Working with universal services

Universal services are key partners in the delivery of a preventive approach to improving outcomes for children and young people. This section has advice on how to engage them in your work. The key universal services for children and young people are:

• GPs, health visitors, midwives and school nurses

• Early education and childcare

• Primary and secondary education

GPs, health visitors, midwives and school nurses

Health professionals make an important contribution to multi-agency working: they have knowledge of the community, relationships with local families and access to local information. They are generally the first contact point for families expecting babies, with new babies or with young families moving into the area.

Health visitors and midwives are, in many cases, already involved in multi-agency working either as part of Sure Start or through other local arrangements. Some services have found GPs more difficult to engage in multi-agency working in and close to schools and early years settings as their work is defined by their GP contract. However, examples of GPs being partners in the delivery of multi-agency work are increasing (see below).

School nurses have a key role in promoting healthy lifestyles to school-aged children and young people, identifying needs and preventing problems escalating. The Government aim is that by 2010, every primary care trust (PCT), working with children's trusts and local authorities, will have at least one, full-time, year-round, qualified school nurse working with each cluster or group of primary schools and the related secondary school, taking account of the health needs of the school population. If there is already a school nurse in the settings you are working in, they will be key partners in the delivery of early intervention support.

The National Service Framework for Children, Young People and Maternity Services (NSF) sets the context for the work of NHS organisations and partner agencies in relation to the health and well-being of children and young people. The 10-year programme requires agencies to work together to achieve sustained improvement in children's health and well-being. It forms an integral part of the Change for Children programme.

Advice on engaging health partners

The sooner key health professionals are engaged in the process of developing integrated services, the more effective the ongoing commitment and involvement is likely to be. Steps to take include:

• Be familiar with the NSF for children and young people and, if possible, local delivery plans for its implementation.
• Find out who your key contacts are in the health sector, for example children's leads in strategic health authorities, children's leads in primary care trusts (PCTs), heads of midwifery/maternity services, children's leads within mental health trusts and local GPs and practice staff.
• Identify and highlight your common aims and objectives.
• Be clear that, in working with health professionals, you are not looking for great changes in structure or practice but an adaptation of approach that will promote integration, prevent duplication and ensure a more consistent approach for families.

You may wish to discuss their input in a number of areas, for example:

• A commitment to seamless working, with good mechanisms for working together and sharing information between service providers
• Signposting families to relevant local services
• Basing health service provision within children's centres
• Co-locating services for families and children in health settings
• Participating in activities such as group work, with other local providers
• Providing specialist input to ensure a preventative approach as well as enabling the early identification of any problems
• Participating in shared training opportunities
• Providing training around health-related subjects and child development
• Creating a shared approach to workforce issues, for example: flexible work arrangements; office space that enhances good communication and team working; examination of each service provider's role to reduce duplication and enhance efficiency.

Reading and resources

Click to download advice from the Sure Start Unit to children's centres on working with health colleagues. The messages in this document are relevant to all multi-agency services seeking to deliver preventive services for children and families. It includes a list of the people with responsibility for children's services in each strategic health authority in England.

This article from Children Now has a number of examples of health involvement in the delivery of integrated services for children and young people.

Early education and childcare

Early education and childcare settings are increasingly seen as a base for the provision of integrated services for children and families.

There are a wide range of services in this area, including:

• Sure Start local programmes
• Children's centres
• Neighbourhood nurseries
• Extended schools
• Maintained nursery schools
• Early excellence centres
• Early years provision in maintained primary schools
• Day nurseries
• Playgroups
• Registered childminders

Most, but not all of these services are funded by the Department for Children, Schools and Families or Sure Start Unit. Many of them have a specific multi-agency remit, for example children's centres will often be the delivery arm for the services provided by children's trusts from the antenatal period until children are five years old.

However, not all of them do, and not all of the services are available in all areas. For example, neighbourhood nurseries and Sure Start local programmes are located in the most disadvantaged areas.

Therefore, depending on where you are and how your local services are structured, you may find that you are already part of or closely involved with multi-agency support for children aged 0 to five. However, if you are not, you may wish to explore the following opportunities for working more closely with early education and childcare services:

• Identify common aims and objectives.
• Discuss approaches and systems for the early identification of problems and integrated mechanisms for addressing them.
• Make services aware of opportunities to signpost families to relevant local services.
• Encourage their participation in activities such as group work with other local providers.
• Participate in shared training opportunities.

Reading and resources

To find out what is going on in your local area, you should contact your local authority early years team.

Click to read a Sure Start guide to the childcare and early education field.

Primary and secondary education

Schools are the largest universal service and vital partners in the promotion of the health and well-being of children and young people.

Some new multi-agency services, in particular extended schools, will be driven forward and led by the school, so not all the issues highlighted below will apply. However, multi-agency services which are independent of the school will need to develop good working relationships to ensure that coordinated and coherent services are delivered to children and families.

Schools are very busy places and, in some cases, may have reservations and need reassurances about this new area of work. That is why existing multi-agency services recommend the following:

1. Establish credibility

• Make sure all members understand the education system, otherwise the language and structures of the school can present a barrier. This will also help to ensure that non-educational staff are not intimidated during school meetings.
• Recognise that building relationships within a busy institution like a school can take time and requires a sustained effort on both parts to effect change.
• Remember that teachers have a lot of knowledge about the children and young people they work with: they see children in social situations, and see the parameters of their behaviour in these circumstances, which is very different to the one-to-one work that other practitioners may be more used to.
• Getting to know the school in both formal and informal capacity can be very beneficial for example, as well as joining in an INSET day, you might want to join in with events such as assemblies or school trips.
• Provide an efficient service by fulfilling commitments within agreed timescales.

