This module focuses on the importance of participation and co-production in the development, evaluation and service delivery of family hubs. Co-production is one element of participation; in this module, we will define both terms and use them according to those definitions.
- Meaningful participation and co-production prioritise the inclusion of children, young people and families whose views and ideas have not previously been heard; whose experiences of working with professionals haven’t always been positive; or for whom services are not easily accessible.
- Without the inclusion of families whose needs haven’t previously been met, there is a risk of repeatedly designing services that do not meet the needs of some of the most marginalised families.
- A commitment to equality, through ongoing training and information-sharing on the principles and practice of equity, diversity and inclusion, is key to good participation.
- Participation work takes time, and can be challenging, but is ultimately rewarding. It is important to plan and factor in participation work and be realistic about the outcomes.
What participation means to those who get involved
There are many reasons why children, young people, parents and carers, and those with lived experiences get involved with participation work. Here are some views from National Centre for Family Hubs (NCFH) participation advisors:
Parent Participation Advisor
As an adoptive parent, I find that participation gives my challenging parenting experiences (of which I have quite a few…) a purpose beyond the personal. I have had experiences with many services for different reasons with my children at different ages and it is rewarding for me to feed back into the system and hopefully to thereby improve services for other families. I think no matter how experienced a professional is, their perspective will always be slightly different from that of a parent who lives with the child. Mental health needs are very individual and teamwork between the professional, the parent and the child is crucial. I like to be intensely involved in projects, so that my line manager knows about my experience and can make best use of my knowledge. Dina, Parent Participation Advisor
Youth Participation Advisor
I was first introduced to participation work through my CAMHS worker and, although it was challenging to step out of my comfort zone, I soon learned the importance of using my voice and how I can bring about change. I’ve taken part in some really interesting and impactful projects over the years. I’ve learned that not only do I have a voice, but that it is important and deserves to be heard. It’s important that all services and policies centred around young people have some sort of input from young people and that adults are transparent about how this looks and in keeping the young person informed. This is especially important regarding mental health as I feel sometimes people with lived experience of mental illness have a passive role in shaping services, and when they find it difficult to express how they feel, they are not aided in speaking up and having input. I hope that I can provide a unique perspective to participation at the Anna Freud Centre by using my lived experience as a young person with mental health difficulties and turning experiences with services, both good and bad, into purposeful learning experiences. Naz, Youth Participation Advisor
How to make participation a reality
The idea of involving service users in the decision-making process is often a common goal. However, how to make this a reality can often be seen as complex, time consuming and costly. But does it really have to be?
In this article, we hear from Nasreen Siddique, Youth Participation Advisor and Dina Koschorreck, Parent/Carer Participation Advisor at Anna Freud. Dina and Nasreen unpick the Lundy model of participation and how this can be implemented.
What is participation?
Participation and co-production in organisations can have multiple definitions. We see participation as children, young people and families informing, influencing and shaping services.
Co-production is one aspect of participation: “Co-production is not just a word, it’s not just a concept, it is a meeting of minds coming together to find a shared solution. In practice, it involves people who use services being consulted, included and working together from the start to the end of any project that affects them.” (Social Care Institute for Excellence (SCIE), 2023)
- recognises that people who use services have the skills and knowledge to change and improve service delivery
- breaks down the barriers between people who use services and professionals
- builds on people’s existing capabilities
- includes reciprocity (where people get something back for putting something in)
- encourages mutuality (people working together to achieve shared objectives)
- works with peer and personal support networks alongside professional networks.
Models of participation
The Lundy model
There are many models of participation; we recommend the Lundy model (2007). This was developed to aid practitioners to meaningfully and effectively implement a child’s right to participate by focusing attention on Article 12 of the UN Convention on the Rights of the Child (UNCRC). The Lundy model has four elements – space, voice, audience and influence – and is used worldwide. Although designed to be used with children and young people, it is an adaptive tool which can be used with various types of participants in the co-production of family hubs. There are some helpful checklists on how to use the Lundy model on the Government of Ireland’s website
Other models of participation
In this module we also highlight Treseder’s degrees of participation model. Treseder’s model builds on the well-known ladders of participation models created by Sally Arnstein and Roger Hart but rearranges the rungs in a non-hierarchical format, recognises the importance of context, and lays out the degrees to which the voice of the child can be made central.
There are many different activities that contribute to participation and co-production, for example, having participants on recruitment panels, collating feedback and holding consultation events. However, it is important to recognise that participation and co-production are not one-off events; it will be essential to think about how you will incorporate collaboration at the beginning and at all stages of family hub development.
