Edge of Care Cost Calculator: Change Project report

Full text

Edge of Care Cost Calculator
Change Project Report
December 2018

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Contents
Introduction ............................................................................................................................................3
Who this resource is aimed at .............................................................................................................3
About this report .................................................................................................................................3
Acknowledgements .............................................................................................................................3
About the Change Project ....................................................................................................................... 4
Background ....................................................................................................................................... 4
Recruiting to the Change Project ........................................................................................................ 4
Dening the edge of care ....................................................................................................................... 6
Where are the edges? ......................................................................................................................... 6
Denitions of edge of care ...................................................................................................................7
Denition One: DfE Innovation Programme (Wave 1) ........................................................................7
Denition Two: North Yorkshire ....................................................................................................... 7
Denition Three: Wider literature ................................................................................................... 8
Denition Four: Service-specic criteria .......................................................................................... 8
Denitions: Summary ..................................................................................................................... 8
Local edge of care services ....................................................................................................................10
Variance in service provision .............................................................................................................10
Outcomes for young people ................................................................................................................11
Data for the edge of care ....................................................................................................................... 12
Child-level data at the edge of care ................................................................................................... 12
Currently available data..................................................................................................................... 13
Finance data ......................................................................................................................................... 14
Costs of support ................................................................................................................................ 14
How data might be used to dene the edge of care cohort................................................................. 15
The Edge of Care Cost Calculator tool ......................................................................................................17
Purpose of the tool .............................................................................................................................17
Data required ..................................................................................................................................... 17
Finance data ......................................................................................................................................17
Next steps ..........................................................................................................................................17
Conclusions ..........................................................................................................................................18
Recommendations ............................................................................................................................18
Data .............................................................................................................................................. 18
Dening cohort/thresholds ............................................................................................................ 18
Bibliography ......................................................................................................................................... 19

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Introduction
In 2017 a Research in Practice (RiP) Change Project, conducted with RiP Partners from 19 local authorities in England,
explored the development of a tool for calculating the nancial costs of delivering services for young people who are on
the ‘edge of care’.
The Change Project method applies an action research approach to developing evidence-informed, practical resources
by bringing together experts from across practice and research. You can read more about this methodology and other
Change Projects at www.rip.org.uk/change-projects
This project was a collaboration between RiP, North Yorkshire Children’s Services, and academics at the Centre for Child
and Family Research (CCFR), Loughborough University (Lisa Holmes and Helen Trivedi, now based at the Rees Centre,
University of Oxford).
Who this resource is aimed at
It is anticipated that the information generated by the resource will be of interest to service, nance and performance
managers and those responsible for commissioning services, including Lead Members, Councillors and Directors of
Children’s Services.
Given the multifaceted nature of a tool that utilises both nancial and child-level data, it is anticipated that the various
reports and analyses will provide information for both operational and strategic purposes.
About this report
Over the course of the project, local authority participants highlighted the diversity of approaches being taken to support
young people deemed to be on the edge of care and informed our thinking on how a cost calculator tool might function
eectively across such a variety of service activity. We have aimed to capture learning from the project and make
recommendations, and have grouped our ndings in the following sections:
1. About the Change Project
2. Dening the edge of care
3. Local edge of care services
4. Data for the edge of care
5. The Edge of Care Cost Calculator tool
Acknowledgements
We would like to thank the local authorities and the individual project participants for their invaluable contribution to this
practice-research collaboration:
Blackpool; Cumbria; Dorset; Hampshire; Hertfordshire; Knowsley; Leeds; Lincolnshire; Manchester; Medway; Oldham;
Oxfordshire; Rochdale; Somerset; Stockport; Swindon; Waltham Forest; Wigan; Wirral

