Outcomes Spring Conference Report

Providing a fitting backdrop for what was to follow, the Department for Education’s representative at CYP Now’s Outcomes Spring Conference stressed the overwhelming importance of evidence in work with children, young people and families. Olivia McLeod, director of the supporting delivery group at the DfE, cited a paper submitted in March to the department, Building Evidence into Education. Its author Ben Goldacre says that evidence “is about empowering teachers, and setting a profession free from governments, ministers and civil servants who are often overly keen on sending out edicts, insisting that their new idea is the best in town. Nobody in government would tell a doctor what to prescribe, but we all expect doctors to be able to make informed decisions about which treatment is best, using the best currently available evidence.” McLeod remarked: “His message has equal resonance across children’s services”.

The event, chaired by Christine Davies, former chief executive of the Centre for Excellence and Outcomes, featured 10 thought-provoking sessions including the following case studies.

Improving outcomes for young people through a social impact bond
Essex County Council and its partners discussed the strategy behind its programme of Multi-Systemic Therapy (MST) for adolescents on the edge of care, funded by a social impact bond.

The council is to run the five-year programme against a background of successive poor inspections, high numbers of teenagers in care, under-developed early intervention and family support services, and a lack of evidence-based interventions, said Essex head of partnerships Roger Bullen. “We invested a lot in a system that continued to fail,” he admitted.

MST is a licensed programme from the US with a history of success. Therapists address the multiple causes of behaviour in young people considered to be at risk of entering care or custody. Essex’s programme is funded by a social impact bond constructed by Social Finance. It has raised £3.1m from eight investors composed of big banks, charitable foundations and wealthy individuals.

“The desired outcomes are to avoid care entry and custody entry. Investors will be paid back their money if we show the outcomes achieved have reduced the time spent in care or custody for those adolescents who receive the service,” explained Social Finance director Lisa Barclay. The eight investors have formed a special purpose vehicle called Children’s Support Services Limited and commissioned Action for Children to deliver the programme. The charity is paid purely for delivery so it takes none of the risks of outcomes not being fulfilled. Action for Children is setting up two MST teams across the county. “Each young person who receives MST will be tracked over two-and-a-half years post-referral for outcomes on care placement days, but also on wider outcomes such as educational attainment and offending. But the payment will be placed on the basis of a reduction of care placement days during that period,” said Barclay. “Investors could risk losing all their money if the outcomes aren’t achieved, but they could also get repaid all their money with a modest return over the life of the contract if the service is successful against its objectives.” It anticipates working with 80 young people and families in Essex a year.

The programme’s clarity and simplicity has been crucial in levering in the investment. “MST is a very targeted intervention. There is a big evidence base of success in the US,” said Bullen. “MST is intensive, time-limited and systemic so the attribution between the intervention and the outcome is very strong and that works well within the framework of a social impact bond. The return is paid from the budget where the saving is derived, which is our placements budget.”

It has also been important to get wider buy-in within the authority. “We had to convince not only ourselves within children’s services but our members and the whole council to get behind this. That simplicity helped garner the support. It is aligned with our troubled families programme and our community budgets programme,” said Bullen.

Having been in planning stages for some time, the programme will finally go live within weeks and the recruitment of the required therapists and supervisors is in full swing.

The Essex experience is likely to provide vital lessons about the long-term viability of using social impact bonds to fund interventions. Social Finance’s Barclay said MST was only the start. “We are working with a number of local authorities to look more broadly at how we can bring in new money to deliver improved outcomes for children and families,” she said.