Targeted Response Team: Service Guide

1. Vision

The aim of the Targeted Response Team (TRT) is to help families make positive changes so they can stay together; we want to keep children and young people out of the care system (where this is in their best interests) and where care is unavoidable, to improve their life chances.

Characteristics of our approach:

• We use Signs of Safety to ensure a shared understanding of strengths and concerns between practitioners and families, setting out clearly what we hope to achieve together;
• TRT practitioners do not hold cases, we work closely with the case- holding lead and the family to achieve agreed outcomes;
• We will only work where families have given consent; this will be initially for a period of 3 months extended to a maximum of 6 months;
• A multi-disciplinary team with extensive knowledge and skills provides effective co-working on cases and will result in better outcomes for families;
• Our work with families is based on a whole family approach;
• Specialist practitioners directly provide integrated advice and support to remove barriers created through the involvement of multiple services;
• We will plan interventions focussing on key risk issues to improve family relationships and to inform assessment and decision-making in the best interests of children and young people;
• Interventions will contribute to the Child's Plan (Child Protection, Child in Need and Looked After), focussing on systemic family relationships and functioning;
• We work to service standards which support effective outcomes and ensure that interventions are credible;
• We develop practitioners who are resilient, reflective and confident.

2. Who is this Guidance For?

This guidance is for:

• Targeted Response Team (TRT);
• Early Help Service;
• Youth Justice Service;
• Children's Social Care;
• Adult Social Care.

It sets out:

• How the TRT works with families and professionals;
• Team roles and responsibilities;
• Standards of good practice;
• Information for induction and supervision;
• TRT outcomes framework.

3. The Targeted Response Team (TRT)

The team is part of Haringey's Early Help and Prevention Service within Haringey Children and Young People's Service's (CYPS), Targeted Response and Youth Justice Service and includes a team manager, senior practitioners, and practitioners with extensive experience of Family Support and Youth Work. The team also includes a group of specialist workers.

TRT practitioners will help with assessing the challenges from, and developing families' approaches to, parenting; encouraging positive behavioural change across families and understanding the perspectives of children and young people.

The specialist workers have expertise in the following themes:

• Child and adolescent mental health;
• Substance misuse;
• Domestic abuse;
• Child Sexual Exploitation.

As well as direct case work involvement with families subject to Child Protection or Child in Need Plans or where children are Looked After, specialist practitioners can provide:

• Training around a particular speciality;
• Assistance with Early Help assessments as part of the Team Around the Family (TAF) processes;
• Advice & consultancy in specialist areas.

Haringey LSCP Needs Thresholds Guidance helps practitioners to identify the level of need of a family, child or young person. This is used by the Single Point of Access (SPA) (see The Guide to the Single Point of Access for services that protect and promote the welfare of children in Haringey) and all professionals in Haringey to help families, children and young people to find the service that is best able to support them.

Click here to view the diagram which sets out the position of the TRT at different levels of need.

The TRT works with families who are assessed as being in need of support at tiers 3 and 4 (Haringey Safeguarding Children Partnership Local Threshold Guidance).

Tier 3 is defined as:

• Families with children that have multiple and / or complex needs and are in need of support.

Tier 4 describes:

• Families with children that have severe and / or complex and acute needs and are in need of care and provision.

The specialist workers as well as working with families at Tiers 3 and 4 will support Early Help colleagues working with families at Tier 2.

The TRT fits within Haringey CYPS wider Targeted Response offer which includes:

• Youth Justice;
• Family Group Conferencing;
• Emergency response for families at risk of breaking down;
• Work with families where there are younger siblings who are at risk of, or a victim of Youth Violence, and developing a targeted response to specific family members;
• Access to timely parenting support.

4. What We Do

We will work in partnership with Haringey's Children's Social Care colleagues and Early Help practitioners to support assessment and aid decision-making about what is 'good enough' and identifies what is risky in parenting. Through a Working Together Agreement made with families, this will set out the wider needs identified in the family's Children's Social Care plan.

The TRT can support families where an intervention is needed with:

• Risk of family breakdown and young person coming into care;
• Returning home from care;
• Child sexual exploitation;
• High risk of offending;
• Families affected by Youth Violence or gang activity;
• Emotional difficulties;
• Substance misuse;
• Disability;
• Play and stimulation;
• Issues around school;
• Attachment and developmental trauma;
• Extremist views;
• Violence against women and girls;
• Development of self-care skills.

