A critical review of cost‐effectiveness research in children's social care: What have we learnt so far?

Suh, Ellie; Holmes, Lisa

doi:10.1111/spol.12795

Cited by 12 publications

(7 citation statements)

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“…Recent calls have been made to move beyond market-centred approaches towards more rights-based and creative, open-minded collaborations between health economists, researchers, service providers and policy makers [ 70 ]. Overall, there remains very little robust evidence on the cost-effectiveness of children’s services, while the appropriateness of traditional cost-effectiveness approaches in the context of complex early interventions in the primary health and social care sector, requires further consideration [ 71 ].…”

Section: Discussionmentioning

confidence: 99%

A cost-effectiveness analysis of a universal, preventative-focused, parent and infant programme

Crealey,

Hickey,

McGilloway

2024

BMC Health Serv Res

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Background This study assessed whether a relatively newly developed Parent and Infant (PIN) parenting support programme was cost-effective when compared to services as usual (SAU). Methods The cost-effectiveness of the PIN programme versus SAU was assessed from an Irish health and social care perspective over a 24-month timeframe and within the context of a non-randomised, controlled before-and-after trial. In total, 163 parent-infant dyads were included in the study (86 intervention, 77 control). The primary outcome measure for the economic evaluation was the Parenting Sense of Competence Scale (PSOC). Results The average cost of the PIN programme was €647 per dyad. The mean (SE) cost (including programme costs) was €7,027 (SE €1,345) compared to €4,811 (SE €593) in the control arm, generating a (non-significant) mean cost difference of €2,216 (bootstrap 95% CI -€665 to €5,096; p = 0.14). The mean incremental cost-effectiveness of the PIN service was €614 per PSOC unit gained (bootstrap 95% CI €54 to €1,481). The probability that the PIN programme was cost-effective, was 87% at a willingness-to-pay of €1,000 per one unit change in the PSOC. Conclusions Our findings suggest that the PIN programme was cost-effective at a relatively low willingness-to-pay threshold when compared to SAU. This study addresses a significant knowledge gap in the field of early intervention by providing important real world evidence on the implementation costs and cost-effectiveness of a universal early years parenting programme. The challenges involved in assessing the cost-effectiveness of preventative interventions for very young children and their parents are also discussed. Trial registration ISRCTN17488830 (Date of registration: 27/11/15). This trial was retrospectively registered.

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Section: Discussionmentioning

confidence: 99%

A cost-effectiveness analysis of a universal, preventative-focused, parent and infant programme

Crealey,

Hickey,

McGilloway

2024

BMC Health Serv Res

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“…The variability in approaches (for example, the use of either top-down or bottom-up methods (a topdown approach to unit costing assembles all the relevant expenditure of providing a placement and divides this by the number of children in receipt of that type of placement. A bottom-up approach identified all of the constituent parts of the delivery of a service (i.e., placement) and assigns a value to each)) and what components have been included in unit costs makes comparisons difficult [37], although some sources do distinguish between local authority provision and the for-profit sector. However, like-for-like comparison of the costs of residential placements by different providers has been an ongoing point of contention.…”

Section: Costsmentioning

confidence: 99%

“…The most recently published unit costs [39] indicate the opposite of the findings from Hicks et al (2009), reporting a higher weekly unit cost for local authority residential care (GBP 5045) [USD 6340] than for private and voluntary homes (GBP 4332) [USD 5444]. The fundamental issue with these comparisons between providers is that without necessary transparency in the calculations and assumptions underpinning the calculations, it is impossible to determine whether the differences are real or just a result of different methodologies [37].…”