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About the Change Project
Background
In September 2014, North Yorkshire Children’s Services were awarded funding from the Department for Education’s (DfE)
Wave One Innovation Programme. The award of £2.1 million was for the development of North Yorkshire’s ‘No Wrong
Door’– an integrated service that aims to improve outcomes for young people aged 12 to 25 who are either in care, edging
towards or on the edge of care. No Wrong Door was established to provide wrap-around care for young people from
within a single service and develop consistent, supportive relationships.
From January 2015 to March 2017, Dr Lisa Holmes and a team from CCFR at Loughborough University led the DfE
evaluation of the No Wrong Door model (Lushey et al, 2017). As part of the team’s evaluation methodology, it was
recognised that there was a need to explore the true costs, and value, of delivering services to children and young people
at the edge of care. The evaluation team began exploring the applicability of extending their existing Cost Calculator for
Children’s Services (CCfCS) so that it could be used with data collected on the edge of care cohort, as well as looked aer
children. A pilot tool – the Cost Calculator for Edge of Care services (EoC CC) – enabled the evaluation team, in partnership
with North Yorkshire, to better understand the true nature of support that young people were receiving and to analyse
more eectively the value-for-money of No Wrong Door.
The EoC CC was conceptualised to support the longitudinal analysis of the needs, support, services and outcomes of
children and young people on the edge of care. As with the original CCfCS, the underpinning methodology for the EoC
CC is to take a ‘bottom-up’ approach to unit costing and to link these costs with data about the needs, circumstances and
outcomes for children and young people.1
The goal of the Change Project was to validate and expand on this work to enable the wider sector to benet from the
developments made in North Yorkshire. Ultimately, we intended to:
>Test and rene the functionality of the EoC CC and its areas of focus with a group of practice experts from a range
of dierent local authorities.
>Use the information generated by this process to inform development of an updated practice-informed tool for
the analysis of needs, costs and outcomes for young people at the edge of care.
Recruiting to the Change Project
Identifying and working eectively with young people before they enter care, and supporting successful reunications
aer a period in care, oer clear benets, such as improved outcomes for children and families, and (where appropriate)
the avoidance or reduction of time in care for young people.
As the term suggests, edge of care services and activities oen bridge service structures and operate at the intersection
between targeted and statutory provision for children and families. Provision may be directed at dierent but overlapping
cohorts such as:
>Young people and their families who are struggling to cope but whose circumstances do not necessarily ‘meet
the threshold’ for statutory involvement.
- Targeted services are structured in a variety of ways around the country and the data collected are
subject to a high degree of local variation. Referral processes, delivery models and monitoring systems
are not uniform; these variations raise challenges in developing a tool with the capacity to gather
comparable and/or linkable data to analyse the relationships between services, inputs and outcomes.
>Young people characterised as at the edge of care may well be involved with a number of dierent services.
- They may be involved with universal provision (in school or college, for instance), targeted provision
(such as family support or adolescent mental health), services focused on specic issues (eg, youth
oending), and statutory children and young people’s services. Bringing together data on these elements
from dierent local agencies can be a challenge.
1 This work built on previous research by Holmes and colleagues to develop a Cost Calculator for Children’s Services (CCfCS). Previous
publications from this research provide detail about the development and use of the bottom-up unit costing methodology (see Holmes
and McDermid, 2012; Ward et al, 2008).

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In order to scope further development of the North Yorkshire pilot tool to function eectively across this complex variety of
activity, the Change Project brought together expertise in research, data, nance, and practice. Organisations from the RiP
partnership network were invited to nominate participants to join a series of four meetings. Invitations were for groups of
three individuals from each organisation:
>Head of service or senior manager with responsibility for edge of care services
>A performance and intelligence lead, such as an intelligence ocer, business intelligence lead, senior data
analyst, or similar
>A nance lead for Children’s Services.
The initial aim was to recruit three participants from eight or nine local authorities or children’s trusts (referred to
throughout this document as ‘organisations’). However, the volume of applications greatly exceeded this target. In order
to meet demand, we revised our plans and ran two concurrent project groups, one in the North and one in the South of
England. In total, this enabled approximately 60 individuals from 19 local authorities to take part in the project.
The aim of the meeting cycle was to engage participating organisations in testing the conceptual framework and wider
applicability of the pilot EoC CC. Key elements of the work included developing a shared understanding of edge of care
services and the cohort of young people these were aimed at, and identifying the necessary data to explore the costs and
outcomes associated with these.
A core issue quickly emerged around dening the ‘edges’ of care. The following section explores these issues, draws on
the insights of those involved with the Change Project, and makes recommendations for future research and strategic
thinking around edge of care services.

