Transcript: Heart Community Teams

Podcast Episode: Heart Community Teams

What follows is a transcription of the audio recording. Due to differences between spoken and written English, the transcript may contain quirks of grammar and syntax.

Michelle: Hi there, welcome to the Iriss.fm podcast. I’m Michelle and in this episode, I speak to Andrew Bryers about Heart Community Teams. Heart is a new wellbeing model of service delivery for children and their families in East Ayrshire. It is an approach in keeping with the principles of human rights based, inclusive service design and delivery.

Andrew has been a social worker since 2007, and has worked in Scotland, London and Australia. He spent 6 years as a team manager in East Ayrshire before taking on the role of programme lead of Heart Community Teams in 2020. He describes the model; its aims, and progress to date.

Andrew, thanks so much for speaking to me today about Heart Community Teams. It’s a wellbeing model of service delivery for children and families, it seems, at East Ayrshire Health and Social Care Partnership. I’d just like to start by asking you where the idea for this Heart Community Teams model; so where did it come from? Was it deemed that something needed to change? Or was it an idea?

Andrew: The origins of this go back to around about 2019, when various people who were involved in different parts of children’s services in East Ayrshire were having conversations about where we needed to go as a service. And they were listening to what people were saying about their experiences of children’s services. And they were also, I think, tuned in to some of the kind of policy debate that was going on at that point. And I think the real kind of foundational idea, I think, is best explained as a where and when. It was about trying to make sure that help for families was available where they needed it which was within their communities or through spaces that they used already and also when they needed it, which meant kind of shifting from kind of crisis focus to prevention and early help.

So, it was that idea; it was about trying to bring help to where families were and make sure that help was available at an early stage. What started out as the Children’s Services Wellbeing Model, developed into what we now call Heart which stands for ‘help everyone at the right time’. And it’s a really neat encapsulation of the central idea of the model. That name came from a public competition; we had people suggesting names, that was suggested by a parent and it won a public vote. And we also got a logo that was designed by a child who also won a competition; it’s a beautiful logo of a rainbow heart encapsulated in hand. And again, it speaks to the real central idea of Heart which is that by working together we can help and support people.

So, there was some kind of initial kind of reaching out and having conversations with communities and starting to try and coordinate some ideas, back in 2019. Then of course 2020 happened and we all went into lockdown and everything kind of went on the back burner but during 2020, there was an agreement that they needed somebody to try and carry this idea forward and I was asked to take on the role as programme lead. So, I’ve been working on this since October 2020 and just kind of following through this idea and working to try to make it a reality.

Michelle: Uh huh. So, in 2019 then was there a sense of crisis in the services that the way family support was being delivered wasn’t quite working for people?

Andrew: Yes. I think there was a sense in different parts of the system that they were seeing similar kinds of things. They were seeing that some of the services, particularly at the more intensive end of the spectrum, services like social work and CAMHS were finding themselves doing a huge amount of firefighting. They were involved in crisis and they were aware that that meant that they weren’t able to focus on some of the issues that were deemed to be kind of lower order. And lots of those families were becoming increasingly frustrated that they weren’t getting early help and support. So, it just, I think, seemed from various perspectives within the system that we weren’t managing to get help to families at the time they needed it. And another part of it, I think, is to do with the geography of somewhere like East Ayrshire.

East Ayrshire is a really mixed local authority, we have large urban areas, particularly Kilmarnock which has got a large population; but we also have large rural areas as well which are a long way away from the towns and cities and traditionally haven’t been well served by services. So, many of the services that run in East Ayrshire have bases in Kilmarnock and if you live all the way down in the Doon Valley it is several bus journeys and a long journey to get up to Kilmarnock for an appointment and those services are very, very hard to reach.

So, it was a recognition that too much of our focus was going on crisis response and families weren’t getting the help at an early stage. And also, that we weren’t really doing enough to bring services to where families were; that too many of our services were concentrated in the urban areas and were difficult for families to access.

Michelle: Okay. So, you having to kind of pick this up in 2020 then was quite a … it’s quite a challenging thing to have to pick up, I guess, as you just entered a pandemic. But tell me … what the work involved in setting up this model?

