Evidence-based policymaking:Seeking to do more good than

harmHelen Jones

Professional Adviser

Or…how research informed the development of Multidimensional Treatment Foster Care (MTFC) in

England

Research, policy and Practice Relationships in England

• Funded, thematic programmes commissioned by DH and DFES:

* child protection

* supporting parents

* residential care

* adoption

* synthesis of foster care studies

* adoption

Research 2

• Office for National Statistics: The mental health of children in England

• Office for National Statistics: The mental health of young people looked after by local authorities in England

Dissemination Process

• Research into Practice

• Making Research Count

• SCIE

• Dissemination seminars

• Looking After Children, Assessment Framework, the Cost Calculator

Looked After Children

If concern, hard work, effort could make a difference then outcomes for looked after children would already be wonderful.

So why aren’t they?

Difficulties of using an evidence base in child welfare

• Lack of trials

• Increasing difficulties in accessing a sample (consent issues)

• Length of time to develop new interventions

• Length of time to generate system change

• Investment

• Political realities

Study 1:Children’s Homes- A Study in Diversity

• How to explain the very different outcomes for children living in apparently very similar children’s homes?

• Are the variations to do with resources?

Sinclair and Gibbs

1998

Key conclusions

• Homes likely to do well if

- they were small

- head of home felt roles were clear and s/he

had sufficient autonomy

- staff agreed how home should be run

• But also found a lot of individual misery and

….also concluded that

• Homes should only be used if they had a specific therapeutic purpose and e should look to the newer American models of treatment foster care as a more effective alternative for young people with the highest levels of need.

Study 2:ONS survey of the mental health of looked after children

Prevalence of mental disorders among 5 -10 year olds:private household and looked after children

Prevalence of mental disorders among 5 -10 year olds:private household and looked after children

11%

3%

37%

5%

11%

2%

0

10

20

30

40

50

Emotional disorders Conduct disorders Hyperkinetic disorders

Looked after children Private household children

Prevalence of any mental disorder oflooked after children by age and sexPrevalence of any mental disorder oflooked after children by age and sex

50%

33%

55%

43%

38%40%

0

10

20

30

40

50

60

5-10 year olds 11-15 year olds 16-17 year olds

Boys Girls

P re v a le n c e o f a n y m e n ta l d is o rd e r a m o n glo o k e d a f te r c h i ld re n b y ty p e o f p la c e m e n tP re v a le n c e o f a n y m e n ta l d is o rd e r a m o n glo o k e d a f te r c h i ld re n b y ty p e o f p la c e m e n t

9%

33%

7%

20%

28%

7%

18%

56%

8%

15%

46%

3%

0

10

20

30

40

50

60

Foster carer Birth parents Residential care Indep. Living

Emotional disorders Conduct disorders Hyperkinetic disorder

Prevalence of conduct disorder oflooked after children by age and sexPrevalence of conduct disorder oflooked after children by age and sex

44%

27%

45%

35%32%

28%

0

10

20

30

40

50

60

5-10 year olds 11-15 year olds 16-17 year olds

Boys Girls

‘Seize the day’

• And the magic ingredient was…….

A comprehensive spending review!!!!

INTRODUCING THE MTFC MODEL INTO LOCAL AUTHORITIES IN

ENGLAND (1)Purpose

• To increase capacity for effective evidence based interventions with this group of CLA

• To evaluate whether this model could be successfully implemented into England

• To determine what additions/adaptations might be needed to take account of legal and cultural differences

INTRODUCING THE MTFC MODEL INTO LOCAL AUTHORITIES IN ENGLAND (2) (continued)

Four rounds funded over 4 years, now 19 teams in total

• Successful applicants were expected to show– Existing joint planning arrangements across social care,

health, education and youth justice services– Commitment and capacity to sustain programme

beyond pump priming stage– Strong links with fostering systems– Understanding of and commitment to

the MTFC model

REFERRALSReferrals received from LA social workersGeneral referral criteria set by DfES recommended targeting young people who are;• aged 10 – 16• have complex and severe emotional or psychological difficulties and/or

– are displaying severe levels of challenging/anti-social behaviour and/or

– self-harming and/or– involved in crime and may be at risk of receiving a

custodial sentence• likely to have had a number of placements or interventions

Teams set their own criteria within these parameters

CURRENT PROGRESS

Successes so far

• Introduction of evidence based model into social care system

• Increased placement and educational stability for young people coming into programme

• Individual successes of graduates from programme

EVALUATION AND AUDIT• Independent evaluation team at Universities of

York (Prof Ian Sinclair, Dr Nina Biehal) and Manchester (Dr Jonathan Green) conducting RCT to evaluate outcomes

• Measure outcomes widely; process, and fidelity

• National team also conducting audit on behalf of teams to collate demographics, costings, assessment information and broad outcome data

• Plan to link with other countries conducting research to share experiences facilitated by OSLC

OPPORTUNITIES• developing an evidence-based effective intervention

• widening options available to children and young people with greatest difficulties

• using the intervention in other contexts

– wider foster carer training

– children and families in the community

– treatment residential care?

– developing MTFC-P