Charlotte McEvoy and Susannah Bowyer explore the arguments for using the Common Assessment Framework
KEY WORDS: Common Assessment Framework | early intervention
AUTHORS: Claire Easton, Geoff Gee, Ben Durbin and David Teeman
Title: Early Intervention, Using the CAF Process, and its Cost-effectiveness: Findings from LARC 3. Published by the National Foundation for Education Research, 2011, http://bit.ly/ikeNkC
Aim: To investigate the extent to which early intervention supported by the Common Assessment Framework (CAF) process is both cost-effective and enables better outcomes for children and young people.
Methodology: An analysis of 80 case studies produced by the 21 participating local authorities. Professionals, parents, children and young people were interviewed, and workshops were held for moderation purposes. A “futurising” methodology was used to assess what the outcomes might have been without early intervention. Futurising allows hypothetical scenarios to be included in the research as qualitative data. In this case, the authors assessed projected costs avoided by the implementation of the CAF process by asking interviewees to consider what future scenarios might have been in the absence of the interventions initiated.
Conclusion: CAF processes lead to better outcomes for children and young people and show that initial investment in early intervention, supported by the CAF process, can lead to significant savings through a reduction of specialist services accessed in the future.
The Common Assessment Framework (CAF) is a shared assessment and planning framework used in children’s services and all local areas in England. It aims to help early identification of children’s additional needs and promote co-ordinated service provision to meet them. The CAF process is the assessment leading to the completion of the CAF form, which includes meetings of different professionals and the family, and the creation of an action plan, with reviews.
This is the third project by the Local Authorities’ Research Consortium (Larc), which brings together councils and national research agencies for collaborative examinations of integrated working in children’s services. Facilitated by Research in Practice and the National Foundation for Educational Research, the Larc project is an established, sector-led initiative, recognised as a means to drive improvement and build capacity.
The first project, in 2007, evaluated the early impact of integrated children’s services; the second, in 2009, focused on the CAF process. This report builds on the first two projects, focusing on an investigation of the economic case for early intervention. The research follows two key lines of enquiry: first, from evidence gathered from Larc members, is the CAF process value for money? And, second, what are the costs of implementing the CAF against the projected costs of not doing so, both in terms of outcomes for children, young people and families and costs on service delivery?
The study finds that implementing the CAF process leads to improved outcomes. All the case studies reported some improvement for the child, the family and the extended family. These included improved home life, better engagement in education, improved behaviour at home, enhanced resilience and emotional health, improved child development and better service co-ordination.
Professionals, parents and young people said accessing the CAF process had helped them avoid a range of short and long-term negative futures. These included poor educational outcomes, emotional health difficulties, continued or escalating parenting difficulties, poor physical health or involvement with police and the youth justice system, as well as negative outcomes for the wider family.
Implementing the CAF process is also cost effective. The case study evidence shows the processes resulted in potential savings from £5,000 to more than £100,000. These were particularly significant in young people with high-level needs, such as children in long-term care or with severe mental ill-health. The studies showed the CAF process could cost as little as just over £100 and in most cases was less than £3,000. Costs rose to £8,000 in cases where higher levels of need demanded the involvement of more professionals. This is still a relatively low cost when set against potential savings, which ranged from £500 to more than £150,000. In more than half the cases reported, predicted savings were between £41,000 and £100,000, with most between £41,000 and £60,000.
The report conveys a convincing case for the CAF process as a “fundamental building block that enables local authorities and their partner agencies to work together effectively to support early intervention and prevention”. Progress is most apparent where “the CAF process underpins specific evidence-based programmes that have been shown to be effective”. As Larc chair John Harris states in his foreword, more research is needed to assess how representative these case studies are and how cost-effectiveness varies across CAFs. Certainly such a study would be valuable to children, young people and families, practitioners, service managers, commissioners and policymakers.
There are strengths and weaknesses in the method used – futurising, which relies on projections of possible futures rather than, for instance, long-term comparative analysis of actual cases.
But, in light of how little UK research includes rigorous cost-benefit analysis, this research is timely and important. We would support the authors’ recommendation that the project be seen as a catalyst for a larger and more wide-ranging longitudinal study that would aim to: nationally map different CAF models of delivery; determine the most successful and resourceful CAF delivery models; and comparatively draw out and differentiate short-, medium- and long-term outcomes for children, young people and families, while also discerning cost implications for services.
The Larc project delivers collaborative research owned by local staff, which, as the authors point out, lets local authorities benchmark their progress and “tell their own story”.
Eighteen authorities are participating in Larc4, which is exploring the interface between CAF and social care teams. The focus is on higher-level-need families that have been involved in a CAF episode with the aim of increasing understanding of how universal and statutory services can work more effectively to reduce the pressures on social care teams.
● The use of CAF processes to deliver effective intervention below the threshold for children’s social care involvement is a vital component in easing the pressure on statutory social work.
● This study encourages practitioners to consider how evidence-informed practice is being actively used and promoted in assessments, decision-making and service planning.
● In cases of high level need, the CAF process helps reduce costs and helps improves outcomes of those receiving services.
For directors of children’s services and policymakers:
● CAFs lead to better outcomes at lower cost. Further research is needed to capture long-term economic and social outcomes.
● The methods used in the research could be useful to policymakers and senior managers responsible for service planning and service costs evaluations.
● Directors might consider participating in further collaborative research in this area to build on and strengthen evidence. This report focuses on positive outcomes; there is a need to gather evidence of cases where the CAF process was unnecessary.
● Grasping the Nettle, C4EO, London (2010), http://bit.ly/bIejSX
● O’Brien et al (2009), “Do integrated children’s services improve children’s outcomes? Evidence for England’s children’s trust pathfinders”, Children & Society, 23 (5), 320-335
● Easton et al (2010), LARC 2: Integrated Children’s Services and the CAF Process, http://bit.ly/g8DshP
● Common Assessment Framework: A guide for practitioners, Children’s Workforce Development Council (CWDC), Leeds (2010), http://bit.ly/qKF2PB
● Integrated Working Self Assessment Questionnaire: Headline Findings, CWDC, Leeds (Forthcoming 2011), http://bit.ly/neNcQK
About the authors: Charlotte McEvoy and Susannah Bowyer work for Research in Practice www.rip.org.uk
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