A comparison of the clinical effectiveness and cost of specialised individually delivered parent training for preschool attention-deficit/hyperactivity disorder and a generic, group-based programme: a multi-centre, randomised controlled trial of the New Forest Parenting Programme versus Incredible Years.
Sonuga-Barke, E. J., Barton, J., Daley, D., Hutchings, J., Maishman, T., Raftery, J., ... & Thompson, M. J. 2018

The objective of this study is to compare the efficacy and cost of specialised individually delivered parent training (PT) for preschool children with attention-deficit/hyperactivity disorder (ADHD) against generic group-based PT and treatment as usual (TAU). This is a multi-centre three-arm, parallel group randomised controlled trial conducted in National Health Service Trusts. The participants included in this study were preschool children (33–54 months) fulfilling ADHD research diagnostic criteria. New Forest Parenting Programme (NFPP)—12-week individual, home-delivered ADHD PT programme; Incredible Years (IY)—12-week group-based, PT programme initially designed for children with behaviour problems were the interventions. Primary outcome—Parent ratings of child’s ADHD symptoms (Swanson, Nolan & Pelham Questionnaire—SNAP-IV). Secondary outcomes—teacher ratings (SNAP-IV) and direct observations of ADHD symptoms and parent/teacher ratings of conduct problems. NFPP, IY and TAU outcomes were measured at baseline (T1) and post treatment (T2). NFPP and IY outcomes only were measured 6 months post treatment (T3). Researchers, but not therapists or parents, were blind to treatment allocation. Analysis employed mixed effect regression models (multiple imputations). Intervention and other costs were estimated using standardized approaches. NFPP and IT did not differ on parent-rated SNAP-IV, ADHD combined symptoms [mean difference − 0.009 95% CI (− 0.191, 0.173), p = 0.921] or any other measure. Small, non-significant, benefits of NFPP over TAU were seen for parent-rated SNAP-IV, ADHD combined symptoms [− 0.189 95% CI (− 0.380, 0.003), p = 0.053]. NFPP significantly reduced parent-rated conduct problems compared to TAU across scales (p values < 0.05). No significant benefits of IY over TAU were seen for parent-rated SNAP, ADHD symptoms [− 0.16 95% CI (− 0.37, 0.04), p = 0.121] or parent-rated conduct problems (p > 0.05). The cost per family of providing NFPP in the trial was significantly lower than IY (£1591 versus £2103). Although, there were no differences between NFPA and IY with regards clinical effectiveness, individually delivered NFPP cost less. However, this difference may be reduced when implemented in routine clinical practice. Clinical decisions should take into account parental preferences between delivery approaches.

A cost-effectiveness analysis of the Incredible Years parenting programme in reducing childhood health inequalities.
O’Neill, D., McGilloway, S., Donnelly, M., Bywater, T., & Kelly, P. 2013

Early onset of behavioural problems has lasting negative effects on a broad range of lifetime outcomes, placing large costs on individuals, families and society. A number of researchers and policy makers have argued that early interventions aimed at supporting the family is the most effective way of tackling child behaviour problems. This study forms the economic component of a randomised evaluation of the Incredible Years programme, a programme aimed at improving the skills and parenting strategies of parents of children with conduct problems. Our results show that the programme provides a cost-effective way of reducing behavioural problems. Furthermore, our cost analysis, when combined with a consideration of the potential long-run benefits, suggests that investment in such programmes may generate favourable long-run economic returns.

