The role and use of cost effectiveness studies for child welfare decision making for both policy and practice

Child welfare services operate with finite resources and need to make decisions about when and how to intervene to produce the best possible outcomes for vulnerable children and their families. This session considers the role... [ view full abstract ]

Child welfare services operate with finite resources and need to make decisions about when and how to intervene to produce the best possible outcomes for vulnerable children and their families. This session considers the role and use of cost effectiveness studies to inform policy and practice decision making.

Over several years the Centre for Child and Family Research, Loughborough University and the Chapin Hall Center for Children at the University of Chicago have been collaborating on a number of research projects to develop an internationally comparable (across the UK and US) conceptual framework, methods and analyses to inform the development of cost effectiveness studies and to provide an evidence base for policy makers and senior child welfare managers to make strategic decisions about whether child welfare practice, or specific interventions offer value for money.

This overview presentation introduces the research background and outlines the different methods that have been used to collect time use data that are used for unit cost estimations. These methods include focus groups, verification questionnaires and web-based surveys and the completion of event records (diaries) by child welfare workers.

The session will consider how knowledge about organisational costs associated with workforce issues, such as the recruitment, retention, training and turnover can be attributed to and associated with specific interventions and working environments. These considerations will encompass not only child welfare case workers, but also foster carers and those working within children’s residential care, thereby covering all workforce components of the child welfare system. Connecting these workforce components, the role- specific efforts, and the outcomes those efforts yield, widens the opportunity to be evidence informed in making both structural and programmatic decisions in systems that seek to improve child and family outcomes.

The presentation will also focus on how the methods and findings to date have been used to inform child welfare policy and practice, and to shape further research into the application of time use evidence into decisions about system capacity and structure. These include:

1) An exploration of the ‘hidden costs’ of service provision such as the different referral and assessment routes to access a range of services and interventions;
2) The costs of the contracting and commissioning processes, and as such the relationship and cost comparisons between public and private agencies in the child welfare system;
3) The proportion of time child welfare workers spend on direct work with families compared to administrative activities, whether this time use can be re-configured, and whether there is a relationship between proportions of time spent and quality of case work;
4) The extent to which outcomes based contracts which are developed to reward strong performance can be structured to reflect practice and policies which are shown to be cost-effective and associated with improved outcomes.
5) Case studies of jurisdictions in the United States which have taken advantage of Title IV-e waivers that allow flexibility in the use of entitlement funds previously available only to offset the costs of out-of-home care. Time use data collected in these jurisdictions may be used to support re-investments of federal and state funding into those case practices and policies that are associated with strong outcomes – including improved prevention as well as more timely permanency.

Taken together, these areas reveal the important ways that the research evidence collected through cost-effectiveness studies can be targeted to promote thoughtful program, policy and practice innovations designed to improve both the structure (the workforce architecture) and the functional components (role-specific work activities) of a child welfare system.