5.11 Research on outcomes and effectiveness
of social care
Could the Department provide details of any research work
currently being sponsored by the Department on the outcomes and
effectiveness of social care?
Summary
RESEARCH INITIATIVE:
COSTS AND
EFFECTIVENESS OF
CHILDREN'S
SERVICES: 13 STUDIES
2000-04
1. A programme of studies has recently begun to investigate
key questions relating to the costs and effectiveness of different
child care services. Thirteen studies have been commissioned.
The studies cover the following important areas of service provision:
non-infant adoption, children's homes, adolescent support teams
for children at risk, foster care, an intervention with sexually
abused children, mental health services through the child protection
system, leaving care services, and aspects of family support.
One aim of the research programme is to clarify the basis on which
costs of services are derived and to develop guidelines for both
research and services. Professor Ian Sinclair of York University
is the academic co-ordinator for the programme. Details of studies
are provided at Paragraphs 6 to 48.
RESEARCH INITIATIVE:
OUTCOMES IN
SOCIAL CARE
FOR ADULTS
(OSCA): 13 STUDIES 19972002:
2. Thirteen projects were funded under this programme,
together with a related programme of projects at the Social Policy
Research Unit, University of York. The overall aim was to see
whether services were meeting policy objectives by delivering
the desired service outputs and user outcomes. Considered overall,
the projects were concerned with the full range of adult client
groups, and addressed the following themes:
Developing methodologies for measuring outcomes.
Assessing the effectiveness of services.
Comparing costs and outcomes.
Evaluating and reviewing the evidence base.
3. The findings and key implications for policy and practice
drawn from across the programme will be pulled together in an
"overview report" which is currently in preparation.
Many of the individual studies have already reported Melanie Henwood
and Eileen Waddington of Nuffield Institute of Health are the
academic co-ordinators. Details of studies are provided at Table
1 and Paragraphs 49 to 64
PERSONAL SOCIAL
SERVICES RESEARCH
UNIT (PSSRU): PROGRAMME
ON THE
RELATIONSHIP BETWEEN
COSTS EFFECTIVENESS
AND PERFORMANCE
4. An important element of work at one of the Departments
long-term funded units is to explore the relationship costs, effectiveness
and performance. Two continuing streams of work focus on this
area, as follows:
4.1 Commissioning and Performance Programme
The aim of the Commissioning and Performance Programme (C&PP),
formerly known as the Mixed Economy of Care Programme, is to evaluate
how different commissioning approaches, and different commissioned
services, can enhance the performance of social care services
in delivering quality care and improving user quality of life.
4.2 Costs and Outcome Programme
The Unit Costs programme draws together information about
unit costs of a wide variety of services in a format that is transparent
and easily adapted.
5. Details of the PSSRU and these streams of work are
provided at Paragraphs 65 to **.
COST EFFECTIVENESS
OF SERVICES
FOR CHILDREN
IN NEED
6. Introducing the Initiative: the Department
of Health's research initiative Costs and Effectiveness of
Services for Children in Need. The first project to be commissioned
under this initiative began in January 2000 and the last in April
2001.
7. Where did the idea come from? The Initiative
is the second in the Department's current series on children and
reflects current preoccupations. A range of terms ("Comprehensive
Spending Review, `Quality Protects', `Quality Strategy', `Beacon
Councils', `Social Care Institute of Excellence'") reflect
the concern of both Central and Local Government with producing
good and effective services at an appropriate cost. The interest
is understandable. Notoriously there is never enough money to
go roundpreventive work, for example, often appears to
lose out financially to services for children who are looked after.
There are unexplained variations in costs both within and between
local authorities. Why, for example, have past CIPFA figures
shown a place in a children's home as costing £18,000 per
year in one authority and £80,000 per year in another? And
how is it possible to commission services in a way that takes
account of both cost and effectiveness?
8. This background helps to explain the current emphasis
on "best value" and on the need to justify expenditure
with evidence that it is being spent wisely. It also provides
the rationale for the research Initiative.