Examples of some of the interventions TRT practitioners can offer are in Appendix 1: Examples of Some of the Interventions TRT Practitioners can Offer.

5. What We Don't Do

Our aim is be as flexible as possible and work proactively to meet the needs of the family/individual. We will always work with the lead social worker to provide an appropriate level of intervention to reflect the need of the family at the point it is required.

Targeted Response Team cannot offer:

• One-off tasks such as, safe and welfare checks for Social Care;
• Social work assistants to provide long term daily support;
• To assume responsibility to take the lead worker role;
• Ad-hoc tasks not in line with agreement e.g. contact visits;
• Take on ad hoc additional work identified during the course of the intervention; these will require discussion on whether or not a further request for a service is required;
• Chairing Child in Need or Core Group meetings in place of social workers;
• Allowing TRT visits or record/notes to be used to record as a statutory visit.

6. How We Work

TRT practitioners will work alongside the social worker, delivering specific and agreed interventions with families to support assessment and decision-making.

All the cases where there is involvement from the TRT will have a clear focus and identified target outcome(s). In partnership with the social worker and the family, we will make sure there are Danger Statements and Safety Goals in place.

We are committed to ensuring the work is timely for families. TRT will work for up to 12 weeks initially with a family before review of our intervention or earlier as appropriate. Ideally, case reviews will be in line with current case Core Groups, LAC Reviews and CIN meetings. We will work with families for a maximum period of 6 months.

Ending TRT involvement:

• TRT's involvement will cease on completion of, or following a review of the planned intervention;
• The family will be made aware that the TRT intervention is ending in consultation with the allocated social worker and TRT practitioner;
• The TRT worker will produce a summary of work undertaken, which includes progress made by the family towards achieving previously agreed outcomes. The focus of this report will be an analysis of the extent of change;
• There is an emphasis on the child / young person's views;
• When negotiating our withdrawal from families, we will identify any on-going support needs and safety-plan with social workers to address these. We will ensure that any new services are properly introduced through careful handover involving 3 way meetings;
• The social worker and TRT practitioner will review outcomes with the family.

7. Outcomes

Our focus is on designing the right interventions by:

• Ensuring there is clarity between the family and the social worker about the specific problem(s) that TRT are being asked to address;
• Using evidence based practice in designing an effective intervention to address the issue(s);
• Showing the extent to which the intervention has worked and the difference it has made.

To identify the difference our support has made with families that we have worked with, we use a range of measurement tools and statements used in combination at the start and end of an intervention. TRT collects outcomes data for each referred child, young person and their family (baseline measures) and we will also use a set of outcome measures directly with the family on a 10 point scale at the start, at review and at the end of an intervention. These outcome measures are selected collaboratively by the family, social worker and TRT practitioner. Both the baseline measures and outcome measures that are selected for use with each family are in Appendix 2: Outcomes Framework.

TRT specialists will also use a range of different assessment tools related to their specialism to explore what is happening for families and to support change.

We will monitor as a service each month:

• Frequency of outcomes selected;
• The degree of change;
• The average score at start, review and end of an intervention;
• The amount of change in one or more areas;
• Where there has been no change in one or more areas;
• Where the child, young person or family's situation has regressed in one or more areas.

8. Requesting TRT Intervention

Requests for TRT Intervention might be identified through the following routes:

• Transfer meeting;
• Resource Panel;
• Legal Gateway Meeting;
• MISPER / CSE Panel;
• MASE Meeting;
• Risk Management Panel;
• CYPS casework supervision.

Requests for a service need to be made to TRT using the TRT request for service via Mosaic. The decision that TRT is needed must be clearly recorded on Mosaic following agreement in casework supervision. TRT supervisors can discuss potential requests for a service with the allocated social worker or their supervisor first. Social workers must be clear about their plan for the family and what the focus of TRT intervention should be. The involvement of TRT must be incorporated into the social care plan for the family (CIN, LAC or CP Plan).

Where a request for a service is specifically being made for an intervention from one of the specialist workers, social workers are encouraged to consult with the specialist beforehand.

Once received, TRT Senior Practitioners or the Team Manager will review the appropriateness / completeness of the service request.

Allocation will be discussed at the weekly TRT supervisors' meeting and then allocated via a case discussion with a TRT practitioner taking into account:

• The family's circumstances;
• The history (and impact) of any previous involvement by other services;
• Service capacity.

