Nationwide Children's Research Centre University of Huddersfield North East Region Sure Start Seminar Sure Start Bramley : An approach to analysing cost-

Nationwide Children's Research Centre University of Huddersfield

North East Region Sure Start Seminar

Sure Start Bramley: An approach to analysing cost-effectiveness including home visiting / client contact services

Programme Manager: Judy Bakes

Evaluators: Brid Featherstone

Martin Manby


Sure Start Bramley - Cost Effectiveness

• difficult for non-economists to get started !

• three phases

(i) 2003 focus on VFM

(ii) 2004 focus on benefits side of equation

(iii) 2004 focus on costs side of equation

• small element in total evaluation activity


Sure Start Bramley

An essay in Cost Benefit AnalysisStage 1

Value for Money 2003

ɡ a tentative start!

갘 Reservations about applying cost effectiveness measures to Sure Start

辸 Local parents occupy multiple roles as clients, members of groups, being involved in community organisation, and as contributors

䜳 partnership arrangements, e.g., seconded health visitor one day per week, provides direct service benefits to clients, and indirect benefits (closer working links with Sure Start, promoting joint work on supporting mothers’ experiencing post natal depression and on smoking cessation) - valuable but not easily costed.


Sure Start Bramley

Value for Money 2003

Context• SSB budgets fixed in 2001 for 8 years with little scope for variation

Principles• transparent approach to funding issues (£) - including SLAs• staff, parents and partner agencies expected to be well informed about £• delegating financial responsibility

- SS Outreach Team produce costed proposals for all initiatives

- training for parents on accounting procedures and using bank accounts

- Parents’ Development Fund (£10k p.a.)• partner agencies expected to contribute to new service development e.g. PCT

contribution to PND groups


Figure (i)

Sure Start Bramley: a Budget aware organisation

Fixed budget limited funding opportunities transparent funding

impact on whole SSB organisation

Partnerships and Service Sure Start Staff ParentsLevel Agreements

Partner organisations all staff understand budget consciousunderstand SSB funding importance of budgets parents with improved

Budget conscious costed proposals managing Parents'community organisations required for all initiatives Development Fund

Sure Start Bramley: VFM Summary


Sure Start Bramley

Stage 2

• Focus on benefits, to service users, involving outreach staff

• Case studies, analysing - presenting problems

- resources within the family

- inputs from Sure Start

- outcomes

- levels of work (Hardiker Grid)

• Issues / problems arising in translating benefits to services users into £

• Cost of Sure Start input (salary and on-costs)


_____________________________________________________________________

Level 1:Available for all children and families

_______________________________________________________

Level 2:Children and Families needing extra support

___________________________________________

Level 3:Children and Families needing

intervention

___________________________

Level 4:Children and

Families in crisisneeding urgentand/or intensive

intervention

Hardiker Grid - Level of Problem


Sure Start Bramley

Case Example A - Outreach Worker 6 (OR6) (Male Worker)

Length of Contact: 7 months

Presenting Issues

In this family, a mother and her one-year old child moved to Bramley from another part of country, experiencing isolation,

post-natal depression and housing problems.

Resources within the Family

Although separated, mother had access to a supportive former partner who remained involved with his son. M had good

parenting and child care skills.

Inputs from Sure Start

Intensive weekly then fortnightly visits by OR6, plus supportive telephone calls. OR6 had an advocacy role, regarding

housing, utilities, benefits. Health Visitor, GP and Home Start involved.

Outcomes

Effective help with housing and financial problems. M became less isolated and overcame post-natal depression. M

developed a network of friends and her son was introduced to Mother and Toddler groups. M more aware of local facilities

and planning to obtain a job.

Hardiker Grid: Level 2


Sure Start Bramley

Problems in costing benefits

• attribution

• difficult to cost benefits of M’s developing social network

• M resilient, may have “recovered” without support

£ able benefits

• debt reduction

• housing obtained

• M ready to work, becoming contributor to local economy

Costs (crude) of OR6’ help for this family (Case A)

£833 based on salary £20k; 1/2 time allocated to one to one support; 7 months input; one seventh of caseload.

£1499 based on same proportion of salary x 1.8 to include total on-costs.


Sure Start Bramley

Case Example B - Outreach Worker 2 (OR2)

Length of Contact: 14 months

Presenting Issues

Mother and five children aged 8 months - 12 years with multiple problems; mother had experienced DV, alcohol problems

and possibly learning difficulties. Daughters aged 2 years and 8 months overweight. Serious non-school attendance for

older children. Son 5 had speech delay. Daughter 8 seemed withdrawn at school. Daughter aged 12 much involved in

supporting mother. Gaps in ante-natal care, health checks and immunisation. Children neglected.

Resources within the Family

M loved her children and bonded with them. M had eventually accepted that she needed support. 12 year old daughter

very helpful.

