Introduction - The cost-effectiveness of many services is unknown. Because the demand for services is growing, whereas budgets are cut, the issue how to enhance the cost-effectiveness of Child and Youth Care is urgent in day... [ view full abstract ]
Introduction - The cost-effectiveness of many services is unknown. Because the demand for services is growing, whereas budgets are cut, the issue how to enhance the cost-effectiveness of Child and Youth Care is urgent in day to day politics and practice. The NJi developed a working model that helps breaking down this issue into different aspects that - within the financial boundaries - need attention in youth policy making as well as in practice. One element of this model is the use of large databases to monitor the quality of life and the epidemiology of problems and disorders of children and adolescents. Another element is focusing on the ex ante effectiveness (‘what works’) of services and professionals, as well as monitoring their outcome in terms of social impact, drop out, client satisfaction, goal attainment, and significant improvement of functioning. Main assumption of this model is that the cost-effectiveness of policy and practice can be improved by using a quality cycle that is fed with information on epidemiological data, the ex ante effectiveness of services, and the outcome of these services.
Objective –This study was to shed a light on the validity of the assumption of the model.
Method – The model was derived from existing quality cycles that aim to improve professional practices and youth policy, such as ‘Diagnostic and treatment Cycle’ (at the level of the individual professional and client – the primary process), the ‘The Breakthrough Series’ (at the level of teams and organizations), and ‘Communities that Care’ (at the local level of youth policy – the municipality). We studied the literature on the effects of the quality cycles – especially on the outcomes - at the different levels.
Results – Although the quality of many studies is limited, there are clear indications that at the level of the primary process the use of outcome monitoring leads to a better outcome. Hardly any information is available about the effects on the costs. It is possible that costs increase due to the use of monitors and clinical tools, and decrease due to more effective services. Moreover, most studies pertain to adult outpatient health care and may not be representative for the child and youth care. At the level of teams and organizations, there are many anecdotal examples of quality improvements using the Breakthrough Series. A qualitative review performed in 2003 showed that the effects can be impressive, but show a lack of sustainability. Moreover - to our knowledge - the Breakthrough method has seldomly been used to enhance the outcomes of child and youth care at the level of teams and organizations. At the level of the local youth policy, a quasi-experimental study has shown virtually no effect of ‘Communities that Care’.
Discussion – In all, the assumption of the model cannot be validated. The positive results in mental health care may show the reasons why the quality cycle in teams and municipalities may not lead to sustainable improvements. (1) At the team and organizational level improvements may not sustain due to turnover in personnel and staff, and a lack of external incentives to keep the performance high. (2) At the level of local policy, success was only monitored by using epidemiological data. The participating organizations were neither asked to verify the quality of their activities, nor to monitor their outcome in terms drop out, client satisfaction, goal attainment, and function improvement.
More research is needed to investigate the mechanisms of the model. The focus in these studies should be on the importance of incentives and the connection between the quality cycles at the different levels.
Program evaluation and quality in child welfare , Other topics
