Chrysalis Associates

This document may be reproduced in whole or in part for non-commercial educational purposes, provided that the information quoted is reproduced without adaptation and the source and date of publication are stated. Chrysalis Associates Inspection report for adoption support agency

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Unique reference number SC387711 Inspection date 5 July 2016 Inspector Stephen Smith Type of inspection Full

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Setting address Chrysalis Associates, 48 Wostenholm Road, Sheffield S7 1LL

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Telephone number 0114 250 9455 Email sarah.allkins@chrysalisassociates.org Registered person Chrysalis Associates Registered manager Sarah Terry Responsible individual Sarah Allkins Date of last inspection 7 August 2014

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Brief description of the service

Chrysalis Associates is a registered company that was registered as an adoption support agency in 2008. The agency specialises in the assessment and treatment of developmental trauma and attachment difficulties. Its multi-disciplinary therapeutic team offers services to adopted, or children looked after and their adoptive parents or carers. Families receive an individually designed service, tailored to their needs, which is drawn from a variety of therapeutic models. The agency has four directors and, at the time of this inspection, employed a staff team of 18 therapeutic staff, comprising psychologists, therapists and social workers, as well as an administrative team of three. The agency has experienced significant growth since the last inspection in 2014. At the time of this inspection, it was working with approximately 90 families.

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The inspection judgements and what they mean

Outstanding : a service of exceptional quality that significantly exceeds minimum requirements Good : a service of high quality that exceeds minimum requirements Requires improvement : a service that only meets minimum requirements Inadequate : a service that does not meet minimum requirements

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Overall effectiveness

The overall effectiveness is judged to be outstanding The adoption support provided by this agency is of the highest quality. The therapeutic packages that it provides are underpinned by detailed research and evidence. Therapy is delivered in a structured and highly planned manner and its results are scientifically measured and evidenced. Consequently, the progress made by families receiving therapeutic support and the positive outcomes that they achieve are highly impressive and their lives are significantly enhanced. The agency’s directors and staff are highly skilled, experienced and well trained. Many are influential in their field and benefit from sharing knowledge and research at a national level. This means that the agency’s practice is current, rigorously evidenced and based upon the latest research. The agency’s leadership and management are outstanding. Despite a period of rapid and significant growth, the agency has retained and improved its quality of service.

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Overall effectiveness

It is efficient and well managed. This means that it is able to support an increased number of families in a way that helps them to make progress that exceeds expectations. The agency has been proactive in its work to plan for its growth, which has meant that it has continued to work efficiently and to respond to requests for assessment or treatment without undue delay. It has done this by recruiting additional staff proactively and by beginning to develop services from locations away from its main base. Impressive levels of staff support and training further support the high standards of practice. Case supervision of the agency’s complex and highly sensitive work is good. However, records of this are not always consistent and records of therapy sessions are not always sufficiently evaluative. Recording and monitoring of the agency’s work is also very good and has developed with the agency’s growth. In the case of the

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Overall effectiveness

rare complaints made to the agency, records do not always show the action taken and any learning points identified, although the manager has a clear understanding of the circumstances surrounding these.

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Recommendations

To improve the quality and standards of care further, the service should take account of the following recommendations:

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Recommendations

 Ensure that entries in records, decisions and reasons are legible and clearly expressed. Specifically, that records of case supervision are retained in a consistent manner and that records of therapy sessions contain an analysis of the effectiveness of the session. (National minimum standards, 27.4)  Develop clear and effective procedures for monitoring and controlling the activities of the agency. Specifically, ensure that records of any complaints contain an analysis of, and the action taken after, any complaint received. (National minimum standards, 25.1)

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service users

Judgement outcome: outstanding Families who approach the agency for therapeutic help often do so when they are in desperate need of help. For example, one young person described this time by saying, ‘My family fell apart’. Many families have researched a number of other agencies before deciding on this one, and a significant proportion travel quite long distances to access the service because of their high level of confidence in it. The agency approaches this extremely high level of need in a structured and efficient manner, which retains a very sensitive approach to people. This helps to ensure that people understand the support being provided to them, feel engaged with the agency and have a voice in the way in which support is delivered to them. One person using the service said that coming to the agency was ‘such a relief’. Another said that the agency was the ‘first place that really believed me and took me seriously’. The agency endeavours to be flexible

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service users

to meet people’s differing needs by offering a choice of therapy times, location and pattern of provision as well as the type of therapy provided. One parent said that the service ‘was tailored to our daughter’s needs’. Assessments are thorough and clearly identify the issues that the therapy needs to focus on. This ensures that people understand the service being provided to them. The clear process of the therapy provision in terms of a predictable start and end date also helps people to understand what is happening and to judge the progress that they are making. The therapeutic approaches that the agency uses are well evidenced in terms of their effectiveness and the efficient and caring way in which they are provided helps families to make great progress and achieve successful outcomes. The structured and measured approach inspires confidence, and outcomes often transform the lives of the people who use the service.