Inputs from Sure Start

OR2 visited twice weekly for a year. Had regularly taken daughter aged 2 to nursery. OR2 had successfully involved a

range of agencies to support the family. Liaison with Education welfare; School Nurse; Learning Mentor; Social Services

(Family Aid); Speech and Language Therapist; Health Visitor; Children’s Centre and Police. SSB Play Workers visiting the

family fortnightly.

Outcomes

Mother persuaded to attend Health Clinic for ante-natal care. Immunisation for five children obtained. OR retained focus

on child safety issues in the home. Problems with benefit forms resolved. Daughter aged two attending nursery regularly.

Ongoing school attendance issues. (Hardiker Grid: Level 3)


Sure Start Bramley

Problems in Costing benefits

• difficult to cost benefits of liaison work / improving home safety, preventing accidents

• major problems of attribution of benefits to multiple agencies

£able benefits include

• benefits of ante-natal care

• benefits to F2 of attending nursery

• benefits of play for younger children

• long term benefits of immunisation for five children

Costs of OR2’s help for this family(Case B)

£2717: based on salary £23k; 1/2 time allocated to casework; 14 months input; one seventh of caseload (£1917) plus 2 playworkers - salaries £32000, one session (out of possible 10) x 6 months fortnightly visits (£800).

£4891 based on same proportion of salaries x 1.8 to include total on-costs


Level of Work (Hardiker Grid)

0

10

20

30

40

50

60

70

80

90

Num

ber

Level 1

Level 1.5

Level 2

Level 3

Level 4

File Review


Stage 3

Bench Marks for costs of Home Visiting

(NESS Website March 2004)

Barton, Treadworth and SS Involvement Worker 20.73White city (Glouster) SS

SS Child Counsellor 36.26

North East SS (detailed explanation) 159.49

Sure Start Weir Valley (no calculations) 42.00

Sure Start Thornhill (visits include all contactswith source users) 60.00

Sure Start Bramley


Meadows (2001) Costs of Home Visiting (Health Visiting Service):Simplified

£

Salary Cost 10,000.00

National Insurance and Superann. 2,500.00

Support/rent/overheads 6,184.00

Total costs per home visitor 18,684.00

Number of week worked per year 42

Average no. of visits per week 15

Number of visits per year 630

Average Cost per visit 31.66


Variations on Meadows' model

Salary too low: assume £20,000 plus on costs (x 1.8) £36,000.00

Assuming no. of visits remained fifteen per week cost per visit would be £55-60

Key variables: salary and number of visits


Home Visits / Contacts

It was agreed that the Sure Start Bramley definition

should include home visits; telephone contact which

included a substantial element of assessment or

support; and contact with the service user in a group

work or similar setting which contributed to their

support.

Identifying the Unit of Service


Sure Start Bramley

Costs per Contact

Year 2002 / 03

No. of children seen: 1588

No. of parents seen: 1519

Total 3107

Actual Costs

Outreach / home-visiting £153,600

Management costs - 20% £ 30,720

Total £184,320

Cost per contact £ 59.32


Sure Start Bramley: Explanatory notes for costs per contact

Outreach/home visiting (£153,600) includes salary, NI and superann: costsfor 0.5 Programme Manager, 0.5 Deputy Programme Manager and 5 FTEoutreach workers

Management costs (£30,720) include 5/12s administration, finance, buildingand running cost.

Salary cost for 5 outreach workers are about £105,000 out of a total ofreckonable costs of £184,320, - similar proportion to Meadows.

Where children and parents are seen together, both contacts are treated asunits of service.

If they were treated as the same unit of service, costs per contact would besignificantly higher.


Sure Start Bramley: costs of other services

Bramley Family Support

Year 2002 / 03

No. of children seen: 1480

No. of parents seen: 1268

Total 2748

Bramley Home Start

Year 2002 / 03

No. of children seen 173

No. of parents seen 142

Total 315

Actual Costs: £131,000

Cost per contact: £ 47.67

Actual costs: £22,282

Cost per contact £70.73


Sure Start Bramley

Notes on costs of other services

Bramley Family Support

• Voluntary sector project, run by Spurgeon’s Children’s Charity

• Provides variety of group care / parents and toddler groups and creche facilities

Bramley Home Start

• Weekly intensive visits by volunteers for families with children under 5

• Include (fairly high) training costs for volunteers


Sure Start Bramley - Cost Effectiveness

Position reached / next steps

• links to other work on VFM / budgets

• involve professional staff and focus on benefits

• SS Team more financially aware - new focus on importance of ending involvement

• next stage: refine calculations - compare costs of group work and one to one support; CB analysis of S S Bramley drop-in and advice service

• intensive support services vulnerable to crude CBA calculations


Length of Contact with Outreach team

0

5

10

15

20

25

30

Per

cent

age

Up to 1 month

1 - 3 months

4 - 6 months

7 - 12 months

1 - 2 years

2 years plus

File Review

Documents

Nationwide Children's Research Centre University of Huddersfield North East Region Sure Start Seminar Sure Start Bramley : An approach to analysing cost-