The family must have consented to TRT involvement prior to request for a service and this must be clearly recorded in the request for a service. If not, the request for a service will not progress.

Social workers will be informed on the outcome of their request for a service; allocation will be within 3 working days and a notification will be added to MOSAIC.

After allocation, a case discussion should take place within 5 working days between the TRT worker(s) and the social worker. A joint visit to scope the TRT agreement and introduce the TRT worker should take place with the social worker within 10 working days of allocation.

The purpose of this visit is to:

• Describe TRT's role and make sure the family know why an intervention has been requested;
• Explain the work the family will do with their allocated TRT practitioner(s) and finalise the Working Together Agreement;
• Gather any missing information and agree outcomes;
• Ensure the social worker's Danger Statements and Safety Goals are properly understood by the family;
• Plan for any specific requirements for example around interpreters, literacy issues and/or disability;
• Check expectations about visits, meetings and sharing information;
• Explain how the family can give feedback about the intervention.

If there is no attempt made to progress planning by the social worker within 10 working days, the TRT will 'end' the request for a service and note on Mosaic that a re-request for a service will need to be made.

Where appropriate, the case discussion and planning meeting with the family could be combined.

9. Request for a Service From Specialists

Specialists can be approached for 'one-off' consultations and case discussions where cases are at Tiers 2 4, or they can be asked to undertake more intensive direct work and interventions at Tiers 3 and 4.

Where case discussions and consultation is needed, lead practitioners can approach specialists directly using the service request via Mosaic. Once the consultation has taken place, the TRT specialist practitioner will record the discussion on Mosaic within 2 working days.

It is the responsibility of the social worker to then discuss with his / her supervisor any recommendations that could influence overall case direction, within 2 working days or sooner if needed.

If a social worker has identified a need for a TRT specialist to undertake direct work with a family, resulting from a case discussion or consultation or independently of this, then the request for a service process outlined earlier should be followed.

There may be times when the screening and allocations of requests for services to TRT specialists will require additional input from clinical supervisors, for example where there is disagreement between the TRT specialist and the TRT supervisor, the TRT supervisor will make contact with the TRT specialist's clinical supervisor for further discussion and clarification.

9.1 Case study

The TRT Domestic Abuse Specialist Practitioner talks about the consultation element of her role:

I met an Early Help (EH) worker and her supervisor about a case. After discussing the case in depth in the consultation, it transpired that the client may possibly be at risk of DV and I recommended that a SafeLives risk assessment should be completed to explore the current level of risk. As the EH worker had not used the risk assessment tool previously, I suggested I complete it with the client with the EH worker shadowing me so that she could see how it is used. I also used the meeting to safety-plan with the client. I then wrote up my findings and sent it to the EH worker to inform her work on the case.

Click here to view the TRT Intervention Process Flowchart.

10. Quality Assurance

Key in improving practice is to make sure teams are part of a learning culture that is valued, continuous and supports service improvement. To support this, the TRT will use the following approaches:

• Auditing of casework;
• Observations of practice;
• Performance information;
• Feedback and evaluation from families and other professionals;
• Auditing supervision and management oversight;
• Recording good practice.

With regard to audit, we will maintain a developmental focus for ongoing and ending TRT involvement which looks at qualitative aspects including:

• The voice of child(ren) in the family is heard and influences the work being undertaken;
• The family's journey is timely and effective;
• The quality of work and that there is interagency working;
• Recording is of a good standard and key information is in place;
• Promotes reflection and learning.

Auditing will take place within 4 weeks of an intervention beginning, at the 3 month stage and at 6 months or when intervention ends (whichever is first).

A template has been developed for recording good practice in casework; this is used in a number of ways including supporting future practice, inspections, contributing to My Conversation etc (see Appendix 3: Targeted Response Team - Capturing What Works: Good Practice).

11. TRT Supervision Model

TRT follows Haringey's CYPS supervision policy. We will also check progress made through joint supervision with lead professionals at 3 months and 6 months. TRT supervisors will provide:

• High quality reflective supervision;
• Regular observations of direct work (every 6 months).

