A collection of essays by two researchers who were at the heart of the UK’s first outcome-driven child care assessment program in the 1990s shows how far, how fast – and otherwise – the theory and practice of designing children’s services have developed during the past decade.
Jane Scott and Harriet Ward were part of the Department of Health team that introduced to the UK system the Looking After Children program, which prepared the ground for more recent attempts to establish a
Common Assessment Framework [1].
Their experience parallels the gradual awakening of children’s services professionals and practitioners in the UK to the importance of measuring need, innovating in service design and evaluating the effectiveness of interventions.
Scott and Ward’s trawl through the literature retraces the journey in relation to four themes. First is the measurement of need, which has improved in recent years in relation to individual assessments but remains relatively primitive at the aggregate level.
Much that goes by the name of 'need audit' fails to measure need. It might capture what provision exists, or the extent of unfulfilled demand, or what consumers think of services, or levels of socio-economic deprivation, but it is rare to find a more holistic picture of the type and severity of the needs of a child population. Even in this collection, a chapter that is avowedly on evidence of need is essentially an analysis of poverty and its impact on children’s life-chances.
Next the editors deal with the features of effective services, concentrating on what is sometimes called 'thick' provision. In the past much has been 'thin' – low level advice, information and support given to families on a one-off or ad hoc basis lacking explicit consideration of its likely impact on outcomes. Here, several chapters discuss 'thick' services, which are by contrast coherent, long-term and intensive, targeted at discrete groups and underpinned by strong logic about why they will achieve specified outcomes.
Aspirations to 'thickness' bring with them the challenge of specifying what services actually do. For every detailed description of the what, where, when, why of a service there will be many more that are vague, confusing to users, inconsistency in terms of what they provide and impossible to evaluate. This applies, for example, to many parenting supports.
Yet as US researchers Richard Barth and Amy Price here point out, being overly specific can alienate users; there is a tension between prescriptiveness and acceptability. Geoffrey Nelson usefully cuts through some of the confusion based on a review of 56 controlled evaluations.
A third theme concerns innovation in service design. Often there is a polarisation between top-down, expert-conceived program and bottom-up, community-based initiatives. Because marrying the two perspectives can be difficult, there is a need for more accounts of the attempts. Here, Michael van Beinum and colleagues describe the development of a specialist mental health service for children in care but they focus more on the rather predictable contextual difficulties (funding shortages, re-organisations etc.) than on the method
The fourth theme is evaluation. Without question we are seeing the bar being raised in this area. As Barth and Price put it, "Without a portfolio of rigorous evaluation results to display, selling new program models is increasingly difficult." Yet it is still rare in the UK for services for children to be tested using experimental methods.
A broader issue is that of monitoring outcomes. Mark Friedman and colleagues describe how measures were selected in one English local authority, while in a concluding chapter Jane Scott and colleagues emphasize the potential for aggregating data collected on individuals. Agencies routinely struggle in this area, so these chapters should be particularly helpful.
Until recently the concept of 'well-being' was conspicuous by its absence in discussions in children’s services (Jordan, 2006). Yet as Gillian Pugh demonstrates, while trends in recent years show a pattern of overall improvement, there has been a deterioration in important areas (eg. obesity, homelessness, drug misuse). This book shows where we have come from and how much further we need to travel on the road to a research-based, outcome-focused children’s services system capable of enhancing children’s well-being.
references
Jordan, B. (2006) "Well-being: the next revolution in children’s services?", Journal of Children’s Services 1 (1), 41-50.
Nick Axford
Dartington Social Research Unit
• Safeguarding and Promoting the Well-being of Children, Families and Communities by Jane Scott and Harriet Ward (Eds), London, Jessica Kingsley, 2005
304pp ISBN 1 84310 141 6 £39.99 (hardback)
Links:
[1] http://www.everychildmatters.gov.uk/deliveringservices/caf/