At the top of the hill

I have posted in the past about the feeling of running a small entrepreneurial venture, and how it can feel like pushing a giant boulder up a hill without much help, and how every time I think I’ve reached the summit a new peak appears. Well, for the first time, it feels like that feeling has changed. Suddenly it feels like I’m at the top of the hill, and I have a team of people to help me think about how to make the boulder roll. It is still a daunting task to get the thing to roll in the right direction, and there is still no guarantee it will start to gain momentum and size, let alone reach a good destination. But it does feel like possibilities are opening up that weren’t in my line of sight before. In fact, I now have the task of trying to scale up my ambitions – which is a really strange thing, after trying to keep my focus very much in the present and not falling backwards for so long!

So what has actually been going on? Well, in 2019 we secured a local small business grant to allow us to prepare to scale up. That gave us £50,000 to cover half the costs of getting some basic equipment and taking on an operations manager. We replaced some very dated laptops, and got some new desks and cupboards for our offices, only for the start of the pandemic to lead us to need to move to working from home.

That was particularly pressing, because the office we rented shared a stairway with three other units, which had just changed from very low risk, low traffic businesses (a geological survey company and a quantity surveyor) to a domicillary care company with over a hundred staff that were coming and going from the office in and out of elderly and vulnerable people’s homes. As an employer with staff who had various pandemic-related challenges (eg an employee with asthma who had to travel on public transport that included a lot of children on the school run; an employee in a multi-generational household; a vaccine-hesitant employee) and as a person with increased vulnerability myself due to preexisting medical conditions, we were quite proactive in that decision. I closed the office the week before the government officially locked down, and made the decision four months later to give up renting the office and go to a fully home-based working pattern until the pandemic risks resolved. Whilst that was a big adjustment, and I miss physically getting together with my team, having that social element and bouncing ideas off each other, in a lot of ways it has worked to our advantage. I’ve personally appreciated not having to travel as much, and reducing my carbon footprint, and it has allowed us to deliver projects all over the UK as everyone has become familiar with working remotely over Zoom.

We then secured a £220,000 Innovate Smart Grant to work with local authorities and complete our data set for BERRI. That allowed us to recruit a research team in the Anna Freud National Centre for Children and Families/UCL, where I also have my Senior Research Fellowships, to help us make sense of the data we collect and publish the validation, factor structure and early findings from BERRI. We have then set up partnership projects with eight local authorities (six in London and two in the north east). We added an Operations Manager and two Assistant Psychologist/Fieldworkers to our team to deliver the project. Working remotely meant we could also provide some light-touch input to placement providers across the UK, so we’ve continued to grow the number of organisations with BERRI subscriptions, and our ability to deliver training and consultancy online. We then secured a £96,000 Resilience grant to mitigate some pandemic related delays in the project, add some clinical staffing, commission an independent social and economic impact evaluation of our work, and use some sessional input from psychology graduates for a project in which we plan to build a wider “ecosystem” of resources around BERRI. Coupled with using the government Kickstart scheme (which subsidised businesses taking on young employees who were claiming Universal Credit) to take on three new members of staff, our team has grown rapidly. We now have input from two other qualified clinical psychologists, a small in-house data analytics team, a post to look at identifying and securing further grant opportunities, and a digital training administrator.

There have been other positive side-effects of the move to remote working. We’ve been able to recruit from a national pool of applicants and become more disability friendly – so our team now includes members from Kent, Cardiff, Somerset, Bradford, London, Buckinghamshire, Birmingham, Essex, Suffolk, Liverpool and the north east, rather than just local colleagues around Derbyshire. So I think we will probably work towards a hybrid model in which we have a small office space we use for meetings and training events, that local staff can choose to use when they want to spend more time with colleagues, which should be ready by the time the latest Omicron wave subsides. As well as continued court expert witness work, training and consultancy, and two new projects with additional local authorities, on the clinical side we are also setting up a second base in north Birmingham, where we plan to run a small neurodevelopmental assessment service. So we have recruited another AP to support that location, bringing our team up from me plus six employees in 2019 to me plus 19 today. We also have a network of placement students, researchers, contractors and sessional workers that mean we have over 40 colleagues in our wider network.

