Integration

Introduction

Family hubs are a way of integrating family services. This module on integration has been designed to be a gateway to other modules in the Family hubs implementation toolkit, which relate to the different elements of integration. The information on this page is high level and will give you an overview of many concepts and topics you will be able to find in the rest of the toolkit. 

This module will be regularly updated to reflect the developing policy landscape, such as changes to the health care integration in line with the Health and Care Bill.  

This module references a number of useful resources but particularly draws on the Early Intervention Foundation’s (EIF) Planning early childhood services in 2020: learning from practice and research on children’s centres and family hubs 

What are we talking about? 

Integration can be a tricky concept to pin down and is used by different people to mean different things. Through integration, we seek to improve the connections between professionals, providers and services. We can think of these connections as on a continuum toward integration. The continuum starts with agencies operating in isolation, moving to increasing levels of communication, coordination and collaboration, and finally achieving integration.   

We might also think about integration as multi-professional care pathways intended to enable effective, focused services where additional needs are identified and supported through the latest evidence in practice. 

Integration may take place between professionals, providers and services operating at the same level, often referred to as horizontal integration (the engagement of several services related to different areas e.g., health, youth and early years). Integration may also take place between professionals, providers and services working at different levels, known as vertical integration (for example, ranging from early intervention to the involvement of children’s social care, or acute and primary care in a health setting). 

Each local authority area will have examples of integrated multi-professional services that have been designed and sustained, everything from children’s centres to youth offending service offers. Those developing family hubs can learn from what has worked well, and what has been learnt in partnership, in the design of these existing services. Integration is also a key part of children’s strategic partnerships and integrated care system (ICS) transformation.  

Children’s strategic partnerships are multi-agency partnerships that provide strategic leadership to improve outcomes for children and young people within a local authority. The partnerships oversee the development and implementation of local children and young people’s plans, which set out the collaborative work programme across all partners responsible for providing services to children, young people and families. The partnerships routinely have direct strategic reporting to health and wellbeing boards. In some local areas, they hold delegated responsibility for progressing the 0-25 strategic transformation agenda. 

ICSs are geographical partnerships that bring together providers and commissioners of NHS services with local authorities and other local partners to plan health and care services in 42 areas across the country. They have a larger footprint and include more than one local authority area. ICSs offer an important opportunity to improve population health through genuine partnership working between the NHS, local government, the voluntary and community sector (VCS) and local communities. 

Family hubs are also a way of joining up locally, bringing together existing family help services across health (physical and mental health) and social care, as well as VCS and education settings, to provide a single point of access. Services range from perinatal, early years and youth services to targeted support, such as support for parents and carers. The integration of services into a family hub model may involve changes to the structure of local service provision and may also involve a shift in how support is offered to families. 

Why does it matter?

  • Context

    An important lesson from over 30 years of policy initiatives is that achieving integration is hard to do. Integration takes time and it is important to acknowledge that it is not possible to integrate all services everything for everyone. Integration should be seen as a journey along a continuum. For some elements of your family hub approach, simply improving coordination between professionals in different agencies may bring significant benefits for families. 

    Differences in language, assumptions, and expectations of what good looks like means that working together in a fully integrated way can be challenging. Gaps in understanding about how the ‘other side’ works and the policy drivers that underpin the practice and priorities of different agencies can add to this challenge.  

  • Current provision

    Current provision relating to family hubs which includes our health and care system, is complex and can mean families receive fragmented care from services that are not effectively co-ordinated around their needs. This can negatively impact their experiences, lead to poorer outcomes, and create duplication and inefficiency. The fragmented nature of provision leaves families vulnerable to ‘falling through the gaps’, particularly when accessing support during transitional periods (e.g., moving from perinatal support services to early years support). 

    The involvement of multiple services and practitioners can be particularly overwhelming for children and families who have previous experiences of trauma, abuse or marginalisation. Artificial service boundaries and thresholds of individual services mean the cumulative burden of multiple needs is not recognised and go unmet. 

  • Evidence and learning

    EIF has highlighted a lack of evidence on the effectiveness of multi-agency service integration in improving outcomes for children at risk of poor / poorer outcomes  and the need for robust evaluation. However, there is a strong practice consensus that greater service integration can benefit families through reduced duplication and greater efficiency. Research suggests that integrated family support services can improve the experience of families when they only need to tell their story once. This is because integration helps services and professionals work together to make the right decisions and give families the right help. Better connected professionals reduce the burden on families of managing multiple relationships and appointments and means they should not have to continually retell their story.  

