Early / family help JSNAA (health and wellbeing needs in South Tyneside)

This Joint Strategic Needs and Asset Assessment (JSNAA) looks at current and future health and wellbeing needs for early / family help.

It was produced in September 2023.

Early / family help is designed to support a family at the earliest opportunity.

This can include targeted selected interventions based on demographic risks with the intent to prevent more serious problems from arising, as well as targeted indicated interventions for where a specific problem has been identified with the aim to stop these problems from getting worse.

Addressing needs early can not only address existing risks or problems but can also increase protective factors for children.

There is a growing body of evidence that at a population level, the early / family help system can improve the outcomes and wellbeing of children, young people, and their families.

This can reduce escalation to higher levels of need and therefore reduce demands on the system.

A wide range of factors can increase the likelihood that a child requires support and includes wider socio-demographic factors, parental capacity, and needs, as well as needs of the child / young person.

Due to the wide range of needs that can be met by the early / family help system, fully quantifying the population who could benefit from early help is challenging.

When looking at statistics of need, South Tyneside scores higher than regional neighbours, England overall, and statistically similar authorities.

South Tyneside has higher than expected admissions for alcohol and substance use, admissions for self-harm, and rates of diabetes; this will have significant impacts on health care resources.

Other statistics of need, including rates of neglect and rates of young carers, are higher in South Tyneside.

High level prioritisation of the early / family help system

We understand the significant impact of poverty on the health and wellbeing of children, young people and families.

The following activities are some examples of programmes that have been introduced to help our residents with the cost of living / poverty issues: 

• the Welcoming Places network
• the Holiday Activities and Food Programme, and
• work with schools around poverty

Involving service user, partner and stakeholder perspectives

• Prioritise the development of mechanisms to actively seek, analyse, and respond to the perspectives and experiences of service users, partners, and other stakeholders.

Working with partners

• Prioritising ongoing support and collaborative working between early / family help practitioners and social work staff to help facilitate innovative and case sharing solutions.
• Consider approach to working with adult services staff to identify potential referrals to  early / family help services for children dependents.

Evaluating existing service to help make improvements

• Perform regular audits of early / family help referrals to ensure quality and to inform ongoing assessments of needs in the borough.
• Following engagement with services in the early / family help system, develop a mechanism to collect data that will support evaluation of the different programmes available.
• Explore a mechanism to integrate agency assessments data into the wider early / family help system to support system-wide assessment of needs.
• Consider further work to review and understand how different services work together to address the same need.
• Consider further work to map early / family help support by geographic location, prioritising the areas of highest need. This will help to understand barriers to provide support based on geography.

Predicting which children will benefit from early / family help is not straightforward.

The 2018 national guidance, Working Together to Safeguard Children, identifies specific groups which are more likely to benefit from early / family help. These include:

• Those in a family situation which is presenting challenges for the child, such as substance misuse, adult mental health, domestic violence
• Misuse of drugs or alcohol themselves
• A disablity or specific additional needs
• Those showing signs of engaging in anti-social or criminal behaviour
• Those showing signs of neglect 

The economic impacts of the pandemic were disproportionately felt by those who were already on lower incomes and economically disadvantaged; many lost their jobs or saw their pay reduce, used up their savings or took on debt.

The cost of living crisis has exacerbated these trends.

According to a recent Barnardo's report:

• 54% of parents have had to reduce food spending for their family
• about 20% have struggled to provide sufficient food
• more than a quarter have said their child's mental health has worsened due to the situation 

There were 4.9 million households claiming Universal Credit in November 2022.

37% of these households were single parents with children and 13% were couples with children.

The number of children living in households with debt deductions being taken from their Universal Credit has risen to more than 2.2 million, more than half of all children in households receiving Universal Credit.

Deprivation

Deprivation is associated with child abuse, neglect, and social service involvement.

According to the 2019 Indices of Deprivation, South Tyneside is one of the most deprived local authorities.

Of the 316 local authorities in England, South Tyneside is ranked 12th most income deprived.

Of the 102 neighbourhoods in South Tyneside, 52 were among the 20 percent most income deprived in England and 7 were in the 20 percent least income deprived in England.

There are an estimated 31,201 children and young people aged 18 and younger in South Tyneside.

Income deprivation affecting children is approximately 26.7% (significantly higher than the England average of 17.1%) with significant variability across the borough.

How many children / young people / families are seeking support

The Front Door in South Tyneside is the main point of contact for families and professionals seeking support for families. 

Contacts fluctuate throughout the year with a decrease in numbers in the summer months and December, and a peak in the Autumn. This trend has been consistent over several years.

Contacts are received through a variety of sources. Schools are the most common source of contact (30%), with police (17%) and health (15%) as the second and third most commonest contact source.

The most common reason for contacts to the Early / Family Help Service from November 2022 to January 2023 were boundaries and behaviours, followed by the child's mental health and family dysfunction.

The wider context of the cost of living crisis is a significant risk factor for exacerbating needs of families and children.

The demand for early / family help is likely to increase as more families struggle financially and seek additional support.

Boys have been noted to lack sufficient services to address their specific needs which has been identified to contribute to anti-social behaviour.