That’s a huge shift, and the rapid growth looks set to continue. We’ve secured two more small grants to develop a digital training platform and a demonstration app version of BERRI, and we’ve just submitted a large grant application to build on our with with local authorities. The independent social and economic impact evaluation has generated some amazing stories of how BERRI has changed the way that services are able to deliver psychological support to young people in care, and their lives have been positively impacted as a result. Whether it is a young person who was stuck in an inpatient secure bed with a negative prognosis who is now living in the community with aspirations of employment, a carer who is able to be more empathic to a child’s trauma history rather than seeing them as naughty, or a professional who feels more able to do their job effectively, it is amazing and rewarding to hear that my little project to develop an outcome measure for children in care is helping to create these increasing ripples of positive impact. It has also shown a remarkable level of economic impact, with a £100 return to the economy for every £1 invested in our service! My goal to change children’s social care and to find a better way to identify and support children’s psychological needs is no longer just a wild fantasy, but might be something we can actually achieve.

The other positive side-effect for me personally, is that I’m finally paying myself the salary I would be on in the NHS. After having started the company by investing my redundancy pay, a decade of subsidising the project through my court expert witness work, and some months where I drew down money from my own mortgage to pay staff, that is no small milestone! It means we are secure enough financially to firm up the social purpose embedded in the business into a formal social enterprise structure, where the majority of profits are pledged to delivering the social impact goals (which isn’t a hard task, given the vast majority of our turnover has always been spent on research and delivery of clinical psychology services).

So, what are the next steps? We have lots of new developments in the pipeline. The BERRI system itself is constantly being improved in various ways, so the next steps are adding third party reporting (eg if a social worker wants to get a questionnaire filled in by a foster carer, or a psychologist wants to get the school to complete a BERRI about a child they are assessing), putting percentile ranks into the reports for greater granularity, and improving our reporting of data to organisation by adding a dashboard with new data visualisations. We are exploring the potential of a Personal Edition of BERRI for concerned parents to fill in to know how best to support their child. And we are building an “ecosystem” of information sheets and videos to advise parents and carers about common issues.

We have several current research studies:

  1. Meryl, our PhD student, is collecting the community norms for BERRI. So if you are a parent of an adolescent in the UK, or know anyone that is, please use this link: https://uclpsych.eu.qualtrics.com/jfe/form/SV_9um9UfYGd2HX9gW (ethics granted by UCL). We really want as many participants as possible, and you don’t need to be concerned about your child or have any involvement with social care – we just want to hear from as many parents as possible (and if your child has no difficulties it should only take 5-10 minutes to compete). If you don’t have kids yourself, please share the link with others, and post the link to our research facebook page on your social media: https://www.facebook.com/BERRIResearch/
  2. If you live outside of the UK or your child is not aged 11-18 to qualify via the UCL research link, and you want a link to the questionnaire to rate a child or young person aged 5-21, just email earlyaccess@BERRI.org.uk, as I can offer free early access to the system to anyone willing to give us some feedback about your experience.
  3. We want a few people to complete a BERRI about their child (of any age) and then to complete a short interview about their experience. So if you are willing to do this, please email David, the MSc student who is doing the interviews, at david.carney2021@my.ntu.ac.uk and he’ll set up a call. (Ethics granted by NTU).
  4. We also want some foster carers to tell us about how different life experiences impact upon children in their care. So if you are a foster carer and have half an hour to participate, Lizzie would love to speak to you about her MSc research. Email lizzie.hill2018@my.ntu.ac.uk to set up a call. (Ethics granted by NTU).

We are also going to look at how we incorporate the young person’s voice into BERRI, and recognise signs of progress, strengths and post-traumatic growth.

I’m going to apply for some larger grants to look at scaling up our impact, and we are busy expanding the clinical side of our services to deliver more assessments and consultancy. BERRI has been used to review the use of residential care in some authorities, and to idenfity when children are able to return to family based care (either a foster placement, or to a member of their birth family) and what support is required to make this successful. This has generated significant cost savings for some authorities, so we have been commissioned to provide a similar review for a new authority. We are also supporting the growth of in-house residential provision in a couple of authorities, and expanding our clinical services to support fostering and edge of care consultancy in others.

So the future seems full of opportunity to make impact and – provided I can keep up with demand and keep all the plates spinning – maybe that boulder I’ve been pushing up the hill will start to roll. I just need to work out where we want it to get to!