Parent and carer panels
The Family Hub and Start for Life programme sets out the expectation for local authorities to have a parent and carer panel.
Parent and carer panels are the forum where parents and carers will work together with local service commissioners to co-design and evaluate services. This will help to ensure that babies and their families are at the centre of service design and delivery.
People with lived experience can bring valuable insights and perspectives to the design of services. Our vision for parent and carer panels is for the Start for Life offer to be co-designed and for panellists to share feedback based on their experiences to support the continuous improvement of these services.”
Communities of practice
The National Voices charity has produced guidance on communities of practice, defined as:
peer-based, collaborative learning between people with shared interests. Communities often form around entrenched, complex problem-areas for which there are likely to be multiple solutions or approaches. The ‘social learning’ nature of communities of practice ensures that competency is defined and developed collaboratively, offering valuable opportunities for new ways of working to be tested and honed, and what is understood as ‘good practice’ to be continually pushed to new limits.
Establishing communities of practice around family hubs can bring together key stakeholders, including the voluntary sector, young people, parents and carers.
There are three key elements of a community of practice:
- Domain: the shared focus of the community
- Community: through regular interaction, the community develops strong working relationships based on trust, reciprocal learning, and shared accountability
- Practice: community of practice members use what they have learned to develop their practice in meaningful and experience-based ways.
(National Voices, 2023)
Why does participation matter?
Working with families is a method of understanding whether integrated care meets people’s needs. You can read more about how the lived experience of families is a powerful tool for improving health and other outcomes in the King’s Fund guide, Understanding integration: how to listen to and learn from people and communities.
Families have the skills and experience to be able to co-design services. Children, young people, parents and carers who have faced challenges often become experts and are invaluable partners. One parent told us:
I have been dealing with social workers, therapists, paediatricians, psychiatrists, SEN support workers, councillors and support workers for 11 years now. I am experienced in dealing with the impact of trauma, ADHD, depression, OCD, anxiety, a chronic pain condition, a tremor induced by bullying, precocious puberty, panic attacks that look like a complete collapse, non-accidental overdoses, anxiety-induced hallucinations, sexualised behaviour and more.
I have read books on these topics, regularly take courses, and attend conferences. Most people I know who are in similar situations have in-depth knowledge about their children’s conditions. That is why I believe participants have real insight on offer and are necessary partners in the development of services.
Participation work needs to be inclusive of children, young people and families, regardless of age and need. Prior to starting participation activity, it is important to consider what adaptions needs to be made. Lawrence (2022) emphasises the need for adults to enable children to express their views and accept this needs to be done in a multimodal way, and not to solely rely on verbal communication in participation work.
The family hub model, like children’s centres, is an integrated service. The model is expected to involve families and communities to build social capital and cohesion, as described in the Early Intervention Foundation’s (EIF’s) Planning early childhood services in 2020: learning from practice and research on children’s centres and family hubs. Findings from the report in relation to local community governance and delivery indicate:
- there is limited involvement of parents and carers in the planning and delivery of children’s centres and hubs
- there is little service co-design work with parents and carers, and
- there has been a decrease in the use of advisory boards or parent forums.
Co-production can help address these limitations, but context is key. The family hub model is an integrated service model, not a stand-alone service. Co-production must therefore focus on the journey through the system and not only on individual services such as GPs or social care. You can read more about integration and how to embed good practice in your local area in our ‘Integration and relational practice’ module.
The interim evaluation of Doncaster’s family hubs outlined how these were capturing the family voice. Family hub staff emphasise to parents that what they say matters. Information from ‘parent’s voice’, collated by family hub teams, is written up and shared with managers to inform service development.
That’s why we do parent’s voice, it is for that reason, because we’re alright changing stuff to suit our staff but that might not be what parents want… because I feel like they trust in us more then, they’re trusting that their opinions matter and their opinions count and that’s key to make sure that then they go off and say to all their friends, ‘Wow, I told them can we make group longer, they’ve done it, they’ve listened to what we say’. Family hub staff member
We do regular evaluations in sessions as well, which give parents a chance to say what they liked about the session, what they didn’t like, what they’d like adjusting for next time, and that gives a real good idea as practitioners of what we can change about the future. Family hub staff member
SCIE outlines that, in the long term, co-production can be cost-effective if services are designed to meet the needs of families and provide preventative support. Co-production may require some additional costs and it may not be possible to evidence cost-effectiveness in the short term.