Specific unmet needs that have been identified are lacking a physical space within which to spend time and requiring support and education with internet, social networks, and personal device use.

The rate of children living in low income families has increased significantly, with more than 1 in 4 children living in low income families.

This trend is likely to continue with the current cost of living crisis. 

The link between deprivation and the need for early / family help and statutory support is well established so this is likely to result in increasing demand on services.

Demand for early / family help services

Referrals and new episodes to early / family help increased more than 10% between 2018 / 19 and 2022 / 23.

The rising population can account for some, but not all of this demand for services.

Family help services

South Tyneside's Family Hub network provides a range of early / family help prevention and intervention programmes for ages 0 to 19 / 25. These programmes include:

• Learning with Play and Learning with Play (SEND) 0 to 4 years.
• Baby Explorers, Little Explorers and Language Explorers which focus on bonding, communication, development milestones, and health and wellbeing.
• The HENRY programme (Antenatal to 10 years). This provides support to parents and children in developing healthy lifestyle habits and a happier home environment.
• The Triple P Parenting Programmes (0 to 19 years) which provides support for families to build healthy relationships and manage children's behaviour.

Adolescent services

Youth Justice services

The Youth Justice Service provides a range of programmes with the aim to prevent re-offending, supporting, and promoting the welfare of young people, improving the life chances of young people, and protecting the public.

The services include:

• educational support
• mentoring support
• skills training
• group work
• ensuring that the young people have the right provision for physical, sexual, emotional, and mental health

Outdoor education and youth services

The Youth Service gives young people the opportunity to be involved in social action / community projects across the borough, access creative activities, and develop their personal, social, and emotional skills.

The service offers sessions tailored to young people with SEND.

Connexions

Connexions provides independent and impartial advice and guidance for post-16 careers, employment, and educational options.

Vulnerable young people in year 11, NEET young people aged 16 to 18, and those with SEND are offered support for accessing education, training or employment.

Matrix

The Matrix service works with young people, their families, and carers whose lives have been directly affected by drugs or alcohol and those who are at risk of developing drug or alcohol problems.

They provide advice and information, support with relapse prevention, counselling where appropriate, and support with social and educational needs.

Additional services

South Tyneside Homes

South Tyneside Homes manages, maintains, and improves South Tyneside's council homes and estates.

It provides services including the Housing Solutions service which offers a range of advice and support about housing, homelessness and includes a dedicated Young Persons Advisor for those aged 16 to 25.

Citizens Advice

An independent organisation specialising in confidential information and advice to assist people with legal, debt, consumer, and housing problems.

Children and Young People's Service (CYPS)

This is a single service for all children and young people aged 0 to 18 in South Tyneside with mental health difficulties.

A range of interventions have been shown to have a positive impact on early outcomes and reduce infectious diseases, including:

• Financial incentives for smoking cessation in pregnancy.
• Lactation support to increase breastfeeding initiation and duration.

Early cognitive outcomes have long term impacts on educational and employment success as well as mental and physical wellbeing.

Interventions which have evidence relating to cognitive outcomes include:

• Parents as First Teachers and the Family Nurse Partnership programmes which improve early language development and other cognitive outcomes.
• Reading Recovery, which is a programme that helps improve reading skills for those who struggle to read initially.

Behavioural development involves development of self-regulatory skills which have long term impacts on developing interpersonal relationships, success in school, and avoidance of criminal activity in young adulthood.

Interventions that have been shown to reducing problematic behaviours in the early years include Group Triple P, Empowering Parents / Communities, and Incredible Years.

Adolescent behavioural problems tend to require more intensive interventions. Intensive family interventions with evidence include Multisystemic Therapy, Functional Family Therapy and Treatment Foster Care Oregon Adolescent.

Through social and emotional development, children gain the knowledge and skills to:

• manage their emotions
• show empathy
• maintain relationships
• make responsible decisions

These skills impact on long term relationships and mental wellbeing into adulthood.

Interventions which improve children's attachment security include infant parent psychotherapy, child parent psychotherapy, and the Family Nurse Partnership.

School based programmes which improve children's emotional and social skills include the Good Behaviour Game, PATHS, FRIENDS for life, and Positive Action.

During adolescence, school based programmes that support general wellbeing include advanced life skills training and FRIENDS for youth.

Family based programmes which have evidence of reducing specific mental health symptoms include trauma focused cognitive behavioural therapy and Group Teen Triple P.

A group conversation was held with the Early Help Family Worker team to discuss the service, the roles of various members of the team and to discuss challenges and successes in the service.

Key themes that emerged from the discussion fell into 3 broad categories:

• Gaps
• Challenges
• Successes

Gaps

• Boys were identified as having specific needs that are presently insufficiently addressed by existing services.
• Non-school attenders and electively home educated children and young people were also identified as a group which at present experience insufficient services to meet need.

Challenges

• Wait lists for mental health services were identified as a significant challenge, with instances of families waiting two years for a community psychiatric nurse. These long waits were identified for both adults and children and within all available services.

Successes

• The increased capacity at the Front Door has allowed for more cases to be managed with advice and guidance at the point of triage which has reduced the number of families allocated to the more intensive Early Help Family Work team.