Podcast transcript
Introduction:
Welcome to NSPCC Learning, a series of podcasts that cover a range of child protection issues to hopefully inform, create debate and tell you all about the work we do to keep children safe. At the heart of every podcast, is the child's voice and how what they tell us, informs the work we do.
Ali:
Hello, and thanks for listening to the latest NSPCC Learning podcast. This week, we’re looking at The Lighthouse, a service for children and young people in Barnet, Camden, Enfield, Haringey and Islington who have experienced any form of sexual abuse, including exploitation. The Lighthouse is based in Camden and it’s a place that puts children and young people at the centre, making sure they have a safe place to recover at their own pace and rebuild their lives.
Medical, advocacy, social care, police, and therapeutic support will be delivered from one place, providing a coordinated approach to supporting children and young people so that they, and their families, receive the justice, support and therapy they need in a timely manner, meaning they can move towards recovering from the abuse.
In this podcast, I talk to Emma Harewood, who is the Delivery and Service Manager at the Lighthouse, Deborah Hodes who is a paediatrician and lead for the Lighthouse’s Health team and Jon Brown, Head of Development and Impact at the NSPCC. Emma, Deborah and Jon talked to me about creation of the Lighthouse, why it’s an innovative service, the multi-agency approaches and partnerships and the value in everybody being physically based in one building. And, as always, we talk about the child’s voice and the crucial role this has played in developing the service and how it will continue to help shape the future of The Lighthouse.
Throughout the podcast, we do interchange between the terms ‘Childs House’ and ‘Lighthouse’, both mean the same thing, and there are a couple of acronyms – CSA Hubs is Child Sexual Abuse Hubs – and MOPAC is The Mayor's Office for Policing And Crime. And finally, we recorded this in one of the Lighthouse’s rooms which has air-conditioning that we weren’t able to turn off, so I hope the gentle humming you might hear throughout, is calming, rather than distracting.
On to the conversation - I began by asking Emma to give me an overview of The Lighthouse.
Emma:
So the Lighthouse is a building, but it's also a service, a multi-agency service. And the reason we arrived here was having identified, a few years ago in London, that children were actually following quite a disparate pathway of accessing lots of separate services and finding that they were trying to navigate themselves through that really complex journey.
The Lighthouse is a place where we bring together all those services, so, the medical and sexual health support that young people and children need after sexual abuse, counselling support for them and their family, therapeutic support, police interviews and really the advocacy, which is a role that walks the journey with the child and the family from disclosure over the next couple of years as they process what's happened.
Ali:
Is there an age range of children that can come here?
Emma:
So, it's open, predominantly, for children zero to 18 but also we're really conscious that young people with a learning difficulty up to the age of 25 might really value a more child, a young person, friendly approach, so we are able to support those children. And The Lighthouse serves children that live in the north central part of London, so five out of the 32 London boroughs we serve.
Ali:
Can I ask about the funding of this building and the service? How has that come about?
Emma:
So it's really been pump-primed by quite significant central government funding. You can imagine trying to get something off the ground that requires many different agencies and organisations to work together, requires a bit of a pump-start of money. So the Home Office were hugely influential, their Police Innovation Fund was one of the biggest sources of funding but followed swiftly by the Mayor's Office for Police and Crime, NHS England London, and then also the Department for Education. And together those four government organisations have been really key in funding, not only the implementation and the delivery of this service, but also that period where we developed the model and the ideas behind it, and that was led by NHS England and the Mayor's Office.
What we're really lucky, and I'll probably hand over to John to describe it, is the additional added value that we've got from this partnership with an organisation such as the NSPCC and additional funding that that's given us.
John:
So that's the, as Emma's described, that's the core funding and without that funding from those government departments and from the Mayor's Office, The Lighthouse wouldn't be in place, that's the absolute core funding for it. But bringing in a voluntary organisation like the NSPCC means that you can provide added value as well. And we've been able to do that particularly with our partnership with Morgan Stanley. We were their 'charity of the year' and they undertook to raise a significant sum of money, almost a million and a half pounds, to support the development of The Child House, particularly during the set up phase, the mobilisation phase. But also to extend some of the provision that we can offer here at The Lighthouse as well.