Andrew: So, the first stage was an exploratory one and I think where this came from was, I read a lot of stuff about the Scottish Approach to Service Design which was really tied in with the promise and other things. And one of the key messages that I took out of that is that whenever you are thinking about systems change, you have to start with the perspective of the people who use the system rather than the system itself. So, you need to start from that perspective, from the outside, you need to understand what a system feels like for the people who use it rather than relying on your perspective as an insider. So, that was a real kind of penny dropping moment for us, I think, in the early stages; we need to really do that part properly otherwise we’re starting from the wrong place.

As you said, this was during covid, it was during times when opportunities to actually reach and meet people were very limited so, we weren’t able to do everything that we wanted to in that sphere. But we did our best to reach as many people as we could. We developed something called the 5 questions which was a very kind of simple survey which we could send out to large numbers of people that, rather than asking them leading questions about where we wanted to go with the model and so on; we just asked them very, very general questions about what was important to them, what were the issues that they faced, what helped for them; those kind of things. And that meant it was very accessible and it was possible for pretty much anyone to respond to. We sent that out to children, young people, parents, carers and professionals across East Ayrshire because we were able to do it through the school app; actually, the majority of the responses were from children and young people.

Michelle: Interesting.

Andrew: And as soon as we got it out in the app, we saw an immediate response and getting responses on a very broad level like that, we had something like 850 responses. It just gave us a very, very general sense of what was important for people at that moment; that snapshot in time. And the very big thing that came out of that was that people identified over and over again, far more than anything else, family as being by far the most important thing for them. So, we were able to draw the responses into a word cloud which showed that the concepts, the words that people used most frequently. And family is huge and right in the centre and things like love and support and care and things like that around it.

We were also able to see where people did need some help, most often the help that they needed was from the services most readily around them. So, people talked about having good support from family initially and from extended family and then they talked about school and teachers and good relationships with teachers. And then fewer and fewer people then talked about the more intensive kinds of supports like HomeLink workers or social workers or so on. So, it kind of gave us that sense, most people; most children and young people are able to be supported within their families, their families can provide enough kind of support and care and love for them. Those who need a little bit additional are often able to find that within their universal services, within the people that they come into contact with, day to day. And then progressively smaller numbers need more help or more specialist or more intensive help from the likes of HomeLink workers or social workers or CAMHS or whatever.

Michelle: So, what did you then do with some of this data? Did the model grow as a result of the data? Or had you already set out that you were going to create this new approach to working with families?

Andrew: Right, there was another stage in between. So, firstly the other part of the exploration phase was trying to go more deeply in to some people’s experience. So, to complement the five question survey, I also carried out a series of in-depth interviews with mainly parents and carers but some young people as well who had used children’s services for a range of reasons; and I tried to get a very broad range of people. I worked with partners in other services to identify people who might be prepared to speak, I tried to make sure I got a really good range. I did some of the interviews in partnership with advocacy services in order to try and reach some people who would probably have struggled to engage with an interview like that on their own. And that gave me a much deeper perspective on what children’s services felt like, what it felt like to be a family who need help and support and have to reach out to try and get it.

So, those interviews were very, very rich and we got a huge amount out of that and we were able to draw out a series of themes that came out. They came up in more than one interview or were fairly common or where there were resonances between different people’s experience. So, all of this information, we’ve got this very broad response from the five questions and then we’ve got kind of a much deeper response from the interviews. In order to try and make sense of this and see where it took us, I needed to work with people; I needed a group of people to help me.

And we put together a group called The Changemakers which was drawn, very broadly, from across children’s services, all the different parts of children’s services that were partners in this. So, we had people from social work and education, from CAMHS, Vibrant Communities, and the third sector and planning, performance, from health; people from all over the place. We worked in partnership with What Matter to You, who are working in East Ayrshire to try and bring the voice of lived experience into decision making around children’s services. They helped us in setting the group up and also with, Columba 1400 helped us with the facilitation of the group. That group helped mainly to consider what people were telling us, what people’s experience was telling us and to develop from that perspective into a series of ideas for what a new model; a new approach to children’s services in East Ayrshire might look like.

Michelle: Okay. And as a result of that then you came out with the sort of Heart Community Teams idea?

