Case study: flexible delivery for a rapidly-changing world

In Nottingham City, families’ needs are being met even during the most challenging of times, through a collaborative partnership that combines evidence-based support with creativity and flexible delivery.

Everyone benefits when parenting support combines evidence and flexibilty

As part of its mission to create a thriving and sustainable city, Nottingham City Council is committed to improving the lives of local families. Nottingham is a culturally diverse and economically successful tourist hub of more than 330,000 people; however, there are also pockets of disadvantage. In recent years, the Council has made headway in addressing the needs of families and young people, in part by adopting a number of key principles such as putting more emphasis on early help and prevention; using a strengths-based and collaborative approach; building resilience and capacity, rather than dependency; and taking an evidence-informed approach (continuous improvement, test and review).

For anyone familiar with the key principles of the Triple P – Positive Parenting Program® the above list will look very familiar. Given the close alignment of their approach, it’s not surprising that in recent years a strong partnership has developed between Nottingham City Council’s Early Help Services; the National Lottery-funded programme, Small Steps, Big Changes (also known as SSBC – see below); and Triple P. Together, they’re working to support more local families and give Nottingham children and teenagers the chance to reach their full potential.

Small Steps Big Changes (SSBC) is a partnership of parents and professionals from Nottingham City Council, health services, commissioners, voluntary and community groups, all helping give Nottingham’s babies and children their best start in life. It is supported by The National Lottery Community Fund’s ten-year ‘A better start’ strategy and covers 4 key wards across the city (Aspley, Bulwell, Hyson Green and Arboretum, and St Ann’s).

Over time, this collaboration in Nottingham has become stronger. Rachel Deane of the Nottingham City Early Help Service and Suzette Leach, Senior Project Officer at SSBC have helped bring together a number of services within a new Nottingham City partnership, allowing local families to access services more seamlessly. The Council’s Early Help Service now works closely with voluntary sector services Homestart, Toy Library, and Framework (who run the SSBC Family Mentor Service and Nottingham CityCare Partnership, SSBC’s governing body).

RACHEL DEANE: We want to move to the mindset…[to encourage more parents to do a Triple P programme] that people say , ‘oh actually I received that - I thought it was going to be horrendous and they'd be on my case every two minutes but actually it was all the support I needed, so yes I would recommend it to another family member’. …We used to do 1-2-3 Magic; we used to do Incredible Years - we used a mishmash of everything. It really helped when we committed to Triple P and now the suite of Triple P programmes, using that as an early intervention up to the eight-week programme. Some of our specialists working with children who have disabilities have gone over to a slightly different pathway, but it's interesting when you read more that there are definitely commonalities.

SUZETTE LEACH: For our Family Mentors, the Triple P training, to deliver Primary Care and Discussion Groups, is considered essential, because we believe that the Triple P approach supports the ethos of the Family Mentor service – so we ask them to use that approach to underpin all the support they offer families, because it’s that parent-led approach.

RACHEL DEANE: SSBC have been instrumental for the partnership with Nottingham City Council because there has been that test and learn. I think that's what we've got to go back to all the time: when we're doing something, we're testing it; we're learning from it; we're making changes for the better; and that's an ongoing improvement plan process. Without that, we wouldn't be in the position that we're in as a local authority. I can't stress how important that's partnership’s been, and the support from the Family Mentor services, not just to me as coordinator, but also to our actual family support workers. Having the shared experience and expertise has given them confidence, and that’s so important to delivery.

Adding Triple P to the mix

Both Nottingham City Council and SSBC have had staff train to become Triple P practitioners and deliver the evidence-based programme in various formats across Nottingham City:

  • Primary Care (a brief, individual intervention based on one or two main issues and making use of take-home Tip Sheets)
  • Discussion Groups (a series of four one-off topic-based 2-hour workshops)
  • Group Triple P (an 8-week comprehensive programme).

At first, each organisation ran separate trainings for staff; but with the partnership now allowing for further funding and mentoring support, late 2019 and early 2020 saw the first combined trainings (both Family Mentors from SSBC and Early Help Family Support Workers from NCC), with more planned for 2021. Both Rachel Deane and Suzette Leach are also trained to deliver Triple P themselves. They say this, along with the open and supportive communication within their organisations, and the support of Triple P UK, are all part of effective local implementation of parenting support.

RACHEL DEANE:It means what you're asking your staff to do is realistic…without that knowledge, we wouldn't have been able to do what we've done [especially during COVID-19], because I wouldn't have had the understanding of the needs and the requirements from both sides: from a practitioner side, and also what a family needs.

With the help of Triple P Implementation Consultant Andrew Freeman (whose previous experience as a family support worker has proven invaluable), the result has been:

  • Improved choices for parents and families (so they can choose the level of support they need, at the right time; not too much, not too little).
  • Better use of funds and a more sustainable model of support.
  • More flexibility while still using an evidence-based programme (including data capture and analysis).
  • More relevant referrals to other services if needed.

The lead-up to COVID-19

In the early months of 2020 delivery of Triple P programmes had got off to a flying start. The partnership had delivered more than 20 group sessions (a mix of Triple P Discussion Groups and Group Triple P), and more than 270 parents and carers had completed the full 8-week Group Triple P programme. SSBC’s Family Mentors had also supported hundreds of parents through regular family visits in Aspley, Bulwell, Hyson Green & Arboretum, and St. Ann’s.