Ali:
John can we talk about the bid? Who created that bid and what was that bid for?
John:
Yes. So, the Health and Wellbeing contract was procured by NHS England and a bid was led by University College London Hospital (UCLH), with two other key partners, The Tavistock and Portman NHS Trust and the NSPCC. So the three of us put in a bid, led by UCLH, and we were successful in getting that contract. So I think having that charitable input into a really exciting initiative, like The Child House, is important because it means that sometimes things can get going quicker but also you can add to the value in addition to the core funding.
Ali:
So talk to me about the innovative side of this service. Is there anything else like it in the UK that we know of?
Deborah:
No there isn't anything like it, so that makes it very exciting. Now there are other services, with elements of what we have here, so it’s not fair to say there’s nothing out there but it’s not been as fully funded as we have had the opportunity to enjoy, if you like, and also to test out, which I think is very challenging, having so many agencies working together in one building and working every day, discussing children and young people who are referred to the service. So we have, within the service, health, social care, police, therapy and the voluntary sector, the NSPCC, so that's five different agencies under one roof, we're all wanting the best for the child and young person, so that is our aim, all of us. And I think most people, well everybody here's very passionate about that, and so that's very exciting to have the opportunity.
But getting to that point of how we're going to do the best for the child and young person, has been challenging because we've all come from different places, we've got different backgrounds, different governance policies, which I'm sure Emma can talk more about, but I'm really glad to say that in the very few months, the whole atmosphere and the whole feeling here has changed extraordinarily and it's a very exciting project.
Ali:
That's really good to hear. And we are going to be talking a little bit later about the kind of partnership/coordination/multi-agency working, so, hold that thought, because I think we're going to delve into a little bit more. Talking about the, kind of, innovation side, before we pressed record on this podcast, we were talking about other areas that do aspects of this service, and ones that we have learnt from that practice in order to create The Lighthouse. Can we talk a little bit about that?
Emma:
Yeah. So I guess if we start with the criminal justice process. So the model of The Child House in London has learnt and drawn from expertise in the 'Barnahus' model in Scandinavia which, whilst it has a different judicial system, actually gave us real food for thought and really challenged us about wanting to create something different and push the boundaries if you like. But we've also learned from best practice in this country as well.
So to give you some examples, in the Barnahus, a clinical psychologist leads the 'achieving best evidence' interview, or their equivalent of that, that's the police-led interview to gather evidence at the beginning of an investigation. They have that led by a psychologist, and that's something we were really keen to pilot and the Metropolitan Police agreed that it was a fantastic idea. As you can imagine, initially met with some resistance from police officers that usually do that role, but actually I would say we've been on a journey and people are interested to see how that pans out within our investigative and judicial system.
We've also learned from the 'live links'. So, various places around England and Wales, non-court venues, use a live link where a child can be cross-examined, so that's much further at the end of the investigative process, they can be cross-examined at the time of the trial, but from a place that they feel more familiar with. So we see that in sexual assault referral centres across England and Wales, and that's something that we'll be doing here at The Lighthouse.
And then the last thing that we've been looking at is the Ministry of Justice pilot, something called 'Section 28 Initiative'. So that's an option where, rather than children being cross-examined during the trial, they have an opportunity to pre-record that, and importantly, to have the questions that the barristers will be asking them checked out and considered to make sure that they’re as child-friendly as possible. So it's a much more controlled and managed process where the child feels more in control.
So those three elements, it's not to say that this is the first time they're happening in England and Wales, but what's really exciting is that we're looking to bring all of those things together and learn from international and closer-to-home best practice. So that's quite a big chunk of the innovation that we'll be seeing here and evaluating very closely. As you can imagine, the Home Office Police Innovation Fund being one of our biggest sources of funding, are very keen to see the impact we have on that broader judicial process.
Ali:
And what are the requirements that they have given you, with regards to kind of evaluating it?
