The age of austerity in children’s services

Most children's social workers agree that early intervention is crucial, but Judy Cooper finds the programmes could be under threat unless evidence is found to prove that they are cost-effective

Most children’s social workers agree that early intervention is crucial, but Judy Cooper finds the programmes could be under threat unless evidence is found to prove that they are cost-effective

Tensions between local authority finance chiefs and children’s services directors are likely to creep up this year. Although most councils will want to protect children’s services from cuts, there is no denying that local government is expected to make £1.16bn of savings in the first round of cuts alone. That is before effects of the emergency budget on 22 June and this autumn’s comprehensive spending review are factored in. With funding for schools ring-fenced, despite the lifting of ring-fencing on other grants, this can only mean that within children’s services departments the axe will have to fall heavily on other services.

Kim Bromley-Derry, the past president of the Association of Directors of Children’s Services, points out that, because the number of referrals to children’s services is increasing monthly and the resulting statutory obligations gobble up huge sums of money, cutting preventive services may be the only option left for some councils.

He says: “Until it is clear which of the ring-fenced grants to local authorities will be cut, it is hard to assess the effect on services for children and young people. But much of the work to intervene early and prevent the need for more intensive service is not statutory and will therefore be under considerable pressure as the resources available reduce.”

Debbie Jones, chair of the ADCS resources committee, says: “The mantra for children’s services used to be how to do more with less. Now it is going to be how to do less with less.”

However, she says maintaining early intervention and prevention services is a “no-brainer” for directors – it is the only way children’s services will ever be able to reduce their budgets and save money. The problem is finding the up-front money and convincing councils to hold their nerve for long enough to allow programmes to make an impact on statutory referrals.

Many feel central government needs to play a part. Anna Turley, acting director of the New Local Government Network think-tank, says, because statutory children’s services swallow such a huge proportion of council costs, it is in the government’s interest to increase preventive services.

“You could argue that there is an obligation on them to help provide some of the up-front funding to put preventive services in place if they are serious about getting public sector funding down,” she says.

Colin Green, director for children, learning and young people at Coventry Council, says central government could help by scaling back the process-driven system that has grown up in children’s services, alongside an intense burden of inspection.

“We need to strip back the emphasis on process,” he says. “We need more flexibility. That’s not just about budgets, it’s about giving social workers the flexibility on how they interpret guidance.”

Freeing up social workers from form-filling and rigidly following guidance would, he says, ensure the work they do with families was more considered and longer-lasting, and so a more cost-effective use of professional time.

Green believes the system needs to return to a welfare model of social care which, he says, is no more expensive than the current one; it simply requires different things to be done. “We need to start asking the question after every intervention ‘what difference did we make?’,” he says.

“Undoubtedly the fact that we are going to have to start making some difficult choices will sharpen our thinking about funding only those services that we can see are making the most difference.”

However, Cheryl Hopkins, director of strategy and commissioning children’s services at Birmingham Council says there is little evidence on which preventive services make a difference.

“In this country we spend a lot of money on programmes that we have no idea what the outcomes are or what the cost effectiveness is,” she says.

Birmingham looked overseas, not only for programmes proven to be effective, but also for a model of applying cost-effective evaluation. “We’re working in the dark in this country,” Hopkins says. “We had to go to the US. To the Washington State Institute for Public Policy and the work of Steve Aos. For 30 years he’s taken evidence-based programmes and applied economic modelling around returns on investment to them.”

However, she says Birmingham has still struggled with determining whether the assumptions made in US modelling will work with a different welfare system and different approach to dealing with anti-social behaviour and young offenders. Aos has agreed to work with Birmingham this month on devising a UK model for cost-effective evaluations.

Hopkins also points out that working out the cost-effectiveness of interventions can be slow. “We need hard evidence that programmes work and deliver good outcomes for children before we can even start applying a cost benefit analysis,” she says.

Although robust academic data is scarce, the ADCS says there is some evidence to aid directors in their decision-making.

Jones says the recently forged partnership between the ADCS, the LGA, and the research community, including Loughborough University and the Centre for Excellence and Outcomes in Children’s Services (C4EO), has been looking at the issue for the past 18 months. It has already collected a large body of data on effective local practice.

“A lot of this work is about making sure we’re not trying to re-invent the wheel each time,” Jones says.

There also seems to be evidence now to suggest that interventions made in early years (up to six years old) have better outcomes compared with those made later in children’s lives. The recent review of health inequalities by Sir Michael Marmot recommended increasing the money spent on pre- and post-natal care, including intensive home visiting by social workers and nurses to all families with children younger than three and who need extra support.

