Practical messages from research on the costs of care

provision

Harriet Ward, Lisa Holmes and Jean Soper

Centre for Child and Family ResearchLoughborough

Why cost services?

• Children cost money

• More intensive interventions cost more

• Transparency allows us to compare effectiveness

• Financial costs to agency versus well being costs to child

Aims of initial study

• To explore the relationship between variations in costs and the type of care for children with different needs

• To devise methods for local authorities to calculate costs consequences for different types of provision

Data collection

• Needs, experiences and outcomes for 478 children looked after by six local authorities

• Illustrative not representative sample• Longitudinal (over twenty months)• Quantitative - MIS and case files• Qualitative Interviews with sub-sample

Costs

• Service Provision Checklist

• Information from finance

departments

• Interviews with social services staff

Time is money (1)

• Social care processes are regulated by legislation

• Looking after Children, Assessment Framework and now the Integrated Children’s System provide the tools to ensure that these processes are adequately undertaken

• The ICS is underpinned by an explicit process model for children’s servicesBUT…….

Time is money (2)

• In order to cost effectively we need to know what happens in reality

• Bottom up rather than top down• Our costs are based on what

actually happens rather than what should happen

• Who does what and how long does it take?

Social worker activity

• Direct client-related activity

e.g. visits to the young person and their family

• Indirect client-related activity

e.g. form filling, meetings and liaising with other

agencies

• Indirect non client-related activity

e.g. supervision and training

Processes1. Decide child needs to be looked after

(including activity for finding initial placement)

2. Care planning 3. Maintaining the placement4. Leaving care/ return home5. Find a subsequent placement6. Review7. Legal processes8. Transition to leaving care services

Standard cost to social services of case management processes for a looked after child

in foster care

Process Cost AU$Process One Deciding child needs to be

looked after & finding a first placement

1,243

Process Two Care planning 233Process Three Maintaining the placement 3286Process Four Exit from care/accommodation 511Process Five Finding a subsequent

placement398

Process Six Review 793Process Seven

Legal processes 5368

Process Eight Transition to leaving care services

2263

Variation between local authorities

• Differences in:

– Policy and practice

– Proportion of out of authority placements

– Proportion of agency placements

Variation by placement type

• Residential care costs per week roughly

8 times as much as foster care; 9.5 times as much as kinship care; 12.5 times as much as placements with own parents.

Costs vary according to children’s needs

• Variation for different groups of children

• Variation in types of placement

• Variation in frequency of processes

The children

• No evidence of additional support needs

• Additional support needs– Emotional or behavioural difficulties– Physical or learning disability– Offending– Unaccompanied asylum seeking children

• Combinations of above

Linking costs and outcomes

• Estimated average annual cost for children with no additional support needs: £27,228 (c. AU$ 66,622)

• Estimated average annual cost for children with EBD and who are offending: £79,167 (c.AU$ 193,706)

• A very few (<3%) exceptional children can completely skew total costs

Linking costs and outcomes

(No additional support needs)• Placement stability

• Better opportunities for contact• Better educational outcomes• Meet eligibility criteria for

additional support• A virtuous circle

Linking costs and outcomes

(High support needs)• Least positive outcomes for children with

emotional or behavioural difficulties AND offending behaviour

• Frequent placement changes• Fewer opportunities for contact• Exclusions and changes of school• Not eligible or refusal of additional

support• A vicious circle

Key Messages• Better cost estimates• Better informed decision making

• Adopting a systems approach within the context of the costs of providing services to all children in need

• A systems approach should also demonstrate how costs are spread across agencies

• Packages of care• Joint commissioning

Key Messages

• Children placed with parents or relatives often require intensive support; it is a false economy to consider these placements as relatively cost free

• For some children postponing service provision only reduces short-term costs; more costly placements and services may be required in the long-term

Cost Calculator for Children’s Services

• Computer application• Accompanied by a User Guide• Excel• Three spreadsheets:

– Placement and child data– Unit costs– Calculations

Child and Placement data• Child’s d.o.b; gender; evidence of disability;

offending behaviour• Evidence of emotional or behavioural

difficulty (specific definition used in research study)

• Start and end dates of placements• Placement type; educational or health

facilities provided; l.a.provided; within l.a. area

• Whether child left care at end of placement

What the Cost Calculator does

• Selects the unit costs that are relevant to children’s characteristics and placements

• Calculates cost of each placement or part placement

• Builds up a table of costs for a user-specified time period

• Aggregates costs for specified groups of children

Current model features

• Facility for user to specify time periods• Actual dates of care plans, reviews and

transitions to leaving care• Automatic allocation to needs group• Automatic identification of extra variations• Links to actual placement costs• Automatically updates costs (eg using

inflator figures)• What if? analysis

Outputs: by child or by group

• Total costs over selected time period• Total no. of days in placement • Total costs of each social work process• Total no. of occurrences of each process• Total costs by need• Total costs by placement type• Total costs by selected outcomes

Outputs: by child or by group

• Average cost per child per day/week - overall and for each process

• Average cost per week by need• Average no of weeks looked after

by need• Average cost per week by

placement type

Current programme (Research and development)

Develop unit costs and incorporate into model:

• Provision of services to all children in need

• Education processes

Future plans

Develop unit costs and incorporate into model:

• Health/mental health processes• Youth justice processes• Socio-legal processes

Future plans (research)• 25 most cost intensive cases from each of

four local authorities• Map how costs have accrued over time

and between agencies• Explore relationship between needs, costs

and outcomes• Identify how patterns of services and costs

differ between agencies and authorities• Identify whether different configurations of

services might have led to better outcomes

• Use findings to inform future planning and commissioning

Strengths of the model

• Deals in periods of time• Additional variations and processes

can be added • Model flexibility allows development

in response to user requests and feedback

• All modifications will build on the Cost Calculator that has been developed