9. The aim of the Initiative is therefore to
address some of these issues by investigating the costs and effectiveness
of services. It seeks to tackle a variety of questions. Do some
ways of running a service produce better outcomes at no greater
cost than others (or, alternatively, similar outcomes at lower
costs)? Are some services or combination of services more effective
than others (and how do they compare on costs)? What is the
relationship between cost and the infrastructure of services?
For example, is the comparative generosity of an authority's
foster care allowances reflected in higher recruitment and retention
rates for foster carers? And why do some authorities have much
higher unit costs than others?
COSTS AND
EFFECTIVENESS OF
CHILD SOCIAL
CARE SERVICES
List of Projects
Children in the community
1. A structured approach to the assessment of family
capacities and children's needs
2. Home visiting in the primary prevention of abuse and
maltreatment
3. Family support for vulnerable families with young
children
4. The mental health needs of children in the child protection
system
5. Costs and effectiveness of adolescent support teams
6. Costs and outcomes of different interventions for
sexually abused children
Children in the care system or adoption
7. Costs and outcomes of non-infant adoptions
8. Consequence of different types of child care provision
9. Leadership, resources and efficiency in children's
homes
10. Services for troubled adolescents: costs and consequences
11. Transitional support for care leavers: an evaluation
of costs and outcomes
Studies of resource use
12. Remuneration and performance in foster care
13. Childcare costs: variations and unit costs
STUDIES IN
THE PROGRAMME
A STRUCTURED APPROACH
TO ASSESSING
FAMILY CAPACITIES
AND CHILDREN'S
NEEDS
Researchers:
Hedy Cleaver and Steven Walker, Royal Holloway, University
of London
Pamela Meadows, National Institute of Economic and Social
Research
10. An effective and flexible assessment and evaluation
system for children in need does not currently exist. In the
context of the Framework for the Assessment of Children in
Need and their Families (Department of Health et al,
2000) the study aims to explore:
whether the records support assessments under
the Assessment Framework
the experience of parents and children
the role of the records in management systems
if the system results in identified objectives
and a plan for the child in need
the costs implications of carrying out core assessments
11. A prototype electronic version of the recording forms
will be developed; the team will act as consultants on devising
the specification for an electronic system for the Integrated
Children's System's data.
12. The study is in two parts, the first of which involved
introducing and supporting local authorities to implement the
Assessment Framework. The second part focuses on information
gathering through: auditing the assessment records at two points
in time, qualitative interviews with parents, young people, social
workers and other key professional, postal questionnaires to relevant
professionals, and a costing exercise.
13. The study will provide important information on the
effectiveness and costs of the assessment records in ensuring
children in need and their families receive appropriate and timely
services which address identified needs.
Start date: November 1999
End date: March 2002
HOME VISITING
IN THE
PRIMARY PREVENTION
OF ABUSE
AND MALTREATMENT
Researchers:
Sarah Stewart-Brown, Jane Barlow and Emma McIntosh, University
of Oxford
14. There is currently much interest in how best to meet
the needs of children who come from deprived families where parenting
skills are poor, social and environmental risk factors are high,
and there is a significant risk of maltreatment. Home-visiting
programmes are seen as a useful method of improving parenting
and preventing child maltreatment.
15. The aim of the research is to evaluate the cost and
effectiveness of such a programme.
16. Mothers/parents at risk of poor parenting or child
maltreatment were identified prenatally and includes families
who require Child Protection Services or Family Support Services.
17. With their consent the families have been randomly
allocated to an intervention (n=130) and a standard treatment
control group (n=130). The intervention group receives structured,
weekly visits from a home visitor trained in counselling, child
development, and parenting, for a total of eighteen months, beginning
antenatally. Parents in both the control and intervention groups
continue to receive the standard help that is currently available
to such families from the health and social services departments.