    The recent Public Services Committee report – Children in crisis: the role of public services in overcoming child vulnerability highlights the significant increase in the number vulnerable children “invisible” to social services, the NHS and the education system during the coronavirus pandemic, and the important role that family hubs can play in supporting this cohort of children by improving service integration at the local level. Learning from case reviews highlights the most serious consequences of poorly integrated services and poor coordination between services, including insufficient joined-up leadership and inadequate information sharing practices. 

  • The case for an integrated model

    An integrated model of family support that improves join up between organisations can provide a consistent, public-facing point for access, assessment and navigation of family support services. Improved relationships with VCS and grassroots institutions will enable a wider range of initial contact points, improving the ability of all families to access services. Integration also promotes a way of working that allows professionals to spend more high-quality time with families and less time on administration and lower-impact work, ultimately yielding better value for money and better outcomes. 

Who needs to be involved? 

You will need to engage a broad range of key stakeholders from across your local family services system. These stakeholders include practitioners, operational managers and strategic leads from local authorities, health, education and the VCS, and families and young people. Engage leaders of adult services at an early stage to discuss the likely needs of parents and carers who family hubs will serve, and to explore potential for integration. 

Within your area, involving both your local children’s strategic partnership leaders (local authority-led) and the partnership leaders overseeing local transformation planning (ICS-led) will be key in agreeing partnership governance. 

Having a core strategic partnership which includes commissioners from the local authority, clinical commissioning group and public health, partnership strategic leaders and a wider stakeholder reference forum, will likely be helpful.  

Family hubs will galvanise many key preventative and early intervention resources. This will support quicker and more effective intervention with families that responds to need and builds on strengths, reducing inappropriate referrals to social care and other partners. In turn, the relationship of trust built by family hubs will help practitioners identify families in need of more intensive or specialist help and support from children’s social care and other partners at an earlier stage – increasing the likelihood of support leading to sustained change.

How do we do it? 

In research carried out by EIF, the following were identified as key facilitators of integration by those developing family hubs:  

  • a shared recognition of the need for change 
  • strong leadership and management 
  • a focus on building relationships and trust 
  • clearly defined roles and responsibilities 
  • good systems for communication and information sharing 
  • support and training for staff 

This is consistent with findings from national and international evidence and research in integrated care. Another useful evidence-based resource is the Local Government Association’s 15 best practice actions for integrated care. These actions draw on evidence about what works from international research and emerging best practice whilst allowing for local variation.  

 

The Department for Education’s Family hubs model framework sets out ways in which integration, or the connection between services, professionals and practitioners, can be improved: 

  • Services working together for families with a universal ‘front door‘, shared outcomes and effective governance. 
  • Professionals working together through co-location, data sharing and a common approach to their work.   
  • Statutory services, the community, charities, education settings and faith sector partners working together in a whole-family way.  

Before starting to design your family hubs, take time to consider: 

  • what the wider partnership commitments are to integrated commissioning, service design and transformation 
  • what can be learnt from what works well and where there are gaps  
  • how a family hubs approach can add value to your local system. You can do this using our family hub development process, starting with the first step – Building consensus on the need for change. 

Case examples from Westminster

In Westminster City Council, the family hub model involves integrating early intervention work delivered by a broad range of services in the universal and early help sectors. In the Church Street Family Hub, the breadth of access is enabled by a Stay & Play, open all day, every weekday, alongside an on-site nursery and many rooms which can be used by local VCS groups to run their activities. Within the Stay & Play space, multiple specialists from child and adolescent mental health servicesspeech and language services, and health visiting are available to families in an openaccess way. This enables help to be offered within an existing safe space, and without the barriers of formal referrals. In addition, the room next door to the Stay & Play is staffed daily by a midwife conducting pre- and post-birth appointments, as well as a room which is being prepared to host a local GP. On the same floor, a co-working office is available for professionals from any other services to use, enabling connections to be made and relationships of trust to be formed between services. 

In Westminster, the development of family hubs is overseen by a family hub steering group which sits under an early help partnership board. The board consists of senior representatives from all local partners- both statutory and private and voluntary sector. Each family hub has a local integrated leadership team (ILT) made up of representatives from local partner agencies working with children aged 0-19, including youth hub leads, health visiting and school nursing managers, as well as social work and targeted early help managers and key VCS partners. ILTs meet monthly with the aim of streamlining and developing joint plans and practice, in response to their understanding of local need. They now develop an annual family hub plan, which sets out how the family hub will meet the priorities identified in the Westminster Early Help Strategy. This is informed by local data, practitioner intel and family feedback. 

Each family hub also hosts a monthly support panel where professionals can take cases for advice or support. Cases can be named, ebanling other organisations to input and offer to share information, or they can be presented anonymously and the professional can receive advice. 