Grand ideas

I recently filled in an application to speak at an event about children in Care. The form asked me to summarise in a limited number of characters what I would bring to the table as a speaker. I wrote:

We have collected BERRI data on the psychological needs of over a thousand children in residential children’s homes over the last five years, and surveyed and trained over a thousand residential care staff to provide care that is tailored to those needs. We can present what this data shows us, and how we have used it to improve the services that are offered, and commissioning decisions made about children. For example, we have learnt that the level of challenge presented varies remarkably little by age or gender, though the types of needs are slightly different. Some types of needs (eg behaviour, risk) are affected much more by proximal stressors (eg exclusions from school, gang involvement, substance misuse, sexual exploitation) whilst others (eg relationships) are affected more by historic adversity and the nature of early attachment experiences. We can present how staff variables (demographic factors, burnout, empathy, ability to formulate) affect the care they deliver, and how the price and types of services commissioned relate to the needs of the child and the impact they make on the life of the child – if at all!

The government spend a billion pounds a year on these 7000 children, and we have good evidence that by better targeting the psychological needs of individual children they can improve outcomes whilst saving costs.

It struck me when I looked at that paragraph that this was simultaneously a grandiose claim and underselling the potential of the systems we have developed*. I think that tension between over and under-selling what we can do reflects one of the big challenges of being an entrepreneur – seeing the potential, whilst being realistic about the frustratingly slow steps it takes to achieve it. I can see so much that we can achieve, and the way that collecting the right data can help put children’s needs in the heart of commissioning decisions, improving outcomes whilst saving substantial amounts of money but it is very hard to get this information in front of the right people. I’ve tried to speak to politicians, policy makers, experts in the field, commissioners, clinicians, funders and the media. I’ve spoken at conferences, written a book, contributed to policy documents, delivered service improvement programmes in major providers in the sector, I’ve even given evidence before a select committee. But because I try to answer the questions that are asked, I don’t always get the chance to promote the products and services that we provide. And it isn’t my personality to aggressively sell what we do.

Looking back, I think that I believed that if you work out a better way to do something, a technique that saves time or money or improves outcomes for people, then once people knew about it then it would start to gain traction until it became the established way of doing things. I figured that was how we had progressed from horse-drawn carts to steam engines, cars and now electric vehicles, or from papyrus to paper to typewriters to computers to the plethora of voice-activated, photo-capturing, text and graphic app laden smartphones – finding iteratively better ways to solve problems. I knew that sometimes there were two simultaneous steps forward that competed (like VHS and Betamax) and that variables like marketing, networks and budget could influence the choice, but I generally thought that the best solutions would win through. Maybe it is my left-leaning political bias or my hippy upbringing, but I think in my heart I have held onto a naive idea of fairness in which everyone should be motivated to solve social problems, and people should be rewarded for their effort and insight.

I suppose the concept that we live in something of a meritocracy is quite a widespread belief, and entrenched in western cultures, that good ideas will surface and the best people will rise to positions of power. That’s taken a bit of a crushing for me over recent years, as I’ve seen the covert influence of the super-rich and we’ve had several prominent examples of terrible people rising to the top of systems that have failed to keep up with social and technological change, but somehow I am still hoping for the system to right itself, because it feels like society should be a functional meritocracy.

I think it is particularly well articulated in the USA, because they started as a nation of immigrants who created their own society. To quote the American Declaration of Independence, “all men are created equal”, are entitled to “the pursuit of happiness” and will rise to their natural position in society. That sounds like a fair way to run a country, but of course the reality has never quite matched the headlines, given the theft of land and resources from native peoples, the decimation of the natural environment and the evils of the slave trade. But somehow the myth of the American Dream has persisted. First described by James Truslow Adams in 1931, it describes a culture where anyone, regardless of where they were born or what class they were born into, can attain their own version of success in a society where upward mobility is possible for everyone. The American Dream is achieved through sacrifice, risk-taking, and hard work, rather than by chance or the privilege of your pre-existing connections. In Adams’ words it is:

a dream of social order in which each man and each woman shall be able to attain to the fullest stature of which they are innately capable, and be recognized by others for what they are, regardless of the fortuitous circumstances of birth or position

Whilst I can see so many places where people are not starting the race from the same starting line, because of geography, race, gender, religion, socio-economic adversity, sexuality, age, or so many other variables I have clung on to my optimism that if you can work out a solution to a big social problem, or have an idea that can really work to make life easier (and/or make lots of money), then it should be possible to gain traction with it, get key people to support you, and get it to happen. The reality is that so many people who think of themselves as examples of a working meritocracy have in fact been handed a huge head start by their privilege. As we joked the other day on Twitter, all the wrong people have imposter syndrome because it is mutually exclusive with entitlement. It seems that private schools in particular train people to expect to be leaders and wielders of power, as we see in the preponderance of Prime Ministers educated in Eton (and in the irritating arrogance of Lottie Lion and Ryan-Mark in the recent series of the Apprentice). Having attended an ordinary comprehensive, and never having been aware of any negative repercussions of my gender or heritage, it has been quite eye-opening to see that maybe the playing field isn’t as level as it appears, even for someone ostensibly white and middle class**.