Emma:
So we've got, and created, quite a complex, some people call it an electronic patient record, some people call it a case management system, but we've created a system to record from all the agencies within The Child House, we all put our information into this one system. And it's been designed with quite a research evaluation focus. So it's a tool that we're hopeful will be able to give us lots of information that's needed for the evaluation. The Mayor's Office are leading that, and their aim is every six months to a year to be able to pull reports as we go, with a review to reporting finally at the end of the two-year pilot.
John:
The key thing that we're interested in, in relation to learning from The Child House, is obviously outcomes for children. You know, to what extent, as Emma's described, bringing everything together under one roof and collaborating together, to what extent does that improve the pathway for a child who's been sexually abused, in terms of the length of time it takes from disclosure through to the conclusion of the case in court, and the speed with which they can get their medical examination, and the speed with which they can then get help, and therapy as well. And the anticipation is that those timescales will be significantly shrunk. But also, importantly, that the child feels and experiences that the provision of the services that they get in The Child House in a very positive way.
So those are some of the things that the evaluation is wanting to measure and that's going to be key learning that we're going to want to take out and showcase to other parts of the country as well as they, quite understandably, become interested in taking on The Child House model themselves.
Deborah:
Maybe I could just add a bit more to what John was saying just now about the outcome for the child and I think that's very important, and about criminal justice system. But also I'm noticing with some of our referrals we've got now, there won't necessarily be a court case but there will be, we're hoping, a good outcome because the child will be supported here from all aspects of their care. It might lead to family proceedings/Family Court, rather than criminal court, or it might need no court process at all, just perhaps and enhance social care intervention. But in the meantime, their emotional and physical well-being will be supported.
John:
It's the service around the child, rather than child around the service. And I think the other thing about being co-located and working together, is that it brings into fairly sharply, the identification of gaps and issues and problems as well. When Emma was talking about Section 28 of the Youth Justice and Criminal Evidence Act, which goes back to 1999, and that is still not properly in place, through a whole range of issues, and having organisations like the NSPCC means we can campaign and lobby on that and make noise about that as well. Because it's wrong that that's not in place. It's wrong that children can't give evidence in chief from The Child House which is set out in Section 28 of that particular Act because of ongoing issues and problems about that. So we can push, all of us, but perhaps led by the NSPCC as a campaigning organisation, can push and lobby on things like that as well.
Deborah:
And we'll have evidence, more evidence as to why that's so important.
Ali:
So there's some really nice examples of how the partnership is working well. So going back, was it tricky to get to this place? Are there still elements where we're refining bits?
Emma:
I think for us in north London there's been some really good learning, that before we started with The Child's House, although we knew we had the funding and at a senior level we're working through implementation, on the ground what we did is set up something called a CSA Hub which Deborah has alluded to. So we set up on a small scale, one doctor, one therapist, one advocate. We brought together a hospital doctor, a CAMHS practitioner (child adolescent mental health practitioner) and an advocate from north London rape crisis. And what that allowed us to do was to test out, how does it feel to work across agencies? It forced the agencies to agree, on a really tiny scale, to something, and that was absolutely invaluable.
So we went through a two or three year process of having a steering group, multi-agency steering group, in this patch. And even though we were working on a tiny project, we knew our goal, long term, was The Child House. And so that was really, really valuable in the developmental phase really. And then I think in the 'go live' phase really, as we have had our implementation and then launched, there have been some things that have probably taken us by surprise that I think are worth sharing with other people that might want to go down this same route. So one was around the complexity of information sharing and information governance. It took a long time to work that out.
And it goes back to John's point about different cultures. We all had different understandings and different language and different expectations around information sharing, so that I think that can't be underestimated. And then that then plays out as we try and set up more operational pathways, how we do things in The Lighthouse, and that again has brought into stark relief the different cultures and expectations and language, particularly, that we all bring.
So I would say we're in a good place now as Deborah said. But again, I don't think that that can be underestimated how long that takes and how, you know, it's really important and built the relationships with the other agencies before you head into that. Otherwise you could come a cropper, but we had a good foundation and relationships from, our kind of, our first step in the Hub.