A critical review of cost‐effectiveness research in children's social care: What have we learnt so far?
Suh, E., & Holmes, L. 2022

This article presents the findings from a critical review of cost-effectiveness research in children’s social care. With a focus on the past 20 years (since 2000), the review aims to assess the use and consistency of definitions relevant to evaluating cost-effectiveness such as financial input (costs) and outcomes, and to review and summarise learnings from cost-effectiveness studies in the English children’s social care system. We included both academic and grey literature and identified 61 relevant publications for inclusion. The results are organised according to three themes: costs, outcomes and cost-effectiveness. We identified that a large proportion of studies contained a discussion on cost, spend or unit cost, and an equal proportion of articles concerned outcomes of service, benefit to children or quality of service provided. The number of studies discussing cost-effectiveness, cost–benefit or economic evaluation was considerably smaller. The findings highlight substantial gaps in the literature, with a disproportionate focus on stating the problem in terms of cost pressures, and very little robust evidence about cost-effectiveness. Furthermore, the article sets out methodological limitations and indicates a lack of transparency in many of the report studies. We conclude that as a result of the gaps and limitations it is difficult for policymakers and other stakeholders in children’s services to make evidence-informed decisions about the best use of their limited resources.

A pragmatic randomised controlled trial and economic evaluation of family therapy versus treatment as usual for young people seen after second or subsequent episodes of self-harm: the Self-Harm Intervention-Family Therapy (SHIFT) trial.
Cottrell, D., Wright-Hughes, A., Collinson, M., Boston, P., Eisler, I., Fortune, S., . . . Kerfoot, M. 2018

Background: Self-harm in adolescents is common and repetition rates high. There is limited evidence of the effectiveness of interventions to reduce self-harm.Objectives: To assess the clinical effectiveness and cost-effectiveness of family therapy (FT) compared with treatment as usual (TAU). Design: A pragmatic, multicentre, individually randomised controlled trial of FT compared with TAU. Participants and therapists were aware of treatment allocation; researchers were blind to allocation. Setting: Child and Adolescent Mental Health Services (CAMHS) across three English regions. Participants: Young people aged 11–17 years who had self-harmed at least twice presenting to CAMHS following self-harm. Interventions: Eight hundred and thirty-two participants were randomised to manualised FT delivered by trained and supervised family therapists (n = 415) or to usual care offered by local CAMHS following self-harm (n = 417). Main outcome measures: Rates of repetition of self-harm leading to hospital attendance 18 months after randomisation. Results: Out of 832 young people, 212 (26.6%) experienced a primary outcome event: 118 out of 415 (28.4%) randomised to FT and 103 out of 417 (24.7%) randomised to TAU. There was no evidence of a statistically significant difference in repetition rates between groups (the hazard ratio for FT compared with TAU was 1.14, 95% confidence interval 0.87 to 1.49; p = 0.3349). FT was not found to be cost-effective when compared with TAU in the base case and most sensitivity analyses. FT was dominated (less effective and more expensive) in the complete case. However, when young people’s and caregivers’ quality-adjusted life-year gains were combined, FT incurred higher costs and resulted in better health outcomes than TAU within the National Institute for Health and Care Excellence cost-effectiveness range. Significant interactions with treatment, indicating moderation, were detected for the unemotional subscale on the young person-reported Inventory of Callous–Unemotional Traits (p = 0.0104) and the affective involvement subscale on the caregiver-reported McMaster Family Assessment Device (p = 0.0338). Caregivers and young people in the FT arm reported a range of significantly better outcomes on the Strengths and Difficulties Questionnaire. Self-reported suicidal ideation was significantly lower in the FT arm at 12 months but the same in both groups at 18 months. No significant unexpected adverse events or side effects were reported, with similar rates of expected adverse events across trial arms. Conclusions: For adolescents referred to CAMHS after self-harm, who have self-harmed at least once before, FT confers no benefits over TAU in reducing self-harm repetition rates. There is some evidence to support the effectiveness of FT in reducing self-harm when caregivers reported poor family functioning. When the young person themselves reported difficulty expressing emotion, FT did not seem as effective as TAU. There was no evidence that FT is cost-effective when only the health benefits to participants were considered but there was a suggestion that FT may be cost-effective if health benefits to caregivers are taken into account. FT had a significant, positive impact on general emotional and behavioural problems at 12 and 18 months. Limitations: There was significant loss to follow-up for secondary outcomes and health economic analyses; the primary outcome misses those who do not attend hospital following self-harm; and the numbers receiving formal FT in the TAU arm were higher than expected.