One figure that has stayed with me is that of all the money invested into fledgling businesses in the UK, 89% is given to all male founder groups, 10% to founder groups containing men and women, and just 1% to all female founders. I couldn’t find any UK numbers, but the figures look even worse if we consider race, with black women only receiving 0.0006% of the of the $424.7 billion that has been invested into startups globally between 2009 and 2017 by venture capitalists. Those white men probably think they simply have better ideas, but the evidence doesn’t support that, whilst the statistics say they are 89 times more likely to be funded than all female groups, whilst a white male entrepreneur is thousands of times more likely to be funded than a black woman, and will have the confidence to ask for much larger sums of money. Only 34 black women have raised more than a million dollars of investment in the last decade. This doesn’t reflect the quality of the idea or the work ethic of the individuals involved (as meaningfully empowered women on boards increase corporate social responsibility and may have a positive impact on the profitability of the business, and diversity increases profitability). It reflects the stereotype of what the (predominantly white male) funders think successful entrepreneurs look like – and they imagine young geeks from silicon valley who are predominantly white and almost always male. And that sucks.

It might also explain why men in suits with glossy patter are able to sell systems they have pulled out of the air for eight times what we charge for properly evidenced tools that do the same job better. Or maybe that’s just a coincidence. But whether or not the playing field is flat isn’t something I can solve alone, and it is unlikely to be resolved within the timescale that is critical for me to make a success of my business and to maximise the impact I can make on the lives of vulnerable children. That means that, despite how discouraging it is to realise that we are not living in a meritocracy where the strength of the idea is enough to sell it to those who matter, I need to find ways to shout louder, communicate what we do better, and get our message in front of the right people.

Because we are tantalisingly close to having all the data we need to understand the critical variables at play in the psychological wellbeing of children and young people in Care, and which placements and services can help to address them. We have an exciting partnership growing with a group of local authority commissioners that will couple our data with commissioning data, and we are applying for grants to help us to gather and analyse that data across much wider samples. We are also scaling up the previous project we did looking at whether BERRI can help to identify suitable candidates to “step down” from high tariff residential settings into family placements with individualised packages of support. These larger scale projects mean that we will be able to show that the model works, at both the human and financial levels. And with a little bit more momentum we can start making the difference I know we are capable of. The trick is hanging onto the vision of what is possible and celebrating what we have already achieved, whilst having the realism to put in the graft that will get us there. I need to keep pushing upwards for longer than I ever imagined, in the hope of reaching the fabled sunlight of easier progress – even if so many variables skew us away from the meritocracy that I imagined.

 

*I think that’s why I used the pronoun “we” and shared credit with my team, even when I was asked to describe myself as a speaker, rather than taking full credit on my own. This transpires to be a common female trait, and part of the double bind for women where being assertive is seen as aggressive whilst being collaborative is seen as lacking leadership. In fact, many words are used exclusively towards women and highlight how pervasive these biases about women in leadership roles are.

**albeit a second generation immigrant to the UK, with Jewish heritage

Seeking collaborator to change the world

LifePsychol Ltd is a company with a clear social purpose – to improve outcomes for people who have experienced adversity through the application of clinical psychology, particularly children who are Looked After in public care after trauma or maltreatment. We deliver effective psychological services for Looked After and adopted children by providing assessments, formulations, therapeutic interventions, consultation, training and outcome measurement tools for placement providers. And we are very much in demand. But at the moment we are clinician led, and we really need a COO with complementary business skills as the company scales up, to ensure that we make the maximum impact going forward.

We are at a very exciting time, with the potential of rapid growth and the first evidence of efficacy for our pathway emerging. We have started the process of applying for DfE Innovation Programme funding, and we have great support from key people (Sir Martin Narey, government advisor who just reviewed the future of children’s homes in the UK, described our pathway and tools as “the missing link for the sector”, Jonathan Stanley at the Independent Children’s Homes Association described them as “the new gold standard for our members”, whilst Lord Listowell said the government should fund part of the cost to ensure there is input from a clinical psychologist in every residential care home). Despite having done no marketing, we have more enquiries about joining our system than we can keep pace with. We are already used in over 100 children’s homes, and we have a growing number of local authorities who wish to roll out our pathway across their entire catchment. We are looking at how we train and license other clinicians to deliver the model both in the UK and internationally.

