@theEIFoundation eif.org.uk Ann Griffiths Early Intervention Foundation Weds 15 July 2015 Smarter Funding: Better Outcomes West Suffolk.

@theEIFoundation eif.org.uk

Ann Griffiths Early Intervention FoundationWeds 15 July 2015

Smarter Funding: Better Outcomes

West Suffolk

@theEIFoundation | eif.org.uk

• Who EIF are and what we do• Why outcomes and evidence matters• Demonstrating impact• Things to consider• Sources of advice

Today

@theEIFoundation | eif.org.uk

Who we are…

An independent charity and a ‘What Works’ Centrelaunched on 4th July 2013 with a mission to promote Early Intervention to:

• Tackle the root causes of social problems

• Improve children’s life-chances, breaking the often intergenerational cycle of disadvantage

• Reduce the cost of failure to the taxpayer

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What we do…

Assess - what works – to determine both the best early interventions available and their relative value for money

Advice - to commissioners, providers and investors on the best practical, evidence-based measures, enabling them to make the best choices to support children and families

Advocate - for early intervention as a serious alternative to the more widespread expensive and ineffective late intervention

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Why do outcomes and evidence matter?

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Adverse childhood experiences

• Abuse, neglect, growing up in household with alcoholism, drug abuse, domestic violence can lead to:

high levels of heart, liver, lung disease, obesity, diabetesdepression, suicide, poor work prospectsalcoholism, drug addictiondisorganised attachment, aggression, violence, criminalitypoor educational performance

• 68% of prison population was abused or neglected in childhood

• Peak age for child abuse, neglect is 0-1

Blackburn with Darwen (2012)Adverse Childhood Experience (ACE) & Adult Health Outcomes

Pregnant or got someone accidently pregnant Under 18 x 4.5 Liver or digestive disease x 2.3

Stayed overnight hospital in last 12 months x 1.5Had a sexually transmitted infection x 30.6

Morbidly Obese x 3.02Heroin or Crack user x 9.7

Regular Heavy drinker x 3.7Been hit in last 12 month x 5.2

Hit someone last 12 months x 7.9Been in prison or cells x 8.8

Increased risk (adjusted odds ratio) having health behaviours and conditions in adulthood for individuals experiencing four or more ACEs in childhood.

The Effects of Weaknesses in Oral Language on Reading Comprehension Growth (Hirsch, 1996)

5 6 7 8 9 1011 12 13 14 1516

16

15

14

13

12

11

10

9

8

7

6

5

Readin

g A

ge

Level

Chronological Age

Low Oral Language in Kindergarten

High Oral Language in Kindergarten

5.2 years difference

@theEIFoundation | eif.org.ukWHY EARLY INTERVENTION? EXPLORING THE EVIDENCE

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• The most common childhood mental health difficulties are conduct problems• A very high proportion of those who have the

most serious conduct problems during childhood will go on to become involved in criminal activity• The best intervention programmes can

reduce offending by 50% or more• Effective help for parents and families to

prevent and manage conduct problems is extremely good value for public money

Some further examples: crime

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Social and Emotional Learning Review

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In order to be able to improve how well people can do in life and how happy and healthy they are, we need to understand what works.

And local service commissioners, and government, need to know they are using reducing and scarce resources effectively and efficiently.

Important for everyone involved – service user knows they are getting a good service, practitioner/provider knows what’s working and what to improve, commissioner and government get good value and make impact…

Outcomes really matter!

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Demonstrating Impact of Early Intervention

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Data…HOW WELL ARE EI SERVICES WORKING?

Customer satisfaction ratings

Number of hits on early help webpage hub Number of young people seen in group work

Number of unique users of early help webpage hub

Outreach sessions offered

Number of two year olds accessing provision through the two year old funding

Number of families attached to the Troubled Families Programme

Number of Early Help Assessments (CAFs) initiated

Number of families on Troubled Families Programme for whom outcome payment is achieved

Percentage of EH Assessments that are multi-agency

Average sick days per FTE in EI teams

Number of Early Help Assessments closed where all outcomes have been met

Percentage appraisal completion in EI teams

Percentage of assessment audits completed and judged as good or better

Number of referrals into MARAC

Number of children under 5's who are receiving a targetted Early Intervention.

