The Essex Edge of Care SIB
THE ESSEX EDGE OF CARE SOCIAL IMPACT BOND
The Essex Edge of Care Social Impact Bond (SIB) successfully completed in March 2019. The SIB was the first of its kind commissioned by a Local Authority and focused on preventing young people from entering care.
The SIB provided a multisystemic therapy (MST) service which operated from April 2013 to December 2018, and during that period provided a service to young people (aged 11 to 17) and their families where the young person had significant behavioural problems and was at high risk of entry into care.
The MST service was provided by Action for Children, a national children’s charity, and was funded through a social impact bond provided through the Children’s Support Services Limited (CSSL) investor group, and commissioned by Essex County Council.
Eight investors provided a total commitment of £3.1m to fund the SIB. The financial return for these investors was linked to the success of the programme in helping children remain out of care and safely at home with their families.
Multi-Systemic Therapy (MST), is an intensive evidence-based family therapy, licensed by MST-UK.
• The service worked with 388 young people over the period. 335 young people fully completed MST treatment and at March 2019, 35 young people remained in care.
• The time spent in care by the young people supported by MST was reduced by more than double the rate expected. The cumulative proportion of days spent in care by the young people on the programme, as at March 2019 was 10.8%. The historical comparison group had a care proportion of 55% and the SIB’s target was to achieve a care proportion of 27%. The care proportion is defined as the ‘total care days/total child days’.
• The results from SDQ data (n=171) indicate that following MST involvement there was a significant improvement in the how young people and families felt about difficulties and challenges they experienced. It was noted that there were marked reductions in conduct problems, problems with peers, and an increase in pro-social behaviours.
• Family feedback showed that families were highly satisfied with the support they received from MST, and parents felt that they were able to better manage their child’s difficulties. 48 families (out of 49 families) said they would recommend MST to another family.
• There was a reduction of over 96,000 days spent in care amongst the service users compared to a historical baseline. This represents savings of £17.9m.
• Essex County Council repaid investors on the basis of these care outcomes to the payment cap of £7.2m.
Key learning points
An end of project learning event was held on 14 March 2019 in Chelmsford attended by over 40 stakeholders. The workshop celebrated the success of the project and of the two Essex MST teams. Perspectives on learning from the project were presented by Essex County Council and by Children’s Support Services Ltd (CSSL – the company set up to run the SIB). Researchers from the Rees Centre, Oxford University, presented a summary of their independent evaluation findings. A researcher from Go Lab, Blavatnik Institute presented her early PhD investigation findings about the impact of the SIB. Delegates engaged in a lively discussion of the project. Some of the key points from this event included:
• The SIB achieved its intended outcomes of preventing young people from entering care and optimised benefits for the Local Authority.
• In the current financial climate, it was considered difficult for Local Authorities to invest in new emerging interventions without the help of a SIB or similar scheme.
• The SIB was the first of its kind and therefore involved testing and learning about this approach.
• There were high levels of family satisfaction and families felt better equipped to manage problems and had improved relationships.
• Many young people had continuing needs particularly including mental health needs.
• CSSL via the SIB was able to support innovation and developments in MST, especially in relation to staff training and staff retention. A highly skilled group of staff was developed and retained to the end of the MST programme.
• There was learning about the need for early and extensive involvement of operational services to ensure that the new service intervention was embedded and integrated into local social care practice. Expert programme management is a key requirement of such projects.
• Building up referrals and creating clarity about the referral pathway took longer than expected in the beginning of the project. A reasonable ‘ramping up’ period should be built in and care taken not to over-value early results. .
• There was effective partnership working despite cultural differences between agencies and a collective commitment to work through problems and flex governance arrangements during the course of the project.
• The cultural challenges of implementing a licensed and evidence-based intervention should not be underestimated.
• Rigorous collection of data and data analysis at times felt burdensome but was important for understanding progress of the project and adapting practice to optimise results.
• The SIB payment mechanism was over-complicated and future payment mechanisms should be kept simple.
For the event agenda please click here.
Workshop slides – for the slides that were presented at the event, please see below:
The evaluation report by the Rees Centre, Oxford University, will be published later in 2019.