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Dening the edge of care
Where are the edges?
Dierent practitioners will have diverse views on what constitutes the edge of care and the term may be
used inconsistently by local authorities, or even within dierent services in the same authority.
(Rees et al, 2017:7)
While the term ‘edge of care’ has gained currency over recent years, the concept is dened in a variety of ways in practice,
policy and research literature (eg, Ofsted, 2011; Institute of Public Care, 2015; Rees et al, 2017).
Change Project discussions underlined that in practice an ‘edge’ does not only describe young people who have not yet
been in care (ie, those ‘edging’ towards it). Multiple edges may be visualised within the journeys a child or young person
makes through early help, targeted family support, statutory child protection services, and in and out of the children
in care system. Children and young people in care experience placement changes or breakdowns, family reunications
(which may also break down) and so may be considered on an edge of care at dierent points (see Figure 1).
These edges – and individual children and young people’s oscillation in and out of care – are, of course, functions of our
system’s thresholds, service structures, statutory frameworks and legal orders. Evidence scopes and international research
remind us that there are dierent types of response (see, for example, Bowyer and Wilkinson 2013; Wilkinson and Bowyer
2017), while innovation can move systems and practice into new congurations. ‘Rethinking support for adolescents in, or
on the edge of care’ was one of two areas of focus for Wave One of the DfE’s Children’s Social Care Innovation Programme
(2014 to 2017) in which nine projects explicitly targeted work with adolescents at the edge of care (see Rees et al, 2017).2
Figure 1: The multiple edges of care
The negative consequences of placement instability and poorly supported family reunications that subsequently break
down have been well demonstrated in the literature (Farmer and Lutman, 2010; Wade et al, 2010), while others (eg,
Holmes, 2014) have highlighted the rising nancial costs of repeat returns to care and subsequent care placements. As
such, both the moral and nancial case for identifying and providing services to support this cohort are clear.
2 http://innovationcsc.co.uk/innovation-programme
Open child in need case Open child in care case
Placement change
Child returns home
Decision the child should
become looked aer and
rst placement starts
Various assessments and
plans to work with child
and family

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Denitions of edge of care
In this section, we describe several alternative denitions and the criteria they use to identify the edges of care.
Denition One: DfE Innovation Programme (Wave 1)
The Evaluation Coordinator for the rst wave of the Innovation Programme worked with colleagues at the DfE to develop a
denition of edge of care which broadly aligns with other denitions set out in recent years (Institute of Public Care, 2015).
It was suggested that those on the edge of care are children and young people are who:
>A senior social worker believes will need to enter care within days or weeks as current levels of support are
insucient to safeguard them, while needs are escalating and/or family relationships or other issues are
worsening.
>Are the subject of early-stage court proceedings and social workers are having to make decisions on whether
sucient change is possible to allow the child to safely remain at home.
>A senior social care manager has agreed should be accommodated if an alternative intervention or support
package is not swily put in place, including those provided with respite care, or who have been accommodated
in an emergency but where the aim is for them to be reunited with their family quickly with appropriate support.
>Cease to be looked aer and return to their parents or wider family network, but who require further support to
ensure they are safeguarded and do not re-enter care.
(Rees et al, 2017)
Denition Two: North Yorkshire
The three-part denition used by No Wrong Door (Lushey et al, 2017) in North Yorkshire is based broadly upon Denition
One above, but with additional criteria and context from their service perspective:
1. Edge of Care: Those children and young people who are at imminent risk of becoming looked aer:
a. Families where there are signicant child protection concerns, where child protection plans are in place
and during the early stages of court proceedings, and where social workers are having to make decisions
on whether sucient change is possible to allow the child to remain at home.
b. Young people who the appropriate social care manager has agreed should otherwise be accommodated
but an alternative intervention or support package is put in place to safeguard them as a direct
alternative to a long-term placement. This would include those provided with respite care or those who
have been accommodated in an emergency but where the intervention will enable them to return to the
family quickly, safely and with appropriate support.
c. Children and young people who cease to be looked aer and return to their parents or wider family
network and where further support is needed to prevent re-entry to care and to ensure they are
safeguarded.
d. Children and young people who the appropriate social care manager considers will need to enter care
imminently (within a matter of days or weeks) without signicant support. This could be where needs
are escalating – behaviour, family relationships or other problems are worsening and current levels of
support are insucient.
2. Edging to Care: Without an intervention package being put in place there is a strong likelihood of the case
progressing to edge of care.
3. Placement Support – Outside of Family: Without an intervention over time the placement is highly likely to
disrupt.