Percentage of Childrens' Centres rated as good or outstanding in OFSTED

Teenage parents who are receiving a targetted Early Intervention

Number of step downs from Social Care to Early Help

Lone parents who are receiving a targetted intervention

Number of re-escalations from targetted early intervention services to Social Care

Number of 5-19s receiving a targetted early intervention

Percentage of parents completing parenting programmes

Targetted Interventions with an SDQ outcome of 4 or higher

Number of staff trained in domestic abuse awareness

Quality and quantity

measures of activity / processes

Quality of targetting

More measures

of activity – within

services

Quality of activity

measures

A few short-term,

‘immediate’ outcomes

Target Populati

on

Quality of

targetting

Input Output

Immediate /

intermediate

outcome

Ultimate outcome

Counter-factual

Who are you

trying to reach?

(Who is it specificall

y that you want

to achieve these

outcomes?)

How well are you reaching

the people you are trying to reach?

What resource is going

into providing

the services/ activities aiming to achieve

the outcomes

?

(£, FTE, buildings)

What activities

are happenin

g?

(Consider quality

and quantity measures

)

What short term

results are seen

soon after

delivery, that are

preconditions of

ultimate outcomes

?

What are your long

term, final

outcomes aimed at?

(Where are you

ultimately trying to get to?

Include £ for CBA)

How can you prove

(or estimate)

that these results

wouldn’t have

happened anyway?

Young people

under 18 that are at

risk of entering

the youth justice system

% YP identified by police data as at risk, who

are worked

with

Service Manager

Advanced Practitioner

Substance misuse workers

Youth Worker

Police staff

Annual training budget

No of YP identified at risk of offending

No of YP allocated for 1-1 work

1 to 1 sessions

Group sessions

Other activities, e.g. training

Referrals to other services

% of YP who increased engagement with EET

% of YP who reduce their risk taking behaviour

% of YP who reduced their offending behaviour

% of YP with increased health and well-being

Young people do not enter the youth justice system – sustained positive behaviour for those who have been through the service

Reduced youth offending rates

National and regional data is available for comparisons

Data available for outcomes before the service was in place

National and regional

data is available for comparison

Historic local data

Young people

under 25 years with a

drug or alcohol issue

Proportion of YP with a problem reached (YP substance misuse needs assessment)

Service Manager

Substance misuse workers

Annual training budget

% staff qualified

No of referrals into the service

No of YP in treatment

No of brief or extended interventions carried out

No of YP discharged from the service

% of YP with a planned discharge

% of YP discharged as drug free or occasional user

% of YP who re-present for the service within 6 months

Young people

remain drug or alcohol

free or occasional

users

Local 0-19 population

with specific needs as

defined by EH

assessment threshold – e.g. teenage

parents

Measures of how many

people within the defined cohort have

been reached by services –

e.g. % of teenage parents

receiving support (and

how that compares to

estimated need)

£ and FTE spend on the interventions

Quantity of activities, e.g.

One to one support work sessions held

Number of Parenting classes and attendance

Quality measures, e.g.

Number of staff trained

Audits rated as good or better

Parents reporting improved parenting

skills/confidence

SDQ scores

Sustained Improvement

in CAF specified

outcomes

Reductions in re-referrals to acute services

Improved outcomes for Children and

Young People, e.g.

Improved attainment

Reduced NEET rates

Reduced LAC and CP inflow

Reduced obesity

Reduced YO entrants and

repeatsReduced DV

rates and repeats

Target Population

Quality of targetting Input Output

Immediate outcome

Ultimate outcome

Counter-factual

Comparison to outcomes for children and

young people with similar

needs in previous years,

or similar areas?

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• Impact is the difference between outcomes measured and those that would have happened anyway – ‘counterfactual’ is vital

• How you choose to measure outcomes matters• Reliable, valid, tested, fit for purpose tools

• Lots of information on costs out there, e.g. unit cost database and CBA model – demonstrating CBA makes a strong case

Points to consider

@theEIFoundation | eif.org.uk

Organisations or projects where you'll be able to both deliver a social impact, which can be clearly defined and measured, and pay back financially.

