Title: Evaluation of the service Option Two
Authors: The team of researchers led by Donald Forrester was a University of Bedfordshire, Brunel University and Birmingham University consortium commissioned by the National Assembly for Wales
The research evaluates a service funded by the Welsh assembly and delivered in Cardiff and the Vale of Glamorgan since 2000. Option Two works with families in which parents have drug or alcohol problems and the children are at risk of harm.
A particular focus of the service is reducing the need for children to come into public care. The Option Two intervention is short and intensive, delivered over four to six weeks by workers available 24 hours a day. The workers use motivational interviewing and solution-focused counselling and other therapeutic and practical interventions.
The complexity of the findings of this research underlines the point that there is no “magic bullet” that will prevent the need for children to enter public care. Nevertheless, the evaluation does offer some of the most positive findings ever reported about family intervention projects in a UK setting. The evaluation included:
● A review of the literature on intensive family preservation services. A summary of evidence from 100 articles or books on efforts to prevent children entering care.
● A quantitative study of 278 children referred and accepted by the Option Two service between 2000 and 2006 and a comparison group of 89 children referred to Option Two but not accepted as the service was full. Information on care entry and associated costs was compared for these two groups. It’s important to note that the group not receiving Option Two did receive other services, so that it was not a comparison of Option Two with “no service” but a comparison with other services.
● A qualitative study of the views of 18 parents and children who received the service in 2006.
● Questionnaires returned by 23 social workers in Cardiff and the Vale.
While Option Two did not reduce the proportion of children who entered care – about 40% of both groups did so – it did significantly reduce the time children spent in care. This is because Option Two children took longer to enter care, when they did enter care they tended to stay there for a shorter time, and a higher proportion of them returned home – 17% returned home compared to 7% of the comparison group children. Consequently, only a quarter of Option Two children were in care at the end of the study, compared to a third of children in the comparison group.
IMPACT ON PLACEMENT COSTS
The average cost of the placements in care was higher for the Option Two children (£14,518.13) than for the comparison group (£11,240.50). This is explained by the fact that when they entered care Option Two children tended to have more expensive placements (average daily cost £45.95 compared to £31.40). Twelve of the Option Two children were placed in very expensive placements costing more than £75,000.
In the comparison group, most of the children remained at home, suggesting that many of these children were not in fact at high risk of care entry. A further 15 of the comparison group children were placed in kinship or adoptive placements that cost far less than the Option Two service.
An attempt was made to measure the savings from the reduced need for public care and “off-set” this against the cost of Option Two. Children from the Vale of Glamorgan were excluded because the figures on costs seemed unreliable. In Cardiff, Option Two saved the local authority £1,178 a child. The authors conclude that “Option Two in Cardiff provides significant cost saving to the care system and is therefore likely to be a cost-effective approach to reducing the need for public care.”
CHILDREN’S AND PARENTS EXPERIENCES
The numbers interviewed were small and only from half the families involved with Option Two in 2006. Those interviewed were positive about the service, but it is possible those not interviewed would have been less positive. Parents interviewed highlighted:
● A non-judgemental and understanding approach which provided options rather than “being dictated to”.
● The high levels of trust developed allowed good communication between families and workers – parents mentioned their workers’ listening skills, honesty and engagement.
● Parents appreciated the high levels of contact – regular, often daily visits.
● Help with practical issues such as parenting, finances advice and support with substance misuse issues.
● Most of the children interviewed believed that their confidence had been boosted as a result of their experience with their Option Two workers. The children felt this helped to lead to improvements at school, with friends and other professionals. As one 11-year-old girl put it, the worker “made me strong and funny” by “talking to me a lot”.
The research made evident that for the families with multiple, complex and entrenched problems, the benefits of a short-term intensive intervention were hard to maintain. Follow-up data showed that although some factors improved after the Option Two work ceased, other problems continued. These parents said they missed their Option Two worker and found it hard to cope when the service ceased.
Social workers who used Option Two were also positive about the service. Prevention from going into care was significantly less highly rated than other aspects of the service, because some children went into care after the Option Two service had finished.
Limitations of the study include the fact that the quantitative element only provided information on care entry difficulties in comparing Option Two with other services the details of which are unknown and the small numbers of participants in the qualitative studies. Particular strengths of the study are that there was a broadly valid comparison group, which is rare in evaluations of interventions in the UK, and that the average follow-up period of 3.5 years is far more than for most evaluations. The authors state that to their knowledge this is the first UK evaluation with a robust methodology that shows a reduction in the need for care from a support service for families, on average delaying care entry and increasing the likelihood and speed with which children returned home.
This evidence contrasts with the “bleak picture” from other research into the impact of this type of intervention – developed on the Homebuilders model – which has shown little effect in reducing the need for care or improving family functioning or child welfare. It can be argued that the Option Two approach has made the Homebuilders model work in some important aspects, making this “a comparatively powerful and effective intervention in reducing the need for children to enter care”.
KEY ASPECTS OF THE SERVICE
● Option Two provides “an unusually highly skilled intervention”. Therapists are experienced, well qualified and receive strong training and supervision. The service manager is “experienced, qualified and dedicated in the provision of an excellent service”.
● Option Two uses evidence-based methods. There is evidence supporting the effectiveness of motivational interviewing as an intervention with alcohol and drug misuse.
● A key focus of Option Two has been on the quality of the interaction and the creation of an equal partnership between parent, child and worker.
Aspects that need further research:
● This study does not provide data on the impact of Option Two on child welfare.
● Option Two did not reduce the proportion of children who entered care. Why this was so requires further investigation.
● Option Two often appears to produce change for a period of time but some families return to previous levels of difficulties. This finding raises the question of whether the brief period of intervention appropriate for families with complex needs.
For families with chronic problems creating lasting change is difficult whatever intervention is used, but a brief intervention is unlikely to be effective.
Susannah Bowyer is research officer at Research in Practice
LINKS AND RESOURCES
The full text of the evaluation report may be obtained from Donald.Forrester@beds.ac.uk