Andrew: Yes, yeah. Well, we came out with four ideas actually.

Michelle: Okay.

Andrew: The building blocks of the new model. Community Teams is the one that we’ve been given a green light to work on so far but it’s kind of an inter-linked series of ideas that are all based around this same central idea about trying to make sure that families get the help they need in early stage and where they need it.

Michelle: So how far have you come then with developing that?

Andrew: Once this had received approval and we had kind of broad support from the council and the health and social care partnership for the direction we were going, they said, we’d like you to move ahead with this idea of Community Teams. And they gave us an implementation date of April of this year. Now, the Community Teams idea is just based around the idea that if services work together around the same kind of model of community, then those services will firstly be much better known and more visible and more responsive to those communities. And they will also work more effectively together because they will have much better, more cemented relationships.

A way that makes sense for me to explain it, is thinking about something that I think already works well in East Ayrshire which is that because it is a relatively small local authority, people tend to build up very good working relationships with their opposite numbers in other services. So, from my experience; my background is in social work and I’ve worked in social work in East Ayrshire for quite a number of years. In my experience, people in social work will, over time, get to know the head teachers or the deputy head teachers of the schools in their area. They’ll start to know the health visitors; they’ll work alongside the health visitors more than once and through that they start to build up person to person relationships which kind of make it much easier when they need to pick up the phone to each other to discuss how best to help a family. So, it’s really, it’s trying to build on something which I think was already good practice, in East Ayrshire and just make it absolutely standard across the board.

Michelle: So, putting a little bit more structure on it, if you like, and formalising it a little bit more.

Andrew: Yes, yeah.

Michelle: Yeah. Because I can see how the importance of those relationships would be crucial to the support working for families.

Andrew: Yes, yeah.

Michelle: So, Community Teams is under way at the moment and is working quite well?

Andrew: I think we’re still in the early stages of this. So, in order to kind of prepare the ground for this, a number of different services needed to kind of realign the way that they worked. First of all, we had to think about what communities we were organising around. And we took the decision that we would work around education groups which are secondary school catchment areas. There are six non-denominational education groups in East Ayrshire; each of which relates to a particular kind of geographical area. And that just gave us, I think, a pre-existing model that we could work around that was in the Goldilocks zone. It wasn’t too big that it felt impersonal or it would make it very difficult for people to travel for services and it wasn’t so small that it was impractical to organise services around.

So, a lot of the early stage was actually kind of going on behind the scenes to prepare all the services for that point to be able to say we now have this group of professionals from social work or this group of professionals from Vibrant Communities who are directly aligned to this area. And that was new thinking for some of the services which had often been far more centralised. And that, I think this comes back to the point we were making earlier on about the systems perspective, I suppose, to the service users perspective because if you are looking to organise services in the most efficient way, from your perspective, that may well lead you to centralise lots of services and bring lots of people together where the largest population is which in East Ayrshire is in Kilmarnock. But if you look at this from the perspective of a service user who lives in the Doon Valley, that doesn’t make sense at all. That means that services for them are very, very inaccessible; it’s really difficult for them to get help when they need it. So, yeah, we had to do that kind of preparatory work of making sure that everyone was ready, the teams were aligned. We had people kind of aligned to each of these areas. And having done that, then really the hard work begins because for these community Teams to be meaningful reality requires culture change and culture change is hard work.

Michelle: Yeah and it takes time.

Andrew: Yes.

Michelle: So, that’s an on-going process; that’s an ongoing journey for you all. You talked earlier about applying a sort of Scottish Service Design approach to this process as well and was that always the goal? In a sense of taking that model as well, taking that approach to kind of help you with the culture change ultimately? Because you knew it was a long journey. Can you tell me a little bit more about that service design approach and how that was helpful?

Andrew: Yeah, yeah. One of the key messages from the Scottish approach to service design is about trying to make sure that the voice of lived experience is absolutely central.

Michelle: Yeah.

Andrew: So, whenever you are making any decisions about how services should run, voice should always be present and voice should always be a part of that. So, that’s something that we have tried to do to the best of our ability, all the way through. I think, my perspective on this, is that generally across the board the reality still falls short of the rhetoric. So, we’re getting there, we’re getting to that point of having lived experience there but we still have some way to go.