There are benefits: • Investors are interested in social outcomes as well as financial• Flexibility about approach • ‘Hands-on’ support and capacity building• Focus on outcomes and rigour in measuring impact• The money gets 'recycled' • May be a better deal because of government help for social investors

And also challenges:• may be complicated or take a while to achieve• for some things, high street bank or government grant are still the way forward

Thinking about social investment?

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What does all this help add up to?

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Helping understand What Works: the EI Guidebookwww.guidebook.eif.org.uk

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Programmes Search Tool

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Ineffective/harmful

Consistently effective

Effective

Theory based

Unspecified

Potentially effective

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0 1 2 3 4

Description of evidence

Non-existent Consistently Effective

Formative Initial Established

Description of programme

Unspecified Theory-Based

Potentially Effective

Effective Consistently Effective

Evidence or rationale for programme

No logic model, testable features, or current evidence of outcomes or impact

Logic model and testable features, but not current evidence of outcomes or impact

Lower-quality evaluation (not RCT or QED) showing better outcomes for programme participants

Single high-quality evaluation (RCT/QED) with positive impact

Multiple high-quality evaluations (RCT/QED) with consistently positive impact across populations and environments

Recommendation for commissioner or provider

Develop logic/measurement model

Track performance and outcome

measures

Pilot and evaluate rigorously

Commission and evaluate

Take to scale (subject to local feasibility and appraisal)

STAGES IN IMPROVING EVIDENCE

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Some sources for more info: Evaluation

• Proving and Improving: a quality and impact toolkit for social enterprisehttp://www.proveandimprove.org

• Tools and Resources for Assessing Social Impacthttp://trasi.foundationcenter.org/

• The Better Evaluation Frameworkhttp://betterevaluation.org/plan

• The Social Return on Investment Networkhttp://www.thesroinetwork.org/

• Unit Cost Database and CBA model http://data.gov.uk/sib_knowledge_box/toolkit

• A guide to impact assessment within volunteer involving organisationshttp://www.chances4volunteering.org/wp-content/uploads/2010/04/Goldstar_ImpactAssesmentGuide.pdf

• Basic Guide to Outcomes-Based Evaluation for Nonprofit Organizations with Very Limited Resourceshttp://managementhelp.org/evaluation/outcomes-evaluation-guide.htm

• The Magenta Bookhttps://www.gov.uk/government/publications/the-magenta-book

• Evaluation: Measuring What Workshttp://www.nigms.nih.gov/Research/Evaluation/Pages/default.aspx

• User Friendly Handbook for Project Evaluationhttps://apps-spisu.sws.iastate.edu/resources/view/id/50

• Handbook on Impact Evaluation: Quantitative Methods and Practiceshttps://openknowledge.worldbank.org/handle/10986/2693

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Some sources for more info: Social Investment Big Society Capital, including funds currently open to organisations looking for investmenthttp://www.bigsocietycapital.com/open-funds Social Investment Business and Big Lottery Fund ‘Big Potential’ website http://www.bigpotential.org.uk/ – overview of SI, including guidance http://www.bigpotential.org.uk/resource/social-investment-guide

Knowhow Non-profit ‘Social Investment Made Simple’ http://knowhownonprofit.org/funding/social-investment-1

Access, the foundation for social investment http://access-socialinvestment.org.uk/ - provide support for charities and social enterprise at early stage of development Cabinet Office Centre for SIBs ‘Knowledge Box’ http://data.gov.uk/sib_knowledge_box/home

Commissioning Better Outcomes and Social Outcomes Funds https://www.biglotteryfund.org.uk/sioutcomesfunds

Directory of SIB Service Providers http://sioutcomesfunds.socialfinance.org.uk/directory-sib-service-providers

Bridges Ventures, including Practitioner’s Guide to Choosing SIBs http://www.bridgesventures.com/wp-content/uploads/2014/12/SIB-report-SINGLES.pdf

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Email: [email protected]: 020 3542 2481www.earlyinterventionfoundation.org.ukTweet @TheEIFoundation

You can contact me [email protected] @anngriffx

Contact the Early Intervention Foundation