2. Build relationships

It is likely that schools will have been key partners in discussions around the development of multi-agency services, and that you will have already developed links with them. But if you have not, it is helpful to remember that the way a multi-agency service first approaches a school can have an impact on the way that relationships develop. Existing practice suggests that the following points are important when first making plans to visit a school:

• Contact the headteacher in the first instance.
• If possible, go as a team to meet the school. It is helpful for the school to know who all the practitioners are, even if they will not see some of them very often. Ensure that you leave contact details so the school staff can contact you informally after the event.
• Stress the fact that your work will only be successful if you work in partnership with the school. This requires a commitment from both parties.
• Produce a poster with names and descriptions of practitioners, which can be pinned up in the staff room. It may also be helpful to produce a leaflet outlining your work.
• Book regular slots in staff meetings and INSET days, where possible, first to introduce the service and then to provide staff training in relevant issues, for example child mental health.
• Identify one member of staff who can champion the work of the multi-agency service and has time for effective communication and liaison. This link should be authorised by senior management.
• Ask the school to identify somewhere quiet for the team to work, including space for therapeutic work, and a dedicated telephone line if possible.

3. Be aware of cultural and professional differences

A research study looking at joint working between CAMHS and education (Pettit, 2003) recommended that support services need to be aware of different working cultures and to discuss these with schools to find solutions. In relation to preventive work to promote children and young people's well-being, these cultural differences might relate for example to:

• Relationships with children
• Understanding of emotional, behavioural and social issues
• Perceptions about school rules and routines
• The language used to describe difficulties which children experience
• Working with families
• Information sharing and confidentiality
• Management arrangements
• Expectations of the multi-agency service
• Willingness to get involved with whole school interventions as well as support for individual pupils.

4. Try to accommodate the needs of the school

• Remember that schools are busy places. Be aware of the school timetable and work flexibly so that you do not interrupt them during lessons or other key times like morning registration.
• Allocate time effectively and creatively, for example some schools may prefer a block of support rather than ongoing regular commitment.
• Ensure that all school members understand the scope of the service, so that you do not become involved in other school issues.
• Make a conscious effort not to disrupt schooling, for example if a child is receiving one to one support during class time, try to make sure it is during different lessons each week, and that the relevant staff members, and parents, have agreed to this.
• Suggest introducing a directory of all school-based support staff, and a diary for their movements, so that all members of staff know what services are available and when people are around (these are already available in some schools).
• Discuss and develop strategies for how you would approach situations in which you may need to challenge a school, for example if an exclusion is made without discussion with the service, even though you have been working to support that child in school.
• Look for a 'quick win' situation for example discuss options for new activities and support with a group of pupils about whom the school are concerned.
• When things are particularly challenging, keep upbeat - schools need to know that someone believes change is possible.

5. Clarify functions within the school

• Set clear aims and objectives.
• Ask for details of other external services working with the school, to ensure that appropriate links are made and that work is not being duplicated.
• Clarify the relationship between your service and existing support structures within the school, for example pastoral support, SEN provision, safer schools partnerships, healthy schools and home/school liaison work, to ensure that work is not being duplicated.
• Agree an approach for assessing and meeting the needs of individual children and/or their parents/carers, building on existing arrangements where these are in place (eg SEN, pastoral support or social inclusion panels). This is likely to involve:
  • regular team meetings to discuss and review individual cases and any on-going input required
  • effective liaison work with key/partner agencies to ensure that where appropriate cases/clients are referred for more appropriate support (for example assessment under the Children in Need Framework, or SEN Code of Practice)
  • the provision of management/supervision to appropriate professional standards for all staff.
• Adopt a range of approaches, including the provision of whole school support, for example training sessions for staff, audit and planning, and consultancy support.

6. Working in primary schools

Primary schools are an important partner for delivering early intervention and preventive work. Primary schools are small communities, where there may be regular contact with parents/carers, and where the headteacher is likely to be closely involved in the work of the multi-agency service, and may even be your main point of contact.

7. Working in secondary schools

Experience suggests that work in a secondary school can be more complex due to a number of factors, for example:

• The increasing responsibility taken by the young people themselves for the support they want
• The larger numbers of staff, which can make liaison with the most appropriate person difficult
• The young person and the school staff may interpret and articulate the behaviour differently
• School staff may have limited time to discuss interventions
• Levels of parental involvement may potentially be lower

At the same time, secondary schools offer a range of opportunities which can help multi-agency working, for example:

• A wider range of support staff who can get involved with your work
• A broader range of teacher expertise to draw on
• Opportunities for peer support and peer involvement
• More extra-curricular opportunities to draw on in building support packages for pupils

You may find it helpful to think through the challenges and opportunities in relation to your local schools so that the support that you can offer appears realistic and sensitive to their needs and strengths.

Reading and resources

B Pettit. 2003. Effective Joint Working Between Child and Adolescent Mental Health Services (CAMHS) and Schools, London