A randomized controlled trial and economic evaluation of the Parents Under Pressure program for parentsin substance abuse treatment.
Barlow, J., Sembi, S., Parsons, H., Kim, S., Petrou, S., Harnett, P., & Dawe, S. 2019

Abstract: Background: There is growing interest in the provision of parenting support to substance misusing parents.Methods: This pragmatic, multi-center randomized controlled trial compared an intensive one-to-one parenting program (Parents under Pressure, PuP) with Treatment as Usual (TAU) in the UK. Parents were engaged in community-based substance misuse services and were primary caregivers of children less than 2.5 years of age. The primary outcome was child abuse potential, and secondary outcomes included measures of parental emotional regulation assessed at baseline, 6 and 12-months. A prospective economic evaluation was also conducted. Results: Of 127 eligible parents, 115 met the inclusion criteria, and subsequently parents were randomly assigned to receive PuP (n = 48) or TAU (n = 52). Child abuse potential was significantly improved in those receiving the PuP program while those in TAU showed a deterioration across time in both intent-to-treat (p < 0.03) and per-protocol analyses (p < 0.01). There was also significant reliable change (recovery/improvement) in 30.6% of the PuP group compared with 10.3% of the TAU group (p < 0.02), and deterioration in 3% compared with 18% (p < 0.02). The probability that the program is cost-effective was approximately 51.8% if decision-makers are willing to pay £1000 for a unit improvement in the primary outcome, increasing to 98.0% at a £20,000 cost-effectiveness threshold for this measure. Conclusions: Up to one-third of substance dependent parents of children under 3-years of age can be supported to improve their parenting, using a modular, one-to-one parenting program. Further research is needed.

Cost-effectiveness analysis of a home-based social work intervention for children and adolescents who have deliberately poisoned themselves: results of a randomised controlled trial.
Byford, S., Harrington, R., Torgerson, D., Kerfoot, M., Dyer, E., Harrington, V., ... & McNiven, F. 1999

Background:Little evidence exists regarding the effectiveness or cost-effectiveness of alternative treatment services in the field of child and adolescent psychiatry. Aims:To assess the cost-effectiveness of a home-based social work intervention for young people who have deliberately poisoned themselves. Method: Children aged ⩽16 years, referred to child mental health teams with a diagnosis of deliberate self-poisoning were randomly allocated to either routine care (n=77) or routine care plus the social work intervention (n=85). Clinical and resource-use data were assessed over six months from the date of trial entry. Results: No significant differences were found between the two groups in terms of the main outcome measures or costs. In a sub-group of children without major depression, suicidal ideation was significantly lower in the intervention group at the six-month follow-up (P=0.01), with no significant differences in cost. Conclusions: A family-based social work intervention for children and adolescents who have deliberately poisoned themselves is as cost-effective as routine care alone.

Enhancing adoptive parenting: a cost‐effectiveness analysis
Sharac, J., McCrone, P., Rushton, A., & Monck, E. 2011

Background: Children adopted from care often exhibit behavioural difficulties. There is however limited cost‐effectiveness evidence regarding different interventions to address this. This paper reports a cost‐effectiveness analysis of parenting programmes for these children. Method: Adoptive parents of children aged between 3 and 8 years participated in home‐based, manualised, parenting programmes delivered by trained family social workers. The adopters were randomly allocated to one of two interventions (n=19) or to a ‘services as usual’ control group (n=18). Baseline, immediate post‐intervention and 6‐month follow‐ups were assessed by questionnaires and adopter interviews. Economic costs were calculated. Results: At 6‐month follow‐up, a significant difference (p<.007) was found for ‘satisfaction with parenting’ in favour of the intervention group. No significant differences were found on child measures between the combined intervention groups and control group, adjusting for baseline scores. The mean costs for the combined intervention group were £1528 higher than for the control group at the post‐intervention point, which was statistically significant (95% CI, £67 to £2782). However, over the entire follow‐up period the difference (£1652) was not statistically significant (−£1709 to £4268). The cost‐effectiveness analysis showed that costs of £731 would be incurred to achieve a point improvement in satisfaction with parenting compared to routine care by the end of treatment, whilst the figure was £337 for a point improvement by the 6‐month follow‐up. Conclusions: Findings suggest that a home‐based parenting programme for adopters caring for difficult children in the first 18 months of placement may be cost‐effective in enhancing satisfaction with parenting, but not in reducing child behavioural problems, compared with ‘services‐as‐usual’.