So, how have we done that? We have used the stories, the comments, the voices of the people who responded to our survey and took part in the interviews. We’ve used that all the way through. We have worked closely alongside What Matters to You who are working with a group of parents in the Cumnock area and supporting them to use their direct lived experience to influence the direction of things are going. So, we have a group of people there that we can kind of call upon to draw upon their expertise from their own lives in order to tell us whether we’re going the right way.

We’ve had a group called The Critical Friends, which has had an oversight role, really, for the implementation of Community Teams. And that’s involved young people and parents and carers and we’ve met with them and said, look, this is the direction we’re going; does this sound right? What thoughts do you have? How does this relate to your own experience? Would this kind of help if you were in that kind of situation again?

And another way that we’ve tried to thread lived experience all the way through this is in a new resource that we have developed which uses composite family stories as a tool to support practitioners from different services, working together and thinking about how they can collaborate more effectively to respond to a family. What we found is that when you talk about something like Heart in general terms, in general theoretical terms; people respond to it up to a certain level. But when you can talk about it in relation to an actual family, a real situation; it becomes much more vivid and much more real for people and it really starts to hit home and they start to see how an approach like this can benefit. So, the new resource is something like a game.

Michelle: Okay.

Andrew: That is designed to be played together by a group of practitioners. It’s based on the stories that families have told us. So, it’s true to life and it’s a family going through a series of events and at each event point, there’s an opportunity for the practitioners who are playing the game to think about how they can best help; what they can best do to support that family at that moment in their lives. So, hopefully that’s going to be a springboard for people to start to think creatively about what sort of approaches might help in their area, in their community team area to support families going through real issues.

Michelle: Uh huh. And no doubt that resource will be of use to other, potential, local authorities, social work teams and managers out there too?

Andrew: We hope so, we hope so. We’re at the early stages of this.

Michelle: Okay. So, that’s still in development?

Andrew: That’s still in development. We’re testing it at the moment. We’ve got a plan to test it in a couple of weeks’ time. And then we’re going to be using it with the Community Teams in October when they come back together for launch events. So, if this works, if this is successful then we absolutely hope this is something that does have much broader use and broader potential and something that can be used in all different kinds of training. It’s just a way of trying to make this real to people.

Michelle: I suppose I’m wondering as well, like have you seen the kind of benefits in terms of people’s lives getting better or improving as a result of what you’ve done so far?

Andrew: I think the broader question about starting to see positives, starting to see benefits; I think we’re still at too early a stage. We’re still, the Community Teams are forming, they’re starting to come together and they’re starting to think about how they can work more effectively. It’s going to take time for the benefits to start to come through.

So, for example, I keep on coming back to the Doon Valley because it is the most sort of geographically remote part of East Ayrshire. And it’s the part of East Ayrshire which historically has not had services and had a deficit of services around it. And it’s also part of East Ayrshire where there’s a high need for services where we know that there is a lot of need for families. So, that area is going to be having a social work team; a dedicated social work team for the first time, rather than it just being an add on to a team from another area. And it’s going to have dedicated workers from other services where those people are going to be meeting regularly, on a monthly basis, that are going to be thinking about what’s happening in that area. They’re going to be sharing what they’re picking up in terms of general trends and they’re going to be starting to think about what they can do together and what kind of collaborations they can come up with which will better serve families in that area. And that might mean, for example, drop ins or pop ups where different services are finding space to meet with families in that area and bringing more of their services down there.

Over time it might mean more services basing themselves in that area or finding ways to base themselves alongside their colleagues in other services. So, all of that in tandem really with what’s happening in adult services which is on a very similar journey towards place-based working and more services based around communities. I think over time will make these kind of services and particularly the early help services, the services that can really prevent serious problems, serious downstream problems occurring. I think they will start to become more visible and more accessible within communities like the Doon Valley.

Michelle: Uh huh. There’s quite a lot going on which is amazing and as you say a lot of that is incremental, isn’t it? And it’s kind of trialling things as you go as well, which is part of the process. There’s that openness to going, “things aren’t working so well so we have to think about change. We need culture change ultimately but you know, we have to start that journey somewhere.”