Who should be involved in participation?
- Quite simply – families! To create a comfortable environment for children, young people and families, adaptations may be necessary to accommodate need and age, and to reflect the project focus.
- Parent and carer forums in your local area, and other parent and carer groups, including those for parents and carers of children with special educational needs and disabilities, and panels for those who are pregnant or have a child under the age of two.
- Family practitioners. Consider who works with families in the local area, from the public sector, the private sector and voluntary services.
- Faith and community groups who may help widen engagement. Pay particular attention to individuals and groups who have not previously accessed services in traditional ways.
- Commissioners and commissioned services. Think about how you can engage those who may be commissioned in future, not just those already working with families.
- Strategic bodies, for example, children’s strategic partnerships and integrated care systems. It’s important to include the voice of families at a strategic and governance level. You can read more about these bodies in the ‘Integration and relational practice’ module.
- National and local charities, which can bring an important perspective to local thinking, particularly in relation to protected characteristics.
- Education settings, including schools and early years provision, as universal settings can facilitate access to services. It’s also important to remember who is not accessing education settings, such as children who are electively home educated and/or children and young people who are struggling and refusing to attend school.
- Social care. It is important to also consider kinship and foster carers and adoptive parents.
How can we do participation?
- Find ways to ‘stand in the shoes of others’ and listen carefully to participants to support shared understanding of reactions, roles and responsibilities.
- Practise the skills of courageous conversations – how to respectfully let someone else know you feel uncomfortable with their tone, language or views, etc.
- Work in partnership with organisations that already have relationships with the people you want to invite to shape your service: schools, health visitors, libraries and local charities, for instance.
- Find different ways to reach different people, for example, through appropriate and safe use of social media, peer support and peer champions.
- Use language that everyone can understand and make sure everyone feels able to challenge language they are unsure of or acronyms they’ve never heard before.
- Make information accessible, for example, try using graphic representation to capture key points or consider graphic facilitation training; see examples from Bigger Picture.
- Consider barriers: is there only one way to join in, for example? Do the meeting times work for the people who want to be involved? Is childcare needed and available? Is there access for people with disabilities? How can those in rural or remote areas take part?
- Work together to become aware of personal bias and assumptions and to take this into account before decision-making. For instance, if there are practitioners who are not familiar with the difference between migrants, refugees and asylum seekers, support them to understand these differences.
- Be an ally: someone who takes action to support underrepresented groups.
- Be supportive of those sharing lived experience. This can be challenging and may be a trigger for others present, so additional pastoral or therapeutic support may be needed.
- Call people by their name – and if you’re not sure how to pronounce it, ask respectfully.
- Recognise the difference between people with lived experience (e.g., a young care leaver with cerebral palsy) and people who represent a group or community (e.g., a representative from young carers charity). Each person brings a unique perspective and can make a valid but different contribution to the process.
- Ensure safeguarding procedures are robust and well-communicated at meetings and events.
- Celebrate ‘easy wins’ to build on success for longer-term goals.
- Be clear about the purpose of engagement with all those involved. For example, you may be asking families to respond to a questionnaire as part of consultation and data collection, which is one aspect of participation. A data collection process may allow someone to share their perspective but, on its own, does not constitute co-production.
- Consider what support and training is needed to develop confidence and skills for co-production in staff and participating families.
- Commit to induction, training and skills for those who are involved in co-production – there is a lot to learn and there are fun ways to learn it.
- Ensure your promises are realistic and make sure you communicate reasons for ‘negative’ decisions – disappointment may stay in community memory longer than success.
- Remember to plan and implement consent and data-sharing processes.
- Ensure your offer is flexible and includes different kinds of participation with different levels of intensity and time commitment.
What next? Rooting service design and commissioning in participation
Once your local authority area understands what children and families say they need, it is important to consider this, together with families, alongside the following:
Understanding quantitative need
Consider the strategic direction of provision
How can family hubs build on and embed key services? For example, they should have a comprehensive Start for Life offer for parents, carers and babies at their core, and enable access to targeted/enhanced services for those with higher/specific need, while integrating with others, including social care, and child and adolescent mental health services (CAMHS).
What partnership services already work well and what is their impact on outcomes for children and families? For example, are SEND services, the Peep Learning Together Programme and maternal mental health services integrated?
What are the gaps – what’s missing locally, who do existing services reach and who isn’t reached, and why is that?