John:
I think it's remarkable what's been achieved in a very short space of time. The Health and Wellbeing contract, that's led by University College Hospital London, was awarded in February of 2018 and The Child House went live and started seeing children and young people in October. And that's a remarkable feat to navigate through all of the organisational complexity, with that range of partners, and to have a twin-track approach of a building being refurbished as well. So it is a remarkable achievement and in a sense the hard work, the legwork, is being done here and I think that learning in terms of interagency collaboration and partnership will be incredibly important to share with others when they're thinking about setting up a Child House in different areas of the country.
Deborah:
What I think is key learning from this in the future, is the job specification and choice, and if you don't choose people who are absolutely 100 percent right for the interagency working, I can promise you, it's not going to work. And I've been working a long time in lots of different multi-agency teams actually, because I've always worked in the community, this is an extraordinary experience with people who are all rather special. So I think to do to replicate, one has to choose very carefully.
Ali:
Can we move on to talk about the child's voice in the creation of The Lighthouse. So, how were children consulted in the run up to this, how are they treated when they're here? So can you talk to me about that?
Emma:
Yeah. If I start a little bit with the run up. Having undertaken the review in London in 2014, as we kind of created the momentum for the model and what it might look like, we spent probably two years developing that in London and I led quite a significant piece of work with young people across all of London to help them, and adult survivors, shape what ours, what an English version of the Barnahus might look like.
So we did a lot of engagement with youth councils, with youth groups, with children in Pupil Referral Units, with children in youth offending schemes, many, many different children. And then also quite a lot of work with adult survivors of child sex abuse and said to them, what would have made a difference for you when you were a child? What would a service need to look like for you to have spoken up earlier? Because we know so many children don't speak up 'til adulthood. So that kind of shaped the model and, broadly, the principles, and how it would work, and who would be in The Child House. But then the NSPCC Participation Team were really helpful when we got more to the nitty gritty of implementation.
John:
They were, and it's been particularly helpful having the Participation Team within the NSPCC to help inform the development of The Child House. From basics, in terms of colour schemes, in terms of the naming of The Child House: The Lighthouse, that was through a very extensive consultation process with quite a large number of children and young people came up with the name of The Lighthouse. I think it's critical to have you know from the outset, in terms of the planning and the shaping of The Child House, the involvement of children and young people to ensure that the final product, if you like, it looks exactly as they would want. That's going to be crucial in terms of what how they experience the building.
As Deborah was saying staff selection is really, really key, but also the physical layout of the building, what it looks like, the light here in the building and hence the name The Lighthouse, I think is really important and that's something that the young people have fed back on in terms of their experience of it. So overall, the involvement of children young people in terms of helping to shape it from the outset that's really, really been important. It's been a really important part of the development of The Lighthouse.
Deborah:
So just to continue with that, we are actually looking for young people and children, maybe, to join the Young People and Child's Forum to help us continue. And we're hoping we'll have our first meeting group of young children and young people and children, and hopefully an adult survivor, who is already interested in The Lighthouse, will come to our first meeting and think about how to shape it going forward, and what is needed. So that's very exciting and actually quite quick, I think as John was saying, to get a group together. It's not easy. But I think we will find some volunteers and I think it's going to really help. It will be very important.
Emma:
I guess the final thing to add to that, picking up on Deborah's point about our team being passionate, I think throughout this whole project, individual people in the team have drawn on contacts and resources and different things and I think that follows through for the children and young people's engagement. So I know that many of us involved in the project may have spoken to colleagues that are teachers to get their school involved, or spoken to someone that we know in a looked-after children forum.
My own children were really involved in kind of looking at the design of the building, looking at the readability of our consent forms, picking some of the toys, and I think it feels like a real kind of family approach and just really strengthens Deborah's point about, if this is going to work somewhere else, they need to be a team of really passionate people who have got a kind of a real personal drive to see this through.
