Intensive Interventions Suitable for Children on the Edge of Care: Report and Recommendations for Social Finance

• Report authors: Kirsten Asmussen, Moira Doolan, Stephan Scott (June 2012)

This report identifies the interventions that are effective for children on the edge of care. These interventions could aim to improve outcomes for children either side of the edge, either by preventing children entering the care system or enabling children in high-intensity residential care to live with well-supported foster families.

The report was commissioned by Social Finance and highlights the interventions that are most likely to be effective so that Social Impact Bond (SIB) investors can make well-informed choices about the interventions they endorse.

SIBs are a funding mechanism whereby socially motivated investors pay upfront for preventative services to be delivered to a target group. The investors take on the implementation risk of service delivery and are paid according to the level of successful outcomes delivered. If outcomes do not improve the investors do not get paid.

Findings and outcomes

The report starts by identifying the demographics of the children entering care. It is found that at initial assessment, the primary need for children between ages of 0-18 years was abuse or neglect. Family issues made up the majority of the rest of the cases.

The report identifies key outcomes which might be achieved by interventions targeting children at the edge of care. These are:

• Improved parental ability to appropriately care for their children
• Improved child outcomes - these include increased time in school, improved educational achievement, higher rates of employment, improved mental and physical wellbeing and reduced anti-social behaviour
• Improved quality of the support provided to children and their parents before they are placed in to care
• Increased stability in out-of-care placements.

There are a growing number of edge of care interventions with strong evidence showing improved child outcomes that are sustainable over a long period of time. Some of the most effective interventions target the whole family and not just the child. Because vulnerable families often resist support - especially where they feel it is compulsory - children at the edge of care may require "high-dosage", intensive, one-to-one interventions to overcome their resistance by creating a sense of trust and a desire to change.

Two of 10 interventions reviewed had strong evidence of significantly reducing the need to go into care - with some of the evidence obtained from the UK. These were Multidimensional Treatment Foster Care - adolescents (MTFC-A), and Multisystemic Therapy (MST).

MTFC-A

For a period of nine to 12 months, the child is placed in an MTFC-A foster home. MTFC-A is designed to meet the individual needs of the child and involves:

• The young person attending weekly therapy sessions with a QCF Level 6 trained therapist
• Support from a skills trainer who helps the young person develop skills for daily living
• Training for the foster parent that includes 20 hours of pre-service training and weekly group meetings with other MTFC-A parents. Members of the MTFC-A team are also available to foster carers on a round-the-clock basis for consultation and crisis intervention.

If possible, the biological parents meet with the family therapist on a weekly basis. These weekly family therapy sessions typically continue for an additional three months after the child and family are reunited.

MTFC-A in England is implemented through licensed sites that are supported by the National MTFC Implementation Team. Pre-service training is delivered to teams of Masters-level qualified practitioners and a supervisor over a period of five days. Intervention effectiveness is continuously monitored through rigorously implemented standardised measures which continuously track children and parents' progress.

MST

MST is a US-developed intervention that aims to improve the outcomes of young people (aged 10 to 17) involved in anti-social behaviour and/or at risk of going into care. MST therapists provide an average of three hours of treatment per week to each family that includes separate sessions with the young person and parents, as well as a weekly family group session. The content of these sessions draws from cognitive behavioural theory, family systems theory and parent skills training based on social learning principles. MST therapists are also available to families 24 hours a day should a crises arise. The average duration of treatment is between four and five months involving 60 hours or more of content.

MST practitioners are required to have a minimum of a Master's qualification in a helping profession - most likely psychology or social work. Pre-service training involves five days of a continuous "orientation" that familiarises practitioners with the theories, goals and activities of the programme.

Implications for practice

The report drew the following conclusions about the effective interventions for children on the edge of care:

• Interventions for children on the edge of care must be based on strong evidence.
• Local Authorities and Social Impact Bond investors must understand the needs of their population. This will enable the correct choice of intervention.
• Quality Counts. Interventions stand the best chance if they are consistently of high standard. Quality assurance may increase cost but they improve the likelihood of an intervention being effective.
• There are no short cuts. When money is tight, commissioners will be attracted to lower unit costs, but the outcomes of interventions must be considered when understanding the value of the intervention.
• Practitioners must be qualified. Interventions must be fully embedded in local authority social work practice and reflect current legislation.

The Children's Society is a national charity that works with the country's most vulnerable children and young people. Research summaries provided by Priya Patel