Multi-dimensional Treatment Foster Care Adolescents (MTFC-A)

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1 Multi-dimensional Treatment Foster Care Adolescents (MTFC-A) 10th February 2015 Manchester City Council 42

2 MTFC-A is One of a series of evidence based programmes for children with complex needs in out residential placements and/or offending behaviour Consists of specialist intensively supported foster care placements supported by a multi-disciplinary professional team The programme supports both the carers and the individual young person to make the transition from living in a Children s Home (Or who are at risk of entering residential care) to spending a year with a supported foster carer to stepping down to either a mainstream foster placement or back home to their family. The programme takes into account the social needs of the young person and ensures that they are linked into a school that is local to the placement and rated Good by Ofsted. The aim is to find a placement as close to Manchester as possible. The programme in Manchester is delivered, under contract, by Action for Children who have recruited and employed the team around the child, The programme is funded by an external investor, Bridges Ventures, through a Social Impact Bond on a payments by results basis The team is designed to manage 8 young people at any one time. 43

3 A Social Impact Bond is.. A Social Impact Bond is a form of outcomes based contract in which public sector commissioners commit to pay for significant improvement in social outcomes (e.g. reduction in offending rates or hospital admissions). A Social Impact Bond transfers implementation risks away from the public sector commissioner to socially motivated investors. Therefore investors bring their own expertise and focus resource on performance management and capacity building to ensure positive outcomes are achieved. This will drive improvements to preventative services and ensure that commissioners only pay out when outcomes are achieved. This kind of investment is actively supported by a range of socially motivated investors. These investors include Big Society Capital, The Prince of Wales, the Esmee Fairbarn Foundation and the Greater Manchester + Merseyside Pension Schemes. 44

4 Criteria for an effective Social Impact Bond.. - Major social challenge; a priority for public sector and investors - Promising interventions that require upfront investment - Robust outcome metric(s) - Clearly defined target group - Cashable savings to be made which can be used to repay upfront investment plus a return - Investors better able to deliver higher performing service and manage risk than in traditional service delivery 45

5 The Financial Model for MTFC-A MTFC-A is funded through the SIB with the investor funding the provider to set up the therapy team, source and support appropriately, both the MTFC-A carers and the step-down carers. The provider is responsible for the quality of the delivery elements of the programme. The provider is paid by MCC at a fixed rate of 1800 per week per placement for up to twelve months (this cost is significantly less than a residential placement where the current average is 2578 per week) with further outcome payments following at a later stage dependent on the young person effectively accessing school and leisure pursuits along with payments linked to the young person remaining out of a residential setting. The aim of the programme is for the young to be stepped down to a mainstream placement where weekly costs will be around 750 per week. MCC will make a variable level of savings as soon as a young person is on the programme. The financial model works on the basis that the savings are shared between the commissioner and the investor and the service provider 46

6 Performance to date Recruitment of the therapy team - complete Recruitment of carers enquiries - 6 under assessment - 3 approved Recruitment of young people - 16 referrals made by MCC - 1 on programme - 10 currently being assessed for suitability - 5 deemed unsuitable 47

7 Case study Y is a 12 year old boy with an extensive involvement within the looked after system. Having been in care since he was very young Y has had a number of placement disruptions from previous foster care arrangements, often with issues at school having then led to these breakdowns. Y has received support from CAMHS to deal with concerns about his behaviour and mental health. At the point at which he was referred to MTFC-A, Y was living in a large children s home following the breakdown of his most recent long term foster placement. There was concern from his social worker and from CAMHS that this environment was inappropriate for Y and this was evidenced by an escalation in his challenging behaviour, and an increase in his involvement with the police. Y was restrained several times by residential staff and he was being bullied by other residents in the unit. On being met by the MTFC team, Y presented as well motivated, wanting to be placed with a family and not to be in a residential setting. Y also was able to articulate a good understanding of the principles of the programme and asked questions about what it would be like to be placed on the MTFC programme. 48

8 Case study continued Y had an initially positive start on a foster placement but, unfortunately, the placement was terminated when the foster carers realised that this role was one to which they were clearly not ideally suited. Y was very upset by the turn of events and, regretfully, had to be placed in residential care for a period of six weeks whilst an appropriate school was found near a potential new placement. During this time, the MTFC-A therapy team continued to work with Y to provide him with continuity and support in advance of his rejoining the programme. This second placement is now a six weeks old, Y has progressed from level 1 of the programme to level 2 and is doing well. (The programme works on the basis of rewards and sanctions progressing up the levels is the aim to demonstrate positive progress). His carers are able to meet his needs and manage his issues, are following the model effectively and are using the support of the team appropriately. There is developing evidence of the benefit to Y of the stable relationships with some of the therapists. If the current progress is maintained, it is anticipated that Y will graduate from the MTFC programme at some point over the coming summer. 49