18. Interim and final assessments will be undertaken
immediately post-intervention and at one-year follow-up, using
a range of standardized outcome measures to assess the effectiveness
of the intervention on infant health and parental well-being.
Start date: January 2001
End date: December 2003
FAMILY SUPPORT
FOR VULNERABLE
FAMILIES WITH
YOUNG CHILDREN
Researchers:
John Carpenter, Jill Dutton, Justine Schneider and Jan Slade,
University of Durham
Jeni Beecham, University of Kent at Canterbury
19. Family Support is a broad term covering a wide range
of interventions with families. The research evaluates the cost
effectiveness of support interventions for vulnerable families
with multiple needs arising from unemployment, unsuitable housing,
poor health and education, and are identified as having "children
in need". The therapeutic interventions under scrutiny are
those provided by social services and, with varying degrees of
joint working, the voluntary sector.
20. The key variables in this study are:
types of service delivery and methods;
types of population and needs; and
21. Study locations represent a range of partnerships
between local authorities and voluntary organisations. Also present
within these locations are differences in the range of intervention
(from child protection to family support) and the services provided
by both social services and voluntary sector present.
22. Sample projects in these locations have been selected
to represent up to four different models of therapeutic family
support defined according to key dimensions of focus, location,
method, contact and staffing. Sample sizes are sufficient to
compare outcomes of models.
23. The goals of the research include:
Determining the role of family support services.
The measurement of family characteristics and
service use.
The definition and measurement of family support
interventions.
Evaluation of outcomes.
Start date: January 2001
End date: December 2002
THE MENTAL
HEALTH NEEDS
OF CHILDREN
IN THE
CHILD PROTECTION
SYSTEM
Researchers:
Ann Hagell, Deborah Ghate and Sunita Bhabra, Policy Research
Bureau
Jeni Beecham, University of Kent at Canterbury
Richard Harrington, Royal Manchester Children's Hospital
Susan Bailey, Mental Health Services of Salford NHS Trust
24. There are a number of disturbing estimates for the
overlap between child protection issues and mental health problems.
While the child protection system may be a child's first point
of contact with services, a proportion will need additional specialist
services and input over and above those usually provided by child
protection agencies.
25. This project addresses a range of important and timely
questions concerning the processes and outcomes for children with
mental health needs who are entering the child protection system.
We are tracking how multi disciplinary teams dealing with at-risk
young people identify needs and refer on to appropriate services.
Services will be costed, and costings of different models of
provision will be compared within and between a selection of local
authorities. The project will describe or develop models for
good and cost effective practice in providing "joined up"
services for young people, and follow-up samples of approximately
600 young people to describe their needs, the services they receive,
the relative costs of different options, and their outcomes over
a period of one year.
Start date: ?
End date: ?
COSTS AND
EFFECTIVENESS OF
ADOLESCENT SUPPORT
TEAMS
Researchers:
Nina Biehal, Sarah Ellison, Helen Weatherly, University of
York
Sarah Byford, Institute of Psychiatry
26. This study aims to evaluate the effectiveness and
cost effectiveness of adolescent support teams in achieving positive
outcomes for young people at risk of care or accommodation, as
compared to mainstream services. It also aims to compare outcomes
for young people admitted to care or accommodation with those
for young people who are not.
27. A prospective, comparative study is being carried
out in eight local authorities, six of which have adolescent support
teams. A quasi-experimental study is complemented by a qualitative
study. The experimental group comprises all referrals to adolescent
support teams which include a request for care or accommodation,
while the comparison group includes all such referrals to mainstream
services for young people age 11 or over. Baseline data and measures
of outcome will be collected on first contact with specialist/
mainstream workers and follow up data on interventions, outcomes
and costs will be collected six months later. Outcomes for a
sub-sample admitted to substitute care will be compared to outcomes
for a matched sample of young people for whom accommodation has
been avoided. The qualitative study will carry out depth interviews
with 30 young people receiving the specialist service matched
with 30 receiving mainstream services. It will explore how, why
and in what circumstances particular interventions come to be
associated with particular outcomes.