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service users

A parent said, ‘Chrysalis supported us at one of the most traumatic periods of our life, and they did this in a caring and compassionate way.’ Others said, ‘We benefitted enormously’, the therapy was ‘tiring but extremely worthwhile’, and ‘We now have a child who is happier in her skin. Happier with her family.’ A young person said that he can manage situations now ‘that would have been an impossibility, completely’, and that the agency ‘changed my life’.

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Quality of service provision

Judgement outcome: outstanding Chrysalis provides a service that is of excellent quality. It works to help keep adoptive families together by helping parents to understand and manage the needs of their adopted children. These needs are often severe and highly complex, arising from trauma and attachment difficulties, and have led to badly damaged relationships within families. The therapeutic work also helps parents to understand and use therapeutic parenting techniques with their children to help them to deal with previous trauma and to develop healthy attachments to their adoptive parents. A local authority social worker said of the agency, ‘They are knowledgeable and evidence led in the services that they deliver.’ The agency undertakes this work through its highly skilled, trained and experienced staff team. The team is comprised of members with a range of skills and specialisms, including social workers, clinical psychologists,

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Quality of service provision

assistant psychologists and therapists. This team is provided with very high levels of support and supervision. It is provided with excellent guidance and management from the agency’s four directors from whom one staff member said, ‘I learned such a lot’. The agency’s staff team has access to a wide range of specialised training to support its work. Many are involved in national research or take part in forums about, and training in, innovative models of practice. This enables the agency to provide a range of well-researched and evidenced therapeutic interventions and to embrace new research and models of working. This helps it to provide highly individualised therapeutic support packages to the families who use it. Staff in the agency are very skilled at working with families who are dealing with highly sensitive difficulties in their lives. Service users benefit from this understanding and the high levels of support that they receive.

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Quality of service provision

One said, ‘We could not speak any more highly about our therapist and believe that the relationship we built with him was built on mutual respect and trust.’ Despite the agency’s significant growth over the last two years, it has continued to be able to offer services in a timely manner. Despite some delays faced by people seeking funding from the adoption support fund, via local authorities and the referral process, the agency works very effectively to reduce any further delay. This is very important as families are often in crisis, and many are close to breaking point by the time they get to this stage. The agency works very well with local authorities. It works openly and shares information positively and appropriately. It also works closely with them to make the referral process better and to speed up its initial contact and assessment processes. For example, the agency is working with authorities to arrange referrals for assessment and therapy

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Quality of service provision

after an initial consultation. This allows a service to begin much more quickly than when the authority refers for an assessment only, then considers a referral for treatment after that. The agency’s initial assessments are detailed, evidence based and clearly determine the type, nature and length of therapeutic intervention required. Therapeutic provision is tailored to individual needs. It is usually provided on a weekly basis, but the agency has also provided some intensive blocks of therapy on a daily basis over a period of a week or two. Therapeutic packages are reviewed through case supervision and, more formally, at a ‘mid-point’ review. This helps to ensure that work done continues to be relevant and is achieving desired outcomes. At the end of the agency’s work, it evaluates the effectiveness of the work done. This is undertaken with the service user and, when applicable, the commissioning body. This

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Quality of service provision

clear and structured approach is followed up by three-, six- and twelve- monthly meetings, after the end of therapy, to support any ongoing difficulties. This approach inspires confidence in the people who use the service. One parent said that they liked the structure of the service and ‘the way it moves on’. They feel confident that ‘they know what we need’ and that they ‘are doing the right thing to help us’. Records of individual therapy sessions are clear in terms of the activities undertaken and the session’s content. However, they are not always sufficiently evaluative and do not always review and appraise the effectiveness of the sessions well enough. The agency also engages with the schools of children who are using its service. This helps the agency to gain important information about children’s behaviour, functioning and needs at school. It also enables the therapist concerned to work with teachers to help them to work alongside

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Quality of service provision

the parents to care for the child in a consistent and therapeutic manner and to support their education.