11.1 Supervision of specialist practitioners

Specialists within the TRT will receive additional clinical supervision from their 'home' agencies or from other specialist practitioners within Haringey CYPS. This is to ensure specialist knowledge remains up to date and to provide additional practice oversight. There are a number of matrix management structures across the TRT, where specialists may have a clinical supervisor in their home agency or another part of Haringey CYPS, as well as within the TRT. Supervision agreements are agreed between TRT and the host agency / clinical supervisor for specialists in the team. Where there is a clinical supervisor, there be will be a quarterly 3-way meeting, between the specialist practitioner, TRT supervisor and clinical supervisor with a focus on developing the role and addressing any practice issues. Specialist practitioners are expected to identify through their own reflective practice skills and in consultation, with TRT supervisors when they need to seek supervisory advice on case issues from their clinical supervisors and ensure this is subsequently recorded on case records. In the case of a significant safeguarding incident requiring immediate action, this should be raised with a Haringey CYPS manager on the same day. Evidence from specialist intervention and work with families could be used to inform Court or Child Protection processes.

12. Training & Development

Haringey's Workforce Strategy, learning and development plan will ensure TRT practitioners are equipped with the right skills, competencies and capabilities to deliver better outcomes for families.

Practitioners will work with their supervisors to keep their training and development up to date. Development needs will be explored in supervision and using Haringey's wider performance management framework (e.g. My Conversation). The TRT are committed to maximising the effective use of knowledge and reflection in practice and encourages the sharing of skills (for example through sessions led by specialist practitioners) and working to establish peer group supervision. Team meetings will have a focus on exploring relevant practice issues and developing knowledge.

Specialist practitioners will be responsible for working with their clinical supervisors to make best use of the performance management frameworks in their host agencies.

13. Recording

Good recording is an essential safeguarding tool. Poor recording will potentially put children and families at risk.

TRT practitioners will record in a way that:

• Provides a concise, clear, straightforward account of involvement;
• Is focussed;
• Differentiates between opinion, analysis and hypothesis;
• Acknowledges different views and perspectives of professionals and family members;
• informs decision-making and planning;
• Provides continuity;
• Demonstrate accountability;
• Supports work with other agencies and professionals;
• Demonstrates progress and outcomes.

We will aim to ensure that recording of involvement with families will be added to MOSAIC within 2 working days of an interaction. Individual practitioners are responsible for maintaining good quality records about the families with which they have involvement, and should raise with their supervisor at the earliest opportunity any concerns they have about recording or the case record.

• All case recording will be in line with the signs of safety principles;
• The recording will explicitly show the voice of the child and include observations (e.g. if non-verbal);
• The specialist posts within the team will record following the same process.

All case recordings will follow a Signs of Safety approach and detail:

• The purpose of visit;
• Date, time, length and location of the visit;
• Who was present;
• Voice of the child - including if the child was seen separately;
• Observations & analysis;
• Any actions, including arrangements for making contact again.

14. Caseloads

Each member of the team will hold approximately 10 families at any one time; caseloads and allocation, at the discretion of supervisors and will be subject to review depending on the nature of each practitioner's workload. It is expected that TRT practitioners will work with each family at least weekly.

The specialist posts within the team will hold a reduced caseload to reflect training and consultancy activity attached to their roles, again this at the discretion of the management team and will be subject to review.

15. Resolving Disagreements

Where there is a disagreement between professionals about a case (e.g. about a threshold decision or service allocation / request for a service) the following steps should be followed:

1. Practitioner to raise issue with Senior Practitioner;
2. Senior Practitioner to discuss with Children's Social Care Senior Practitioner or Team Manager;
3. If unresolved after 2 working days, the Senior Practitioner or Team Manager to raise the issue with their respective Service Manager or Head of Service (in the case of TRT);
4. Head of Service makes a final decision.

The final decision should then be recorded on Mosaic.

If there is a disagreement between a practitioner and a TRT specialist then the issue is to be raised with the practitioner's Senior Practitioner or directly with the TRT Team Manager. The TRT Team Manager will then liaise with the clinical supervisor with responsibility for that particular specialism.

If there are persistent issues or concerns around flexibility of practice, thresholds or allocations then these could be addressed as part of the commissioning process, as applicable.

16. Service Standards

TRT Service Standards

Click here to view the TRT Service Standards table.