Estimating Children’s Services spending on vulnerable children
The Children’s Commissioner Office 2019

This report provides new estimates of how much is spent on children in specific categories of need and vulnerability across a sample of local authority children’s services departments.The Children’s Commissioner’s Office visited over a dozen LAs between November 2018 and February 2019 to gather evidence from Directors of Children’s Services, elected council members, heads of finance and programme managers on local pressures on children’s services budgets, specifically budgets for high needs and early intervention. The Children’s Commissioner Office then worked closely with nine local authorities to develop a methodology to allocate financial data and produce a set of estimates.The work does not provide a nationally representative picture of demand and spend intended to benefit children in England. The aim was to get a better understanding of the current cost pressures facing councils and then work with local authority children’s services to co-create a common framework and methodology for mapping the level of support and spend on children and to work with a small sample of LAs to use this framework to obtain comparable data.In the absence of a full national dataset on where money goes this study provides an important contribution to the debate on the efficiency, effectiveness and fairness of current funding.

Incredible Years parenting programme: cost-effectiveness and implementation.
Edwards, R., Jones, C., Berry, V., Charles, J., Linck, P., Bywater, T., & Hutchings, J. 2016

Purpose: There is growing interest in the economic evaluation of public health prevention initiatives and increasing government awareness of the societal costs of conduct disorder in early childhood. The purpose of this paper is to investigate the cost-effectiveness of the Incredible Years (IY) BASIC parenting programme compared with a six-month waiting list control.

Mapping the evidence about what works to safely reduce the entry of children and young people into statutory care: A systematic scoping review protocol
Brand, S. L., Morgan, F., Stabler, L., Weightman, A. L., Willis, S., Searchfield, L., ... & Evans, R. E. 2019

Introduction:The increasing number of children and young people entering statutory care in the UK is a significant social, health and educational priority. Development of effective approaches to safely reduce this number remains a complex but critical issue. Despite a proliferation in interventions, evidence summaries are limited. The present protocol outlines a scoping review of research evidence to identify what works in safely reducing the number of children and young people (aged ≤18 years) entering statutory social care. The mapping of evidence gaps, clusters and uncertainties will inform the research programme of the newly funded Department for Education’s What Works Centre for Children’s Social Care. Methods and analysis The review uses Arksey and O’Malley’s scoping review methodology. Electronic database and website searches will identify studies targeting reduction of care entry, reduction of care re-entry and increase in post-care reunification. Supplementary searching techniques will include international expert consultation. Abstracts and full-text studies will be independently screened by two reviewers. Ten percent of data abstraction will be independently conducted by two reviewers, with the remainder being extracted and then verified by a second reviewer. Descriptive numerical summaries and a thematic qualitative synthesis will be generated. Evidence will be synthesised according to primary outcome, intervention point (mapped across socio ecological domains) and the realist EMMIE categorisation of evidence type (Effectiveness; Mechanisms of change; Moderators; Implementation; Economic evaluation). Ethics and dissemination Outputs will be a conceptual evidence map, a descriptive table quantitatively summarising evidence and a qualitative narrative summary. Results will be disseminated through a peer- reviewed publication, conference presentations, the What Works Centre website, and knowledge translation events with policy-makers and practitioners. Findings will inform the primary research programme of the What Works Centre for Children’s Social Care and the subsequent suite

Mapping the evidence about what works to safely reduce the number of children and young people in statutory care: a systematic scoping review
Brand, S., Morgan, F., Stabler, L., Weightman, A. L., Willis, S., Searchfield, L., ... & Evans, R 2018

The increasing number of children and young people entering statutory care in the UK is a significant social, health and educational priority. Development of effective approaches to safely reduce this number remains a complex but critical issue. Despite an increase in interventions, evidence summaries are limited. This study is a scoping review; using systematic searching methods to map published evidence in the area of what works in safely reducing the number of children and young people, under the age of 18 years, entering statutory social care. Including exploring the clusters and gaps of research evidence in this area.

Multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour (START): 5-year follow-up of a pragmatic, randomised, controlled, superiority trial.
Fonagy, P., Butler, S., Cottrell, D., Scott, S., Pilling, S., Eisler, I., ... & Goodyer, I. M. 2020

Background: Multisystemic therapy is a manualized treatment programme for young people aged 11–17 years who exhibit antisocial behaviour. To our knowledge, the Systemic Therapy for At Risk Teens (START) trial is the first large-scale randomised controlled trial of multisystemic therapy in the UK. Previous findings reported to 18 months after baseline (START-I study) did not indicate superiority of multisystemic therapy compared with management as usual. Here, we report outcomes of the trial to 60 months (START-II study). Methods: In this pragmatic, randomised, controlled, superiority trial, young people (aged 11–17 years) with moderate-to-severe antisocial behaviour were recruited from social services, youth offending teams, schools, child and adolescent mental health services, and voluntary services across England, UK. Participants were eligible if they had at least three severity criteria indicating past difficulties across several settings and one of five general inclusion criteria for antisocial behaviour. Eligible families were randomly assigned (1:1), using stochastic minimisation and stratifying for treatment centre, sex, age at enrolment, and age at onset of antisocial behaviour, to management as usual or 3–5 months of multisystemic therapy followed by management as usual. Research assistants and investigators were masked to treatment allocation; the participants could not be masked. For this extension study, the primary outcome was the proportion of participants with offences with convictions in each group at 60 months after randomisation. This study is registered with ISRCTN, ISRCTN 77132214, and is closed to accrual. Findings: Between Feb 4, 2010, and Sept 1, 2012, 1076 young people and families were assessed for eligibility and 684 were randomly assigned to management as usual (n=342) or multisystemic therapy (n=342). By 60 months’ of follow-up, 188 (55%) of 342 people in the multisystemic therapy group had at least one offence with a criminal conviction, compared with 180 (53%) of 341 in the management-as-usual group (odds ratio 1·13, 95% CI 0·82–1·56; p=0·44).Interpretation: The results of the 5-year follow-up show no evidence of longer-term superiority for multisystemic therapy compared with management as usual.

Multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour (START): a pragmatic, randomised controlled, superiority trial.
Fonagy, P., Butler, S., Cottrell, D., Scott, S., Pilling, S., Eisler, I., ... & Goodyer, I. M. 2018

Background: Adolescent antisocial behaviour is a major health and social problem. Studies in the USA have shown that multisystemic therapy reduces such behaviour and the number of criminal offences committed by this group. However, findings outside the USA are equivocal. We aimed to assess the effectiveness and cost- effectiveness of multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour. Methods: We did an 18 month, multisite, pragmatic, randomised controlled, superiority trial in England. Eligible participants aged 11–17 years with moderate-to-severe antisocial behaviour had at least three severity criteria indicating past difficulties across several settings and one of five general inclusion criteria for antisocial behaviour. We randomly assigned families (1:1) using stochastic minimisation, stratifying for treatment centre, sex, age at enrolment to study, and age at onset of antisocial behaviour, to receive either management as usual or 3–5 months of multisystemic therapy followed by management as usual. Research assistants and investigators were masked to treatment allocation; the participants could not be masked. The primary outcome was out-of-home placement at 18 months. The primary analysis included all randomised participants for whom data were available. This trial is registered, number ISRCTN 77132214. Follow-up of the trial is still ongoing.Findings: Between Feb 4, 2010, and Sept 1, 2012, 1076 families were referred to nine multi-agency panels, 684 of whom were assigned to management as usual (n=342) or multisystemic therapy followed by management as usual (n=342). At 18 months, the proportion of participants in out-of-home placement was not significantly different between the groups (13% [43/340] in the multisystemic therapy group vs 11% [36/335] in the management-as-usual group. Interpretation: The findings do not support that multisystemic therapy should be used over management as usual as the intervention of choice for adolescents with moderate-to-severe antisocial behaviour.