Ali:
Deborah can I talk to you about the child's journey, from the minute they walk through these doors? We're currently in the Nature room, which is a very nice, tranquil, room. So can we talk about what that child would experience, a little bit more about the different rooms? Could you give us a bit of an overview?
Deborah:
So they come to the reception, it's a very nice open area with a most wonderful computerised sand tray, which I'm sure you've seen. The two receptionists there will greet them, take their names, explain that they will contact the person who they're meeting, and that they should, you know, sit down, there's some nice chairs, relax, having a drink, cup of tea or coffee as they want, I think there's some biscuits there as well. And then they will ring the one of the members or somebody in the team who's on duty to greet that child. And then someone will come down and greet the child who might have...of course that's the other thing about the journey, children come with different people, they might come with their carer, they might come with their social worker, they might come by themselves, there’s all sorts of different combinations.
And so then this group or individual will come up to the fourth floor, where there is a suite of rooms which includes the health room, and therapy rooms and an activity room and a very nice waiting area, again with the kitchen with facilities. So someone else, usually from the team who's going to meet them at that first appointment, say a doctor or therapist, introduce themselves.
We do have a lot of people in the team who might be offering some support to the child, so we don't want to overwhelm people with too many doctors, therapists, advocates, play specialists etc in one appointment. So we tend to then decide how to break off into groups and then perhaps a whole team will meet to decide what the next plan is at the end of the consultation.
Ali:
John you were talking about the room down here which is for children and young people to record statements for court...
Deborah:
Yes I was just talking about sorry...one aspect of it, because usually it'll be a different time that they come to record. Now that's usually before what I've just described which is the initial assessment. Before that, they will come for the 'achieving best evidence' interview which Emma's been talking about, how it's going to be arranged hopefully with a trained psychologist in a special room that we have for it on the ground floor. So it's kind of separate from the other rooms and they would probably...they should have come here before, maybe a week, maybe two, maybe three weeks before to have that interview.
Ali:
So they will be familiar with the building before? Okay.
Deborah:
And at that point they might have met the advocate. I've met a few people who have come to their interview and just said, 'Hello I'm the doctor, this is who I am', then put a name to a face and look forward to seeing you next time you come. Just to make people feel welcome and to know that there are other people around.
Emma:
Yeah I think that join up is really valuable. Even though it might just take us a few moments to do those introductions, that's the real value of us being physically based in one building. That's what you get for investing in lots of people that work together, that flexibility, and that just gives continuity for the child and family.
Ali:
So to tie up, the last question, we're here, we've got a two-year pilot that we're evaluating, have we thought about next steps? What's the future for this? I'm looking at you John specifically!
John:
It's a huge challenge, the replication of the model. It's not cheap. Yet, we are very confident that the outcomes for children are going to be really positive. Obviously the evaluation is going to need to demonstrate that, but I think everything that we've learned so far, we've already talked about this being a culmination if you like. The Lighthouse hasn't been invented out of nothing. It's a culmination of excellent work in London and around the country and internationally as well. So really it's the pinnacle of many, many years of hard work and huge, huge amounts of expertise and experience. So we are pretty confident that outcomes of children are going to be significantly improved. Funding is, as I say, is not cheap. And we are, at this moment, talking about what the replication models might look like and that work's being led by the Mayor's Office for Policing and Crime, through a Sustainability Board, that's chaired by the Chief Executive of MOPAC.
From my perspective, I think probably the most likely model of replication is one where the funding is fairly plural, and by that I mean it is not just 100 percent government funding, that there is input from the voluntary sector that can then lever in other funding sources as well. And if you look to North America, for example, and the child advocacy centers that have been in place for three decades or more in the US and Canada, that's the kind of funding model that they've got that has sustained them over many, many years now and I think probably if we look at the replication of The Child House model across the UK, that plural funding model probably offers the most realistic opportunity I think to ensure that we can offer the best for children in the long term.
Ali:
Well it's brilliant. Thank you for having me here. It's been a real kind of eye opener and maybe we'll come back in two years’ time, and speak to you all again and see where we are! Emma, Deborah, Jon, thank you very much for speaking to us. Thank you.
(Outro)
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