What is in development through new transformation work? When will that be ready? How it might relate to, or integrate with, family hubs?
Consider what contracts or service provisions are time-limited or subject to review.
Seize the opportunities presented by integrated care systems
The Health and Care Bill placed integrated care systems (ICSs) on a statutory footing from July 2022.
Integrated care boards (ICBs) bring together the local NHS and will take on the commissioning responsibilities previously owned by clinical commissioning groups (CCGs). Have ICB commissioners been engaged in the development of the family hub? Are there opportunities for joint commissioning?
Integrated care partnerships (ICPs) bring local partners together across the ICS area to integrate care and improve outcomes for their population. ICP service transformation and family hub service transformation are ideally aligned to improve outcomes for children.
The ICP is responsible for producing an integrated care strategy for the ICS area, covering health, public health and social care. Are the objectives of the family hub aligned with the objectives for babies, children and young people in the integrated care strategy?
For many ICSs, the footprint will cover several local authorities. Can family hubs within an ICS area collaborate to identify opportunities for join-up, such as in workforce planning, and consider joint commissioning across a wider area?
Joint commissioning and pooled funding
In a review carried out by EIF, joint commissioning of services was seen by those developing family hubs as key to enabling multiagency working. This is consistent with practice findings from a range of studies of multiagency systems, which suggest that joint funding and commissioning arrangements are associated with better joined-up systems of support.
With a complex array of providers involved in each local family hub network, joint commissioning bridges the gaps between organisations and provides clearer pathways for families to journey through the network of services.
Through joint commissioning, local partners can execute their vision and strategy for integration within their family hubs approach.
Joint commissioning means organisations collaborating and sharing responsibility for family hub services and their outcomes. To facilitate effective joint commissioning, there should be a joint commissioning plan, agreed between the local authority and partners such as health commissioners, for the services accessed through the family hub network. This should be extensive, routine, formally agreed, and cover the majority of family hub services.
Leaders will need to decide whether to align services and budgets, or to pool budgets. Pooled budgets combine funds from different organisations to enable them to fund truly integrated services. A well-developed family hubs approach will involve the pooling together of budgets from a range of funding sources such as the local authority, health commissioners and potentially other public sector, voluntary, community and faith sector (VCFS) and/or philanthropic partners.
Pooling resources requires investment decisions from a range of different stakeholders. In the context of financial pressures, each participating organisation will need to consider costs and benefits, as well as risks and rewards, and how these will be shared.
The Social Care Institute for Excellence has developed a checklist for pooling budgets:
- Consider and agree the aims and objectives of the pooled budget, using documents such as the local joint strategic needs assessment.
- Establish which partner organisations should be involved and clarify the role of each one.
- Clarify the services in scope and develop business cases with clear outlines of cost and benefit realisation over time.
- Based on the business cases, identify how the initiatives are to be funded and how the pooled budget will be managed.
- Develop a detailed and shared understanding of the associated risks, both for individual partners and the programme as a whole.
Develop a joint funding agreement with documentation that outlines:
- aims and outcomes, and the relevant functions covered
- expected benefits and how they will be measured, realised and shared
- key risks, and how they will be managed, shared and – where possible – mitigated on an ongoing basis
- respective financial contributions and other non-financial resources provided in support of the joint initiative
- how the pooled budget will be managed, with associated governance and reporting arrangements
- the duration of the arrangement, including the provision and mechanisms for annual review, renewal or termination
- technical matters, such as treatment of VAT, legal issues, complaints, dispute resolution and risk-sharing.
- What narrative do our data tell us about the involvement of families whose needs haven’t been met? Have we involved families in the interpretation of this data?
- Are there any voluntary and community organisations we could work with to support participation in family hub development?
- How can we co-produce from the outset of our project?
- What do we need to consider when communicating with our diverse communities?
- What are my own biases and assumptions?
- How might I stay motivated and motivate others when meaningful co-production gets challenging?
- What skills might I need to mediate and balance seemingly contradictory viewpoints or tensions that co-production can raise?
- What do I know about bias in research and evaluations and how can I compensate with co-production?
- Practical application of the Lundy model
- Co-production project planner
- People not process: co-production in commissioning tool
- Reflective questions to support co-produced research
- Oxford Council on co-production
- Social Care Institute for Excellence on co-production
- Communities of practice
- How involving children and young people can positively transform your service
- Voice is not enough: the Lundy model and early childhood
- What is co-design? A brief overview
- Youth participation: models used to understand young people’s participation in school and community programmes
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