an early stage. Done well, it can bring a unique and sustainable benefit to children and young people’s wellbeing, that can endure into adulthood (Centre for Mental Health, 2020).