Appendix 1: Examples of Some of the Interventions TRT Practitioners can Offer

Examples of some of the interventions TRT practitioners can offer:

• Assessments and interventions to address substance misuse issues;
• Training in CAADA risk Assessment;
• Interventions to support families where there has been Domestic abuse;
• Improving School / home relationships and behaviour management approaches;
• Sex and relationships (Speakeasy);
• Work with Early Years;
• Youth Advocacy;
• Direct work with Children;
• Solution focussed approaches to problem solving;
• CAMHS Assessments at Tier 2;
• Solihull Approach;
• Motivational Interviewing;
• Direct work with Parents Direct work with teenagers;
• Home / environmental observations;
• Advice and intervention on play & stimulation;
• Routines;
• Parental attitudes & behaviour;
• Adolescent to parent abuse.

Appendix 2: Outcomes Framework

Baseline measures

• The child is no longer subject to CIN or any other social care process after 6 months and there has been no further referral;
• The child is no longer subject to CIN and has stepped down to Early Help 6 after 6 months;
• The child is no longer subject to CP 6 months after TRT intervention and has stepped down to CIN;
• The child is no longer Looked After 6 months after TRT intervention.

Engagement with support activities sustained for 6 months (or as required dependant on the intervention).

Baseline measures - specialists

Baseline measures (selected depending on intervention):

• Adult / young person has reduced use of drugs or alcohol following TRT specialist's assessment at end of intervention;
• There has been a reduction in risk according to the SafeLives DASH risk assessment tool;
• The parent reports feeling safer after working with DV practitioner;
• Improved Safety;
• Improved Intimate Relationships;
• Increased Resilience;
• Reduction in Risk Indicators;
• Reduction in Offending Behaviour;
• Reduction in Involvement or Association with Gangs.

Family outcomes

These are measured for each referred family using a 10 point scale, at the start, review and end of an intervention from the following perspectives:

• Social worker;
• TRT practitioner;
• Child(ren);
• Parent / carer;
• Physical care within the family promotes the child / young person's welfare;
• The family's housing is sufficient;
• Child(ren)'s / young person's physical health care is promoted within the family;
• Supervision within the family is sufficient to promote the child / children's welfare;
• Child(ren) / young person report that they feel confident;
• Parents / carers' attitude to child / young person demonstrates sufficient warmth and care to promote the child / young person's welfare;
• Child(ren) / young person receive age / stage appropriate stimulation to promote their welfare;
• Child(ren) / young person feels family relationships are positive;
• Parents / carers are positive about their support network;
• Child(ren) / young person are positive about their support network;
• Child(ren) / young person report that they can manage their behaviour well enough to keep themselves safe;
• Parents and carers report that they can manage their child / young person's behaviour well enough to keep themselves safe;
• Child(ren) / young person are not at risk of exclusion and parents feel their child(ren) / young person are sufficiently supported in school so that they can acheive;
• Parents / carers feel their children enjoy school;
• Child(ren) and young people feel they enjoy school;
• Parents / carers and children / young people report they are aware of, and know how to access services;
• Parents / carers and children / young people report they are confident to work with agencies supporting them.

Specialist outcome measures

These will be used in addition when specialists work with a family:

Substance misuse

• Parent / carer or young person recognises the impact of their use of drugs and / or alcohol on their family / household;
• Parent / carer or young person report they are more aware of and feel confident to access services in future;
• Parent / carer or young person report they are confident to work with agencies supporting them.

Domestic abuse

• Parent / carer or young person recognises the impact of domestic abuse on their family / household;
• Parent / carer or young person report feeling safer as a result of DV intervention;
• Parent / carer or young person report they are aware of, and feel confident to access services in future;
• Parent / carer or young person report they are confident to work with agencies supporting them.

CSE

• Child or young person feels safe;
• Child or young person feels able to cope;
• Child or young person understands healthy relationships;
• Child or young person can manage risky situations and keep safe;
• Child or young person believes in themselves;
• Child or young person is aware of, and is confident to, access services in future;
• Child or young person is confident in working with agencies supporting them.

CAMHS

• Child / young person are positive about their emotional health;
• Parents / carers are positive about their child / young person's emotional health;
• Child / young person understands their emotional health needs;
• Parents / carers have a good understanding of their child's emotional health needs;
• Children report that they can manage their emotional health well enough to keep themselves safe;
• Parents / carers are confident that they can manage their child / young person's emotional health well enough to keep them safe;
• Parents / carers report they are aware of and know how to access specialist mental health services;
• Parents / carers report they are confident to work with agencies supporting them.

Appendix 3: Targeted Response Team - Capturing What Works: Good Practice

Click here to view Appendix 3: Targeted Response Team - Capturing What Works: Good Practice.