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families

The agency’s practice to safeguard the people who use its services is of excellent quality. The agency’s purpose is to improve the emotional well- being of the people who use its service, and this plays a vital role in safeguarding people across all areas of their lives. The agency’s therapeutic approach is well planned and very well evidenced in terms of its success. Practice is innovative, and the agency works well with other national bodies and in line with the latest research and practice to keep its work up to date. This means that the suitability of the therapy provided is well assured and the work is very effective in improving the quality of its service users’ lives. Staff members are trained in safeguarding and child protection. This awareness remains at the forefront of their practice, which ensures that any matters of concern are discussed confidentially within the service and referred if necessary. This understanding means that staff are highly alert

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families

to any concerns and take the necessary action to safeguard the people concerned, but continue to recognise the need for the ongoing therapeutic support to continue. In the course of its work, the agency provides support to young people and their families, which increases their safety. For example, work has helped young people to avoid getting a criminal record and has identified a situation in which a young person was at considerable risk of exploitation. In many cases, improved relationships between adopted children and their families reduce the risk of violence and aggression in their home. One parent said, ‘We feel safe here and safer at home because of the help we get here.’ When child protection or safeguarding concerns are identified, the agency makes the necessary referrals in line with its own comprehensive safeguarding policy. Direct links to the relevant local authority’s safeguarding procedure and contact information are retained on each

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families

service user’s case file to make any necessary referral easy. The agency also has a clear policy regarding any historic abuse that may come to light during the course of its work. It makes sure that families it works with know that the agency has a duty to pass on any safeguarding concerns to the relevant authority. The agency’s therapists are trained in a recognised method of behaviour management, including a form of physical intervention, which would be appropriate, if necessary, to help to keep a child safe from harm during their time in therapy or on the agency’s premises. This is rarely needed, as parents are present with their children most of the time. The agency has a clear complaints policy in place. Information about this is given to parents and children at the commencement of the service. There have been two complaints from people who use the service, since the last inspection, which were dealt with appropriately.

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families

The agency deals with highly sensitive matters and holds sensitive and personal information. Effective systems are in place to keep this confidential and secure. Staff recruitment processes are thorough, with appropriate checks being undertaken on applicants’ suitability and qualifications to carry out their roles. This helps to ensure that the agency only employs suitable people and helps to safeguard the people who use the service.

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Leadership and management

Judgement outcome: outstanding This is an extremely well-managed agency. It understands its purpose and knows its strength. It is efficient and effective in its functioning but retains a person-centred approach that people who use the service appreciate and benefit from greatly. The agency has undergone a period of significant growth over the last two year. It is a testament to the quality of leadership and management provided by the directors that this has been achieved while maintaining the extremely high quality of service that it provides. Leadership is influential and inspiring, and there is a strong focus on quality. The manager is very experienced and well qualified. The agency is well represented at a national level on bodies involved with the provision of adoption support. In this way, it is able to keep up to date with, and influence, policy and the latest developments in the field. The commitment to quality is reflected in the agency’s highly motivated

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Leadership and management

staff team. The team is very well qualified, experienced and trained. It is made up of people from a range of complementary professions, including social work, psychology and psychotherapy. Staff understand the lifelong implications of adoption and the impact of early trauma and problems with attachment that adopted children and their families might face. The staff team benefits from exceptionally high levels of support from the manager and directors who recognise the extremely stressful work that they undertake. Case supervision is frequent and beneficial although the way that this is recorded is not fully consistent. Staff have access to, and are encouraged to undertake, ongoing training to ensure that they are fully up to date with latest developments in their field. They are encouraged to take part in research projects, which help the agency remain at the forefront of the work it does. The agency has the resources necessary to undertake its work. It is

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Leadership and management

financially viable and works effectively to ensure that it develops in a way that supports the quality of work that it does. The manager and directors have effective processes in place to monitor the work of the agency and the quality of its service. These have changed and developed considerably as the agency has grown, and they allow the directors to have a close oversight of the work that the agency carries out. The agency has addressed the recommendations made at the last inspection in 2014. Case records contain full information about the work undertaken. There is a clear and logical progression from referral, through assessment, to the provision and review of therapy, which is well recorded. As stated earlier, although records of each therapy session are clear they are not sufficiently evaluative and, thus, do not review the effectiveness of the session well enough. Complaints about the agency are rare, and the agency responds

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Leadership and management

appropriately to these. However, records of complaints do not contain details of any learning points identified or any changes that may be required from this learning. The agency’s statement of purpose is clear and detailed. It is well supported by additional information leaflets given to children and adults who used the service. The agency’s operation is underpinned by a range of suitable policies and procedures. It operates from suitable premises and has systems in place to maintain the security and confidentiality of records of the sensitive work done.

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About this inspection

The purpose of this inspection is to assure children and young people, parents, the public, local authorities and government of the quality and standard of the service provided. The inspection was carried out under the Care Standards Act 2000 to assess the effectiveness of the service, and to consider how well it complies with the relevant regulations and meets the national minimum standards. The report details the main strengths, any areas for improvement, including any breaches of regulation, and any failure to meet national minimum standards. The judgements included in the report are made against the inspection framework and the evaluation schedule for the inspection of adoption support agencies.

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