Start date: March 2000
End date: October 2002
COSTS AND
OUTCOMES OF
DIFFERENT INTERVENTIONS
FOR SEXUALLY
ABUSED CHILDREN
Researchers:
Tara Weeramanthri, Paul McCrone and others, Institute of
Psychiatry
28. The Tavistock/Maudsley outcome study of psychotherapy
for sexually abused children, funded by the Department of Health
and the Mental Health Foundation, ran from 1993 to 1998. Girls
aged 6-14 and their carers were assessed at baseline and treated
on two main sites, the Tavistock Clinic and Camberwell Child and
Adolescent Service.
29. 81 sexually abused girls and their carers were assessed,
and 71 girls entered treatment. They were randomly allocated
to time-limited individual or group treatmentspsycho dynamic
psychotherapy and psycho-educational group therapy. Follow-up
assessments were carried out one and two years after treatment
commenced. At final follow-up, over two-thirds of the girls had
improved on a range of measures, including psychiatric diagnoses,
co-morbidity, symptoms of post-traumatic stress disorder, general
functioning, educational achievement and carer views of outcome.
There were few significant differences in outcome between individual
and group treatments.
30. It is the intention in this small follow-up study
to collect and analyse costs. Cost-minimisation and cost-consequences
comparisons will be conducted between the two intervention groups.
Start date: ?
End date: ?
COSTS AND
OUTCOMES OF
NON-INFANT
ADOPTIONS
Researchers:
Julie Selwyn, Wendy Sturgess, David Quinton and Kate Baxter,
University of Bristol
31. This study examines the care costs and psycho-social
outcomes of a complete epidemiologically based sample of children
who underwent medical assessment prior to adoption. The children
were aged between 3-10 at assessment and at follow up will be
12-19 years of age. Carers are being traced and interviewed to
establish the type and length of contact with all agencies since
the medical. Estimates of sample size yield approx 90 adoptive
placements and a further 45 children who were never placed for
adoption. The latter group are being used to determine why some
children are adopted and some not as well as providing some comparison
with the adopted group by mapping routes and outcomes through
the care system.
32. Psycho social outcomes for the children are measured
using questionnaires following the seven dimensions of the Looking
After Children system. Other measures include SATS results
and involvement with the criminal justice system. Psycho social
costs and benefits for the adoptive parents are also measured.
In addition, the financial cost of delay, disruption and support
will be calculated. The use of post adoption support services,
formal and informal, and their contribution to placement stability
is a central feature of this study.
Start date: January 2000
End date: July 2002
CONSEQUENCE OF
DIFFERENT TYPES
OF CHILD
CARE PROVISION
Researchers:
Harriet Ward, University of Loughborough
Jean Soper, University of Leicester
33. The research aims to assess how far variations in
the costs of different provision for children looked after is
reflected in the quality of care and in impact on developmental
progress. A prospective longitudinal study is being undertaken
in six local authorities, matched for similarities in the extent
of deprivation and differences in the costs of placement. Six
hundred children aged 10 and over, looked after away from home
in these authorities are being followed for two years.
34. The study assesses how far placements of different
costs meet the needs of subsets of children who display evidence
of educational difficulty, behavioural problems, health concerns
and/or significant disability, as demonstrated both by the quality
of care experienced and their developmental progress. Qualitative
data from interviews with about fifty children with significant
disability further informs the analysis. A decision analysis
model is used to estimate the different probabilities of outcome
for children with different needs and histories who receive placements
of different costs and quality.
35. Outputs include a fully developed computer application
for estimating the probable costs and consequences of various
types of provision.
Start date: ?
End date: ?
LEADERSHIP, RESOURCES
AND EFFICIENCY
IN CHILDREN'S
HOMES
Researchers:
Leslie Hicks, Ian Gibbs and Helen Weatherly, University of
York
Sarah Byford, Institute of Psychiatry
36. Residential homes are a key, albeit expensive and
often criticised, part of the provision for "looked after"
children. Among a number of recent studies two in particular
have suggested that, while the heads played a key role in the
success their homes, staffing ratios appeared of less consequence.