A wider partnership (or network) is made up of all the services that work with families across the given family hub area, including for example schools, health practitioners, nurseries, health visitors and smaller VCS providers. The aspiration is that this wider hub partnership will meet on a quarterly basis.

  • 1. Understanding integration from the perspective of families

    The needs and experiences of babies, children, young people and families must be at the at the heart of any family hub. It is imperative to consider what integration means from the perspective of families, recognising that families will not take a linear journey through the system, often accessing multiple forms of support at the same time. An approach based on needs rather than service boundaries and threshold, can help families navigate the support system.  

    TheTHRIVE Framework for system change is an integrated, person-centred and needs-led approach to delivering services for children, young people and their families. It has been developed by a collaboration of authors from the Tavistock and Portman NHS Foundation Trust and the Anna Freud Centre, and is now being embedded to facilitate service transformation across the UK. Though initially designed as an approach to delivering mental health services specifically, it is a helpful framework for thinking about the whole family help system.  

  • 2. Building trusting relationships across the system

    A focus on building relationships and trust is key to integration. Successful implementation of a family hubs approach requires the behaviours and relationships that support collaboration to be developed, nurtured and modelled right across the family services system. A relational frame can support you to think about the people who make up a system and how those people relate to one another. 

    Adaptive Mentalization Based Integrative Treatment (AMBIT) is a relational approach developed by the Anna Freud Centre. It provides tools for using mentalization within teams, wider inter-agency networks, and with clients. Mentalization is the ability to think about thinking. It is being able to understand our own mental state and that of other people, and how this understanding affects our behaviour. It is sometimes described as ‘understanding misunderstanding’. AMBIT uses the concept of dis-integration to support professionals working in networks to understand the impact that differences between services can have on efforts to work together. 

  • 3. Community ownership and co–production

    Co-production describes a way of working together in which both support providers and service users are recognised as stakeholders and are part of the same decision-making process.  

    Within the context of integrated services, listening to families and communities is key to improving services and understanding how efforts to join up services are progressing to meet people’s needs. The King’s Fund has developed a useful guide, Understanding integration: how to listen to and learn from people and communities. It includes practical steps to help partners come together and work with communities to identify what people need, what is working and what could be improved in the provision of joined-up support.  

    For more guidance on embedding co-production within your family hubs, please see the co-production module.

  • 4. Outcomes

    Many of the best examples of successful integration have begun with partners developing a shared vision about the outcomes that they want to achieve for local people. 

    Clearly defined and shared aims, objectives and outcomes that prioritise the needs of the children and families are central to effective local partnerships. A key message from EIF’s research with children’s centres and family hubs is the importance of being clear about what a local area is seeking to achieve, and then designing services in a way that is likely to meet this purpose. Questions around who family hubs are for, and what they will do, form the basis of a theory of change. The second stage of our family hubs development process sets out how to go about developing a theory of change to specify your local family hub approach.  

  • 5. Governance and leadership

    The importance of clarity on strategy, funding and commissioning in local areas developing family hubs, as well as formal and consistent arrangements to support joined-up working, were highlighted in the review carried out by EIF 

    You will need an effective multi-agency board in place to own your family hub strategy and lead delivery across local agencies. The board should also have strategic oversight or be closely linked to other core functions of integrated early help, for example Supporting Families. Governance structures must enable different agencies to take collective responsibility, share risks and jointly invest in the local network of family hubs. 

    You can read more about the roles of local communities in governance structures in the co-production module [link] 

    Strong, shared, collaborative and outcomes-focussed leadership is key to integration: 

    • Leadership should enable staff to transcend traditional professional boundaries and individual organisational interests, and work together systemically towards a shared ambition. 
    • Senior leaders, including local politicians, should speak with ‘one voice’ on the importance of joined-up family hub services, and should champion the delivery of the local strategy and vision for the network of family hubs. 
    • Service managers working in or through family hubs should understand the governance structure and how it relates to them. The whole family hubs workforce should understand one another’s roles as part of the local system, rather than being concerned about who works for which organisation.  

    The Social Care Institute for Excellence (SCIE) has developed a checklist of factors that facilitate effective system leadership, including how to develop a shared purpose and resolve difficult conflicts.  

  • 6. Commissioning and funding

    In the review carried out by EIF, joint commissioning of services was seen by those developing family hubs as key to enabling multi-agency working. This is consistent with messages from practice from a range of studies of multi-agency systems which suggest that joint funding and commissioning arrangements are associated with better joined-up support systems of support / help for families.  

    With a complex array of providers involved in each local family hub network, joint commissioning bridges the gaps between organisations and makes clearer how families should journey through the network of services. 

