A view on early help and troubled families from Alison Michalska


President, ADCS

In April this year I became President of the Association of Directors of Children's Services (ADCS). The role is an absolute privilege and one that I undertake alongside being Director of Children's Services (DCS) for Nottingham City.  It gives me the opportunity to see things at a city perspective and at a national level and hopefully use what influence I can to try to improve the lives of children and families.

Early Help and Troubled Families

As DCS I have a great enthusiasm for the work of the Troubled Families Programme, which we call Priority Families in Nottingham, and the role of early help. Early help and early intervention should be part of a coherent package of support on offer for children. In Nottingham City I’ve seen the impact that targeted early help and edge of care services can have on managing the numbers of children being looked after. Despite relentlessly rising demand, we have managed to keep relatively stable our Children in Care numbers through a comprehensive range of intensive interventions, successfully keeping 90% of the children they work with at home with families rather than needing to come into care. In the current financial climate, stemming the flow of cases into the statutory system is vital – quite aside from the fact that it is the right thing to do to give our children and families the best chance to stay together and live happily and safely in their communities.

A priority is learning from and sharing practice

One of my key policy priorities for my time as President is to mobilise knowledge and learning from improvement and innovation and share it across the sector. That’s why when I met with the National Troubled Families Team a while back I was pleased that this was also a key priority for them up until 2020 – and hence the launch of this good practice blog.

We need transparency and visibility about the good work of all Local Authorities. But, also honesty with ourselves and each other about the conundrum of ‘what works’. It is rarely the case that any initiative or intervention can be simply lifted and shifted wholesale from one place where it appears to work, to another place, without contextualized modifications. So, whilst we must share learning, we need to think hard about the practicalities.

Measuring the effectiveness of early help?

The importance of intervening early is a priority area for many local authorities. However, the difficulties can often lie in evidencing that early help is working. We all believe instinctively that it works, but if we are using it as a tool to manage demand on statutory children’s social care services it could be perceived as failing - given the rising number of referrals, child protection plans and children in care. Or, are we, as I believe, through early help and early interventions identifying children who need the protection of statutory services earlier, and as such, protecting them from further harm and making long term plans for these children to thrive?

Measuring the effectiveness of early help is tricky. Outputs such as the number of early help assessments (EHAs) completed doesn’t tell us about the range or effectiveness of early help services. The evidence base that underpins our commissioning and indeed de-commissioning decisions needs to be built on evidence beyond what can simply be counted.

What can Nottingham City tell us about using evidence in early help?

Nottingham City has a proud history as an ‘Early Intervention City’ and continues to commit to prioritise spend on early help, and prevention. Our children's early help locality hubs bring together schools, health, children’s centres, youth & play services, family support workers and Social Workers.

Recently described by Ofsted as outstanding, our locality hubs are a key component of managing demand, especially for the most expensive tiers of support. We are increasingly taking the learning from children's services and applying it across wider council services, building capacity in families and across communities, encouraging them to look after each other rather than rely on services.

Critical to our success has been implementing programmes with a proven evidence base. This has included; Family Nurse Partnerships, Stronger Families and the Dolly Parton Imagination Library as well as locally developed programmes which we have critically evaluated ourselves. Including:

  • Active Families – increasing opportunities for families in areas of the City with the highest child obesity rates, to engage in physical activity
  • DrugAware – supporting schools to address drug and alcohol issues (accredited by the Early Intervention Foundation)
  • Maths Mastery – an approach to teaching maths in early years based on schemes in China and Singapore where there are no ceilings to expectations of what children can achieve.

As I have already mentioned, our edge of care services are helping manage demand such as Multi-Systemic Therapy (MST), MST-CAN and a particular favourite of mine Safe Families for Children.

Concentrate on what works for you

It is easy to become swamped by lots and lots of new initiatives though – and that’s why we concentrate our energy on embedding evidence based approaches that are working for us, for example the use of Signs of Safety methodology right across the local children’s partnership (not just in children’s social care).

More than anything, we need to learn from each other and not be afraid of making mistakes.

Please let me know your views by posting a comment below. You can also read a blog by Sophie Russell from Nottingham City Council about Payments by Results.


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  1. Comment by Stephen Crossley posted on

    Hi, I'm interested in the idea that Family Nurse Partnerships is a programme with 'a proven evidence base'. An RCT carried out in the UK that published a report in 2015 found that the FNP 'was no more effective than routinely available healthcare alone' across almost all of the primary issues that the FNP aims to address. Could you please point me to
    the proven evidence base for the programme, preferably in the UK, that you mention?

    Many thanks,


    • Replies to Stephen Crossley>

      Comment by Early Intervention Foundation posted on

      The Early Intervention Foundation is a ‘What Works’ centre tasked with assessing the strength of evidence for the effectiveness of intervention programmes that aim to improve outcomes for children and young people. We reviewed the evidence for Family Nurse Partnership (FNP) in 2016, as part of a wider review of interventions aimed at improving a set of early years outcomes. The results of this review are summarised here:

      The FNP programme has now undergone five rigorous randomised control trials: three in the US, a fourth in the Netherlands and, most recently, a fifth in the UK. In comparison to the four previous trials, findings from the UK study are indeed the most disappointing, observing no significant benefits for FNP mothers and infants with respect to four main outcomes: reductions in smoking during pregnancy, improved breastfeeding rates, increased birth weight and reduced subsequent pregnancies.

      When judging these findings, it is important to note that FNP was not developed to improve these routine healthcare outcomes. Rather, the programme was developed to improve a variety of longer-term outcomes which include reductions in child maltreatment, improved child intellectual development and increased maternal participation in higher education and employment. And these were the outcomes achieved in the US and Dutch trials, albeit one or more years following programme completion. So while the UK trial’s findings are clearly disappointing, it is possible that many of FNP’s benefits have yet to be observed.

      It is also worth recognising that the UK trial did observe consistent improvements in children’s language development at 12, 18 and 24 months, as well as improvements in child cognitive development at 24 months. These child outcomes are more closely aligned with FNP’s primary goals, and have the potential to reduce the early language gap targeted in the recent government green paper. From this perspective, we believe that FNP still represents an evidence-based option for teenage mothers and their children.


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