Andrew: Yeah.

Michelle: So if others are listening to this and they’re thinking, we need to maybe make some changes here too; we could think about using this type of approach or similar approaches or we could learn from East Ayrshire; what would you say needs to be in place?

Andrew: Well, I think you need to have the mechanisms for trying to include the voice of lived experience at an early stage from the beginning and for that to be meaningful and not tokenistic. I think on an organisational level you need to have buy in from all the key partners and that’s difficult because when we talk about our partners in Heart, we’re talking about a very wide range of services and organisations; it’s education, it’s CAMHS it’s health visiting, school, nursing, it’s the third sector, Vibrant Communities, social work, it’s the police, it’s lots and lots of different people. All of those people are in different places in their own organisational journeys. All of those people are dealing with different priorities and different demands and so on. So, getting all of them on the same page is hard work and needs to be really, really invested in.

And in order to do that, you need to have a clear vision and something that people can really rally behind. So, a lot of the work in getting us to the stage we have got to so far has been about working both with the strategic leaders in all of these services. Kind of getting them together and making sure that they all share the same vision for this and also reaching practitioners, people at the coal face in all of the services and having regular conversations, regular check ins with them so they know about what’s happening, they understand what’s happening and they feel brought along in the change journey. So, I think real investment in communication with people throughout the system at all levels from the strategic level right down to the practice level, people who are dealing with families is essential and you need to have that central vision for them to organise around.

Michelle: Fantastic. I’m just really curious quickly. You said there was four ideas that have come out of some of the exploratory phase. Could you tell me briefly what other ideas have come out as well as the Community Teams?

Andrew: Yeah. Okay. So, the other ideas were Community Places. So, Community Places; other people might think of them as being hubs or one stop shops and things like that. It’s an idea which exists and is being used in quite a number of places. Where this comes from is the families often told us that there were real barriers, both geographic and cultural to them getting help and support. Having to go somewhere like a social work office is really stigmatising, it’s very difficult for people to get across that threshold. What helped with that was when help and support was available either through spaces that families used anyway or through kind of multi-use spaces where people could be coming for a range of different reasons. So, places where you could be coming for any reason but also by being there you could access help and support.

This kind of thinking has been central to, there’s plans afoot for development of the new Doon Academy Campus in Dalmellington which is going to be a really, really exciting multi-use, multi-generational space where people can come for all kinds of different reasons. They don’t need to identify themselves as needing kind of help or support because the families told us that that often felt very shameful for them. So, we would like there to be more spaces like this where families can come for a range of reasons but access kind of help and support because they’re all tied into the same system. They know who their partners are in the Community Team and they can help families get to wherever they need to go to.

The next idea is fairly similar and it’s Connectors; in families stories when they talked about their experiences, they often talked about periods when they were lost within the system where they knew that they needed help but they didn’t know how to get it. And the people who were assigned to them or allocated to help them weren’t kind of meeting their needs. When things got better was when they found someone within the system who was able to pick up their cause and help them get to the form of support that they needed that was right for them. And so, we think of these people as being Connectors and it’s pretty similar to the Community Connectors model which exists in East Ayrshire and other places. People whose job it is to kind of help families navigate systems in order to get to the right form of help and support. So, that is an idea we would like to develop more; we would like to try and find ways to put Connectors where they can be easily contacted or make contact with families so that they can get to the help that they need at an early stage.

And the last idea was just a very broad idea was just about family support and it’s a recognition of one of the central ideas in the promise which is that we need far more early help family support. And families were able to tell us a lot about what that support should look and feel like for them. And we would also, I think, like for there to be more routes for families to be able to support each other through volunteering or mentoring kind of programmes.

I’d just like to say that we are always happy to speak to colleagues in other areas who are doing similar things or interested in doing similar things. I think everything we’re doing here really should be open source. So, we’re very, very up for comparing notes and hearing about what you’re doing and letting you know more about what we’ve got going on here. So, I think you would put our email address in the show notes and we’re very happy to be contacted.

Michelle: Andrew thank you very much for speaking to me today about Heart Community Teams and wishing you all the best.

Andrew: No worries. Thank you for having me.

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