A sudden change

By mid-March, 2020, dealing with the restrictions on face to face delivery, building closures, travel restrictions, staffing changes and even limits on what software could legally be used were among the challenges faced by Rachel and Suzette’s teams. At the time of face-to-face delivery being suspended, various groups were schedule and more than 80 families were due for individual support. Solutions to meet these families’ needs had to be quickly developed.

Stability and the voice of experience in a time of crisis

The Early Help Services team and SSBC knew that parents’ need for support would be greater than ever; in all likelihood, parents who’d never looked for support in the past would now be doing so.

RACHEL DEANE: Buildings were closing, delivery was changing…but we still knew that families needed the support. We really valued having somebody to speak to straight away [at Triple P]…We made a very clear communication out to our staff and our partners, to let them know that we were still very much working to support families, were just going to work differently. We wanted referrals to continue, because the need would still be there, and even though we’re not a statutory service, we have a very important role to play as an early help service…We’re very conscious of the fact that in this period, we’re probably going to be contacted by families that would never have ordinarily done that, with mental health issues and financial issues. I think it’s the uncertainty as well.

Under such circumstances, and with their own workers also under stress, there was a deliberate focus on avoiding knee-jerk reactions and instead creating a plan to continue to offer clear, structured and evidenced-based support to families. A triage and delivery model was established.

Andrew Freeman, the partnership’s Triple P Implementation Consultant, received urgent emails and phone calls as the team assessed the situation and looked at what could be done to support parents and families at such a stressful time. Free resources for parents, such as Top 10 Tips for Parenting During Uncertain Times, a Triple P Guide to Parenting During COVID-19, and a series of short videos, were all developed and made available within a number of weeks. Other resources for practitioners were created, to help them deliver effectively via phone and video; support webinars allowed practitioners to share ideas and ask questions, and even talk with other LGAs and agencies about their experiences.

SUZETTE LEACH: [talking about the practitioner support webinar organised by Triple P] …as a group we had a conversation about what support might the practitioners need in order to deliver remotely. For example, it's very different for them to sit on a phone when they’re used to visiting families in their houses. So actually they needed time to get familiar with that, not necessarily with the platforms, like WhatsApp and things, because everyone uses that in their personal time abut just that whole idea of now they're delivering in this very different way. So our expectations as well needed to be right in terms of what support they needed, and how quickly things could change and happen. For me, that was really helpful to do the webinar session and be able to think that through, then have further conversations, and add to what Rachel mentioned already – the built-in support sessions they’re having for managers to support staff.

RACHEL DEANE: …that certainly helped me, bouncing ideas around and asking `do you think that will work’? …I think Andrew was quite pivotal in just checking things out - what do you think, is somebody else or another council's done it or another organisation, what are the pros and cons that they faced - so we weren’t starting from nothing...Andrew was keeping us up to date with all the new things, you know, the COVID tip sheets and the videos and that’s been really helpful…Andrew understood the uniqueness of Nottingham and the complexities of Nottingham and what as two separate organisations were trying to achieve together. I think we've been really, really fortunate because we established a really good relationship from the first meeting, I would say. It was really positive and as Suzette said, and I want to echo it as well, it's that trust between all three of us … it makes life so much easier.

New ways to deliver support

From phone calls and WhatsApp messaging, video calls and old-fashioned postal delivery, the Triple P services parents need have been delivered to families during this time. Continuation and possible expansion of the use of Triple P Online as part of SSBC’s "test and learn" approach will help Nottingham City Council meet the needs of families who need additional support.

RACHEL DEANE:We’ve now developed the virtual delivery of Triple P Discussion Groups…Triple P Online has been a welcome option for parents and carers deemed to require the 8-week programme when we haven’t been able to deliver in a group format.

Overall, COVID-19 has created the urgent need for completely different ways of thinking, working, and engaging with families. Triple P UK have been able to step in and offer support to develop ways of working that will continue as many recognise the value in offering more flexible options to families and support workers.

RACHEL DEANE:For us as an organisation we've had to start working very much out of our comfort zone. Sometimes it takes a long time for a change within a local authority. But now constantly there are things that we are doing if it wouldn't have been for COVID-19. Our IT teams have been amazing. We've had to change and therefore I think it's going to make us stronger and better and coming out of this.

It’s taken exceptional professionalism and adaptability under challenging circumstances, but everyone involved in the Nottingham City partnership have been able to achieve a great deal to help local families; open communication and being able to count on the advice and assistance of their Triple P Implementation Consultant have played a vital role.

RACHEL DEANE:I think the support you [Triple P] give is amazing … when you’re leading a project, when you’ve done a business case for funding of, you know, 20, 30, 50 thousand pounds’ investment, you've then got the responsibility on your head. You have to make it work. And that can be a lot of pressure. But if you have other people to bounce ideas off, it makes things, well, easier but also evidence-based. You can say, ‘well, the reason why I'm not going down that route is because I've consulted with this other organisation similar to us, and when they did that, and…’.

ANDREW FREEMAN, TRIPLE P IC:What we’re talking about today is a good example of how working with Triple P is long term partnership, not just about those few days of training. And it’s also showing how we support that balance of programme fidelity with flexibility, because you’ve got to have both, as we know. I think that with our support, that’s something that’s been able to be achieved in Nottingham, long term but also just now in response to global pressures that have affected all of us.I think as terrible as this situation has been, it’s made every organisation, all the commissioners of services, at every level, look at how we do things. I think we're going to be looking very differently how we deliver services and I think that could be a good thing actually.

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