We have a great clinical team, a graduate project manager/admin, a fantastic professional network and a great product set. What is important to us now is getting the right person to drive the business side forward at this critical time. To do that we really need someone with business skills and experience, combined with a passion for making social change to take on a leadership role on the financial/business side of the company. We are therefore seeking an extraordinary COO who will help us achieve extraordinary things.

Who are we looking for?

You need to genuinely care about making the world a better place, and to share our goal of making a measurable difference to the lives of vulnerable children and young people. As a clinician CEO it is vital for me to have someone I trust to bounce ideas around with, who will ensure that we are on a sound financial footing to enable us to deliver our ambitious plans. You will be familiar with all aspects of the finances for running a business, have a good working knowledge of the UK social care system and be a dynamic manager, but with a willingness to turn your hand to other aspects of the business (from fundraising to recruitment to CRM) until we are large enough to take on a full team. You understand the value of evidence-based practice and you have a good awareness of the financial demands of the social impact sector. You are the kind of person that can nail down complex ideas and grand ambitions into concrete and achievable plans that will make genuine social change.

You will ideally be based in Derbyshire at our new Matlock office and will help to develop a team there, but with some travel to other sites. However, we already have a base in Milton Keynes that I visit fairly regularly, along with existing relationships and use of shared working space in North London (Kings Cross), so if you are the right person then these might be possible alternative locations, provided you are prepared to travel regularly to meet with me in Matlock and are comfortable using video chat in between times.

How to apply

If what we are looking for sounds like you, and you are looking for a new challenge, please get in touch and we can set up a meeting. Or if you know someone that might be the right fit, please pass this information along to them. Email lifepsychol@gmail.com to express an interest. No agencies or recruiters please.

Background information:

LifePsychol currently consists of a small clinical team who provide assessment and therapy services, particularly for children and families, and services commissioned by local authorities to support Looked After Children, adoption or families at the edge of care. Our Clinical Psychologists also provide expert assessments for the family court and to local authorities considering entering proceedings. We provide consultations advice on service development and service evaluations for social enterprise and third sector organisations. Our main specialist area is around attachment, trauma and maltreatment and how this evidence base can inform the care of children who do not live in their family of origin. We therefore provide training for adoptive, foster and residential carers, as well as health, social care and legal professionals, and have a network of associates who provide regular consultation into organisations.

However, our primary goal at present is nothing less than to improve the quality of placements for all Looked After Children in the UK. LAC are a particularly vulnerable group of children and young people because their needs are complex, and often include mental health, developmental difficulties, problems with relationships and behaviour. We hope to achieve this ambitious goal by training carers and implementing a new set of standards for care providers (PRIME) and through regular use of outcome measures (BERRI).

The PRIME standards are about ensuring that strategies carers use are evidence-based, individualised to the background and needs of each child, evolve as the child’s needs change, and are based on a thorough psychological assessment and a multi-faceted formulation of the child’s needs. We believe that having advice from a clinical psychologist to inform the care of all Looked After Children (and other children with complex needs) will both reduce stigma and improve outcomes, whilst helping carers to feel better equipped to meet the children’s needs. We have developed a training program and care pathway as one means to implement these standards for placements.

We have also developed a set of online tools for commissioners and placement providers to use to identify and track the needs of children in their care. The tools are known by the acronym ‘BERRI’ because they explore Behaviour, Emotional well-being, Risk to self and others, Relationships and Indicators of psychiatric or neurodevelopmental conditions that may require further assessment or diagnosis. We want every young person with complex needs to have a service that meets their needs in an effective and evidence-based way. We have therefore developed tools that allow us to gain a more holistic picture of children’s needs, to track how this changes over time and to target particular concerns and monitor the effectiveness of interventions to address them.

Our first data suggests that we can reduce concerns about children significantly within six months of using the pathway and tools we provide, and our services gain exceptional feedback from carers and professionals, but we hold ourselves to tough standards of evidence, and gather data about our effectiveness every step of the way.

Note: The BERRI questionnaire and online tools were developed to improve the outcomes for children Looked After in public care in the UK. However, the system is also applicable to those receiving other forms of intensive or multi-agency input, such as those on the edge of care, attending special schools, placed in inpatient services, secure units or involved with services for young offenders. The system would also be equally applicable in other countries, and could be adapted to other populations (eg adults using mental health inpatient services, people with learning disabilities, or those within the criminal justice system).