Some councils, such as Surrey, have also started to strip back their multi-agency working to focus on whatever their three biggest local priorities are, such as looked-after children, homeless 16- and 17-year-olds and specific pockets of local deprivation. Others are focusing resources on what is already known to be the three biggest risk factors in child protection: domestic violence, mental health and drug and alcohol abuse.

Green says a combination of the two approaches would be even more effective. “Domestic violence has the greatest impact in families with very small children, both in terms of the level of physical risk and emotional risk, so it makes sense to target resources in that area,” he says.

In this aim, he hopes the lifting of ring-fencing on funds will help. It still remains to be seen, however, whether the advantages of greater freedom will soon be negated by a massive decrease in local authority coffers.

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Case study: BRIGHTER FUTURES Birmingham

Total Place pilot makes a convincing case

As part of its overall Total Place pilot, Birmingham Council proposed an overarching early intervention programme for children. These comprised nine pilots, including the Incredible Years parenting programme, the Triple P Teen programme, the family nurse partnership, children in care family functional therapy and restorative justice for young people in children’s homes who are at risk of committing criminal offences.

The cost-benefit model for the pilots, which started in July 2008, shows a cost of £41.7m and a benefit over 15 years of £103.5m. This excludes potential additional benefits of about £48m which, for the purposes of supporting experimental implementation, was treated as a “benefit buffer”.

The council is now also proposing a 10th pilot: an extension of the Triple P parenting programme into more universally-based services to try to remove the stigma of asking for help with parenting. The start-up costs of the pilot have been estimated at £140,000.

Cheryl Hopkins, director of strategy and commissioning children’s services at Birmingham, said: “Because we could not find any evidence on cost-effective early interventions in this country we went overseas. We’re now replicating some of those programmes to see whether we get the same level of outcomes for children and the same cashable returns in this country.

“So far we have a guaranteed budget for 15 years and that was supported by all parties on the council. For the start-up costs, we got the money from prudential borrowing [which increases the council’s income in future] and we took some money from school balances. We persuaded schools there was a benefit to them from these programmes producing better behaved pupils, so they are giving us £25m over three years.”


Outcomes are clear but cost effectiveness cloudy

The Breaking the Cycle Project and the Aberdeen and Dundee Families Project were put in place during 200-6. The aims were to reduce the risk of family homelessness due to eviction (for anti-social behaviour), reducing the incidence of complaints about anti-social behaviour, reducing the risk of family break-up and children taken into care.

Families at risk of eviction were referred to the projects and interventions involved intensive visiting and work with families to improve lifestyles and their conduct.

The evaluation of the project in 2009 found that the cost per closed case (based on average contact of 12 months) was between £15,500 and £23,000 and the cost per family per month was between £1,300 and £1,900. Based on this, a caseload of 20 families requires an annual budget of about £360,000.

However, the overall costs associated with an anti-social family of four, including the costs of eviction, temporary accommodation, costs per crime, cost of a young offender in custody as well as the cost of placing a child in care were estimated at between £200,000 and £300,000.

The evaluation report stated: “The short-term outcomes data showed that some family members experienced considerable improvements to their health and welfare during the evaluation period and that the proportions benefiting from these always outweighed the numbers experiencing deterioration.

“Reducing depression and drug and alcohol abuse, improving employment prospects and children’s education progress and prospects may lead to a wider range of positive outcomes for families over time, with associated future reductions in public expenditure. However, given the limited evaluation period, it has not been possible to determine whether these longer term outcomes are being generated.

“Overall the project’s costs will largely be incurred in the short run, while some of the outcomes and benefits may only become apparent over the longer term. Consequently it is not possible to state definitively whether the projects are cost effective.”

What works

A call for evidence of effective local practice in early intervention by researchers and directors has found several key common themes.

● Working together with other agencies and maintaining a focus on the family as a whole.

● Schools and children’s centres sit at the hub of a “continuum of support”.

● Outreach work or home visits to target hard-to-reach groups.

● Building capacity and finding resources creatively: use of peer support, volunteers and the resources of young people themselves in designing and delivering projects, for example.

● Evaluation to discern impact at an early stage, particularly on costs.

Source: C4EO Early Intervention- Early messages from effective local practice ‘call for evidence’.

Article published in Community Care magazine 3 June 2010 under the heading ‘Can preventive services survive?’


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