Parenting programme for parents of children at risk of developing conduct disorder: cost effectiveness analysis.
Edwards, R. T., Céilleachair, A., Bywater, T., Hughes, D. A., & Hutchings, J. 2007

Objective: To investigate the cost effectiveness of a parenting programme.Design: An incremental cost effectiveness analysis alongside a pragmatic randomised controlled trial of the effectiveness of a group parenting programme delivered through Sure Start in the community. Setting Sure Start areas in north and mid Wales. Participants: Parents of 116 children aged 36-59 months (87% of the clinical sample) at risk of developing conduct disorders defined by scoring over the clinical cut off on the Eyberg child behaviour inventory). Children were identified by health visitors and recruited by the research team.Intervention: The Webster-Stratton Incredible Years basic parenting programme or a six month waiting list control. Main outcome: measure Incremental cost per unit of improvement on the intensity score of the Eyberg child behaviour inventory. Results: The bootstrapped incremental cost effectiveness ratio point estimate was £73 (€109, $142) per one point improvement on the intensity score (95% confidence interval £42 to £140). It would cost £5486 (€8190, $10 666) to bring the child with the highest intensity score to below the clinical cut-off point and £1344 (€2006, $2618) to bring the average child in the intervention group within the non-clinical limits on the intensity score (below 127). For a ceiling ratio of £100 (€149, $194) per point increase in intensity score, there is an 83.9% chance of the intervention being cost effective. The mean cost per child attending the parenting group was £1934 (€2887, $3760) for eight children and £1289 (€1924, $2506) for 12 children, including initial costs and materials for training group leaders. When we categorised the sample into relatively mild, moderate, and severe behaviour groups based on intensity scores at baseline the intervention seemed more cost effective in those with the highest risk of developing conduct disorder. Conclusion: This parenting programme improves child behaviour as measured by the intensity score of the Eyberg child behaviour inventory at a relatively low cost and was cost effective compared with the waiting list control. This parenting programme involves modest costs and demonstrates strong clinical effect, suggesting it would represent good value for money for public spending.

Perspectives on safeguarding and child protection in English schools: the new educational landscape explored.
Baginsky, M., Driscoll, J., Manthorpe, J. and Purcell, C. 2019

Changes in England’s education policy have increased the autonomy of schools, thus substantially altering the nature of the role played by local government. Concurrently, a sharp rise in referrals to children’s social care services, together with budgetary pressures, have led local authorities to seek to manage demand by emphasising the role of other agencies in providing early help to children and families.Purpose:This article focuses on schools’ engagement with safeguarding and child protection from the perspective of senior education and children’s social care professionals employed within local authorities. It considers the effect of policy developments on the relationship between local authorities and schools in meeting their statutory duties to identify and support vulnerable children and families (safeguarding) and intervening in those considered to be at risk of significant harm (child protection). This research was undertaken as the preliminary stage of a study investigating schools’ decision-making in child protection, their engagement in multi-agency working, and the support available to schools.Methods:Scoping interviews were conducted with 68 professionals working in children’s social care or education services in 20 local authorities across England that varied in terms of geographical location and socio-economic diversity. Interview transcripts were analysed qualitatively, using a two-phase process. The analysis included the identification of a thematic framework, mapping and interpretation.Findings: In-depth analysis of the rich interview data allowed exploration of the participants’ perspectives, which elucidate and give insight into some of the emerging pressures that are challenging schools and local authorities, as well as the agencies supporting them. Key factors identified were: increasing school autonomy; the upward trend in the rate of referral to children’s social care services and rising thresholds for accessing those services; and the availability and nature of ‘early help’ for children not meeting the threshold for social care intervention.Conclusions:Pending later data gathered through surveys and directly from schools, the findings from this preliminary study suggest that local authorities face new challenges in working with a fragmented educational community: while their statutory responsibilities remain, the channels by which they are carried out have been severely weakened.