    Through joint commissioning, local partners can execute their vision and strategy for integration within their family hubs approach. For further guidance on commissioning, risk management, agreements to support integration and budgets, please see the commissioning and service design module which is coming soon [link to coming soon tile on website] 

    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 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.  

    You will need to decide if you are going to align services and budgets or if you want 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 of budgets from a range of funding sources such as the local authority, health commissioners and potentially other public sector 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. 

    SCIE 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 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. 
  • 7. Evidence-led practice, evaluation and quality improvement

    Evidence and evaluation play a key part in family hub development, informing the approach a locality chooses to adopt and ongoing learning about how we can improve services for the benefit of children and families. 

    Different agencies delivering services through the family hub should have a clear view of which parts of the family hub network are working well. They should and use this insight to inform strategy and service development and take action to address underperformance. 

    For further guidance on using evidence and evaluation to inform family hub development and delivery, please see the evidence and evaluation module. 

  • 8. Co-location of services

    Co-location is not essential to integration and may be more suited to some physical locations than others. It can enable practitioners to build closer working relationships, develop a shared workplace culture and help practitioners to share concerns, issues and information. It is important to note, however, that it is the quality of joint working that is most important to effective integration. Two key factors for joint working reported by those developing family hubs are: practitioners working together across organisational boundaries to deliver interventions; and sharing of data about the families that different agencies are working with.  

    Co-location can support families’ experiences of services when care and thought has gone into the potential journey a family might take. When relevant services are close to one another it can reduce the burden on families to travel. Familiarity with hub spaces enables more trusted relationships to develop and front-door staff can better maintain consistent relationships, even when families are interacting with multiple specialists. 

    Ideally there should be an extensive range of statutory and non-statutory services co-located within family hub buildings, including the majority of 0-5 services. These services span education, health, social care, Supporting Families and other areas. To meet the basic definition of a family hub, areas should have a co-location review or strategy underway. This strategy or review should involve education, health and social care partners, and should aim to determine the extent of co-location within family hubs and necessary plans for change. 

    Effective partnership working and co-location with VCS organisations is also key to an integrated family hubs approach. This is particularly true of local grassroots groups, which can enable those who are often underserved by family help systems to become more involved in family hub design and governance. Doing so will be essential if we are to utilise the potential for family hubs to start to redress the inequalities exposed and exacerbated by the coronavirus pandemic. 

    For further guidance around co-location, please see the family hubs spaces module which is coming soon.

  • 9. Data sharing

    In the review carried out by EIF, clear protocols for data sharing were seen by those developing family hubs as fundamental to good interagency working relationships and trust. This is consistent with other studies on multi-agency systems. These studies suggest that effective information sharing, enabled by appropriate hardware and software and taking account of data protection and differing professional practice and habits, support good local partnerships. 

    To facilitate integrated working, data from family hub partners should be provided to whole family workers to inform casework, and partners should have access to authority held case recording. Ideally, reportable and quantified outcomes should be available in case management systems, and partnership outcomes data should be used to inform workforce development and strategic and commissioning decisions.  

    Further guidance will be included in the data sharing module coming soon.

  • 10. Integrated referral, assessment and case management

    In the review carried out by EIF, those working within family hubs cited the development of support pathways for families as an important way of creating integration. Some areas had developed child journey maps to improve access and reduce the number of ‘hand-offs’ between services, alongside holistic assessments and simplified referral processes.  

    Comprehensive, integrated referral pathways should be used for the full range of family hub services and should include third sector, community and faith sector partners and education settings. Pathways should be shaped to take account of impact, user feedback and new evidence on what works, and services should flex to respond to demand using live data. Using integrated monitoring systems across family hub services will enable you to target interventions to families with different needs. 

    An agreed common assessment approach needs to be in place across your local network of family hubs. This sounds include a clear, consistent and aligned process for identifying need and risk and providing appropriate support at an early stage, to support practitioners to work together to meet the needs of families. Practitioners across all agencies in the family hub network should use the agreed approach to ensure effective targeting. You should also actively monitor impact at the individual case level using valid and reliable measurement tools, including tracking over time of any paths between family hubs and other universal or specialist services. 

    A common case management system or interoperability between case management systems should be used across your local network of family hubs. This should include the case management elements set out in the Early help system guide: 

    • Do you have a case management system which allows for accurate whole family case recording? 
    • Have you embedded all individual outcomes in your case management system from notification or assessment to closure? 
    • Can you report from your case management system (and design these reports yourself)? 
    • Can you use reports from your case management system to monitor soft outcomes? 
    • Do all whole family workers record on the same case management system, or interoperable case management systems, that ensure workers can view records from partners? 

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