Following on this work the current research aims:
to describe (and, where appropriate, measure)
the practice of heads of homes, explore their use of resources
and carry out an economic evaluation of their costs
to assess the impact of heads of home on:
a) the morale and unity of the staff
group
b) the quality of the residential
environment
c) changes in the residents over one
year
to assess the conclusions in terms of their relevance
to practice and to the experience of staff and heads
37. The project involves a quantitative study of 45 homes
and a qualitative study of a sub-sample of eight homes selected
to present contrasts in resource use and leadership style. All
the homes and a sample of residents in them will be described
at two points in time. Information about the young people and
the homes at these two points will be related to variations in
costs, size, the approach of the heads of homes and other factors
likely to affect performance.
Start Date: April 2000
End Date: September 2002
SERVICES FOR
TROUBLED ADOLESCENTS:
COSTS AND
CONSEQUENCES
Researchers:
David Berridge, Isabelle Brodie and Virginia MacNeill, University
of Luton
Jeni Beecham, University of Kent at Canterbury
Martin Knapp, London School of Economics
Harry Daniels and Ted Cole, University of Birmingham
38. This exploratory research focuses on services for
adolescents living in children's homes, (specialist) foster homes
and residential special schools for young people with emotional
and behavioural difficulties ("EBD"). The specific objectives
are:
To develop a profile of the differences and similarities
amongst samples of young people living in children's homes, (specialist)
foster homes and residential special schools.
To compare and contrast key factors relating to
the organisation of these different settings, including information
on costs.
To develop measures of "quality of care"
which will permit comparison of services for adolescents living
in these settings.
To highlight key policy and practice issues in
the care of adolescents.
Development of hypotheses for further research.
39. The research is based in four, geographically diverse,
local authorities. Data regarding the three most frequently used
children's homes and EBD schools as well as by the users of these
services are being collected via interviews with managers and
keyworkers. For the fostering group, examination of up to 50
case records is taking place. In the next stage, case studies
will be undertaken involving qualitative, semi-structured interviews
with young people, parents, social workers/educational psychologists,
carers, and teachers. As far as possible, integrated research
tools are being developed which can be applied to these different
forms of provision and groups of young people.
Start date: June 2000
End date: June 2001
TRANSITIONAL SUPPORT
FOR CARE
LEAVERS: AN
EVALUATION OF
COSTS AND
OUTCOMES
Researchers:
Jim Wade, Jo Dixon and Helen Weatherly, University of York
Sarah Byford, Institute of Psychiatry
40. Leaving care is a difficult challenge for young people,
especially when they lack the guiding hand and support of parents.
The study will investigate the plans and support for young people
aged 16-19 leaving the care of seven local authorities. The study
aims to:
evaluate the outcomes achieved by young people
across a range of dimensions
evaluate the costs associated with packages of
support of different types and in different local authority contexts
identify the constituent elements of "good"
supported transitions
relate the outcomes and costs of these packages
to the strengths and weaknesses of different organisational frameworks
for delivering leaving care services.
41. The primary unit of analysis is the care and post
care careers of individual young people. The study comprises
two elements:
42. Extensive study: Statistical data will be collected
through questionnaires to approximately 200 young people and their
personal advisors. Baseline data and outcome measures will be
collected soon after leaving care (T1) and followed up 9 months
later (T2) to gather information on interventions, outcomes and
the costs of services provided by social services and other agencies.
43. Intensive study: A sub-sample of 80 young people
will be selected for interview at T2. Semi-structured interviews
will be conducted with them and their personal advisors to provide
a depth focus on their histories, the processes associated with
transitional support and to understand how, why and in what contexts
particular forms of support achieve the outcomes that they do.
Start date: March 2001
End date: December 2003