Promoting the retention,mental health and wellbeing of child and family social workers: a systematic review of workforce interventions
Turley, R., Roberts, S., Foster, C., Willis, S., Morgan, H., Warner, N., ... & Nurmatov, U. 2020

Mental health, wellbeing and retention are pressing concerns within children’s social care. This systematic review aims to summarise existing evidence on workforce interventions to improve mental health, wellbeing or retention of child and family social workers. Findings suggest a number of potentially promising interventions, particularly organisational level interventions. However, there is very little high quality or consistent evidence available, and more research is needed.

School-based interventions to prevent anxiety and depression in children and young people: a systematic review and network meta-analysis
Caldwell, D. M., Davies, S. R., Hetrick, S. E., Palmer, J. C., Caro, P., López-López, J. A., ... & Welton, N. J. 2019

Rates of anxiety and depression are increasing among children and young people. Recent policies have focused on primary prevention of mental disorders in children and young people, with schools at the forefront of implementation. There is limited information for the comparative effectiveness of the multiple interventions available.

Systematic review of economic evaluations of children’s social care interventions.
El-Banna, A., Petrou, S., Yiu, H. H. E., Daher, S., Forrester, D., Scourfield, J., ... & Wallace, S 2021

Background: Children’s social care/child welfare services, are under pressure to maximize the value of resource expenditure in meeting the needs of children and young people exposed to risk factors for care entry or residing in care. Economic evaluations can support the decision to adopt, routinize or discontinue an intervention, informing the allocation of limited resources. There is a paucity of economic evaluations in children’s social care, partly because this is an emerging area, hence topic-specific methods are lacking. Prior to the development and recommendation of methods, it is important to systematically synthesize those adopted to highlight challenges that have arisen and guide future research. Objective: To assess the methods applied and the cost-effectiveness evidence generated by economic evaluations of children’s social care interventions. Methods: Searches of electronic databases and websites were carried out to identify full economic evaluations of children’s social care interventions in journal articles and the grey literature. A narrative synthesis of methods adopted and cost-effectiveness results is presented. Results: Twenty studies were eligible for inclusion. These covered parenting programs (n = 8), in addition to a diverse range of other interventions. Cost-effectiveness analysis was the most common approach taken (n = 17) and a large number of studies concluded that the intervention was cost-effective (n = 14). Conclusion: The number of published economic evaluations of children’s social care interventions is limited. The available evidence supports the adoption of several of the interventions evaluated, however, the review highlighted a number of challenges in the use of standard economic evaluations methods in this area.

Vulnerable children and social care in England: a review of evidence
Crenna-Jennings, W. 2018

According to the latest official statistics there are 389,430 children in need (CIN) in England. These are children deemed unlikely to achieve reasonable health and development without the provision of services, including those with a disability. Since 2010 at least, there has been a rise in the numbers of children in need issued with Child Protection Plans and council care orders. This has been partially attributed to a deliberate response by social care authorities to high-profile serious case reviews into child deaths resulting from abuse. Other factors, including cuts to early intervention (EI) services and deprivation, may also be contributing to a rise in acute need.The increase in these more acute forms of monitoring and intervention is occurring in spite of staff-reported increases in thresholds for access to services.Over half of LAs in all regions except London were rated Requires Improvement or Inadequate by Ofsted, according to the latest data.

What works to improve the lives of England's most vulnerable children's: a review of interventions for a local family help offer
Asmusen, K., Waddell, S., Molloy, D., & Moore, I. 2022

This report identifies over 50 interventions and activities with evidence of improving child and family outcomes within five categories of vulnerability: problematic child behaviour, family conflict, parental mental health, domestic abuse and parental substance misuse.