Section: Costsmentioning

confidence: 99%

Charting the 21st Century Rise of For-Profit Residential Child Care

Sen,

Ulybina,

Holmes

2024

Youth

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This article explores the increasing prevalence of for-profit residential care, with a particular focus on Great Britain, while also drawing on the international evidence from the Global North. Comprising a critical review of the published evidence (both academic and grey literature), the article seeks to examine what might explain the rising prevalence of and the possible associated impacts of the increase in for-profit provision. The findings indicate that the rise of for profit-companies among residential child care providers appears to have occurred by default, rather than explicit policy design. Our analysis also highlights gaps in the knowledge base about the quality of care and whether better quality is associated with the type of provider. Furthermore, the relationships between provider, quality, cost and outcomes are unclear. There are inconsistencies in the evidence base, with different conclusions being reached. However, available evidence tends to suggest the increased prevalence of for-profit residential child care providers has had an overall negative, rather than positive, effect. The best case in favour of the continued use of for-profit residential care is currently a non-moral pragmatic one: that in countries with medium and high prevalence of the use of residential child care, it would be hard to sustain care systems if for-profit providers were to suddenly withdraw or be withdrawn.

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“…9 46 47 54 56 Conventional LSW interventions are costly, 43 45 48 52 tend to focus on younger children with care-experience [54][55][56][57][58] and, like other interventions in children's social care, lack focus on the longer-term impact and attributable outcomes. 59 Adolescent-focused low-intensity LSW interventions have the potential to improve the mental health of Open access adolescents with care-experience. 55 However, there is a clear need for research capable of building theoretically rich explanations of how low-intensity adolescentfocused-LSW works.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…LSW is a widely accepted and currently used intervention which is assumed to promote mental health, but its’ evidence-base is limited 9 46 47 54 56. Conventional LSW interventions are costly,43 45 48 52 tend to focus on younger children with care-experience54–58 and, like other interventions in children’s social care, lack focus on the longer-term impact and attributable outcomes 59…”

Section: Introductionmentioning

confidence: 99%

Improving the mental health and mental health support available to adolescents with social care-experience via low-intensity life story work: a realist review protocol

et al. 2022

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IntroductionAdolescents are the fastest growing group entering social care and are most at risk of mental ill-health. Life Story Work (LSW) is an existing transdiagnostic intervention thought to improve the well-being and mental health of children and adolescents under the care of a local authority by assisting the processing of trauma. Yet LSW is poorly evidenced, lacks standardisation and focuses on younger children. LSW is also high-intensity, relying on specialist input over several months. Adolescent-focused low-intensity-LSW is a promising alternative. However, there is poor evidence on how LSW, let alone low-intensity-LSW should be delivered to adolescents. We aim to identify why, how, in what contexts, for whom and to what extent low-intensity-LSW interventions can be delivered to adolescents with care-experience.Methods and analysisUndertaking a realist review, we will: (1) develop an initial programme theory (PrT) of adolescent-focused low-intensity-LSW by consulting with two key expert panels (care-experienced and professional stakeholders), and by searching the literature to identify existing relevant theories; (2) undertake a comprehensive literature search to identify secondary data to develop and refine our emerging PrT. Searches will be run between 12/2021-06/2022 in databases including MEDLINE, PsycINFO, ASSIA and relevant sources of grey literature; (3) select, extract and organise data; (4) synthesise evidence using a realist logic of analysis and undertake further iterative data searching and consultation with our expert panels; (5) write up and share the refined PrT with our expert panels for their final comments. From this process guidance will be developed to help improve the delivery of LSW to support the mental health needs of adolescents with care-experience.Ethics and disseminationEthical approval is not required. Dissemination will include input from expert panels. We will develop academic, practice and youth focused outputs targeting adolescents, their carers, social, healthcare, and educational professionals, academics, and policymakers.PROSPERO registration numberCRD42021279816.

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A critical review of cost‐effectiveness research in children's social care: What have we learnt so far?

Abstract: Article (Accepted Version) http://sro.sussex.ac.uk Suh, Ellie and Holmes, Lisa (2022) A critical review of cost-effectiveness research in children's social care: what have we learnt so far? Social Policy and Administration. pp. 1-15.

Cited by 12 publications

References 40 publications

A cost-effectiveness analysis of a universal, preventative-focused, parent and infant programme

A cost-effectiveness analysis of a universal, preventative-focused, parent and infant programme

Charting the 21st Century Rise of For-Profit Residential Child Care

Improving the mental health and mental health support available to adolescents with social care-experience via low-intensity life story work: a realist review protocol

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