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Denition Three: Wider literature
Across the wider literature, denitions of edge of care provide a broader view. Pulling together denitions from research
and evidence scopes (Dixon and Biehal, 2007; Ofsted, 2011; Ward et al, 2014; Dixon et al, 2015; Institute of Public Care, 2015)
the edge of care population may be dened as comprising those children or young people who match one or more of the
following criteria:
>Is currently at high risk (professionally judged) of requiring protection from harm
>Has previously been considered for a care placement, which did not go ahead
>Has experienced multiple diculties in their lives and shows signs of escalating need for support
>Has suered abuse and/or neglect at some point in their life
>Has not been successfully supported by a service or multiple services, and has subsequently been moved around the
Children’s Services system
>Is in an alternative to a long-term care placement with some sort of additional support
>Has very recently le care
>Has previously been in care and is still at risk of personal and accommodation instability.
Denition Four: Service-specic criteria
Working with Change Project participants raised the challenging issue that in local practice the denition in use may simply
be ‘all children and young people who meet the criteria for and are being supported by our dedicated edge of care service’.
Given the variety and limited capacity (and in some areas, the complete absence) of named edge of care services, this
pragmatic approach presents diculties for ongoing research and development. Change Project participants consistently
expressed the aspiration that a tool might provide analyses for benchmarking purposes, but ambiguous denitions and
diering referral and eligibility criteria exacerbate the complexities of benchmarking and comparative analysis of outcomes.
Denitions: Summary
Across these multiple denitions diering approaches give weight to evidence gathered through two primary sources:
>Professional judgement: A practice-driven denition where service managers (or other appropriate professionals)
identify young people as edge of care. This primarily applies to young people who are already on the cusp of being
looked aer or in the process of entering care, where professionals are able to assess cases closely and make
decisions.
This approach may help with the immediate provision of support but it is limited in its ability to enable earlier
intervention and prevention of the need for care. Furthermore, it is subject to dierences in individual professionals’
judgements and to human error.
>Service/child-level data: This broader denition considers multiple factors that may indicate a young person is at
a higher risk of entering care. It might involve case history, current service provision, assessment data, and various
other proxy indicators that evidence suggests are related to care entry.
This approach might support earlier intervention and meaningful preventative work with young people; however,
it might also result in over-identication and present diculties in directing support where it is most valuable.
Furthermore, this approach does not take direct account of the expert, qualitative judgements of professionals, who
will have a much deeper understanding of the cases that the data shows. It is also susceptible to human error, such
as missing data and delays in updating records.

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These approaches should be seen as complementary. Wherever organisations can supplement their service provision with
additional insight from available data, there may be opportunities to intervene at an earlier stage with young people who
will most benet from access to services.
As such, a combination of denitions Two and Three above (the North Yorkshire denition supplemented by a research-
driven denition of ‘edging to care’) might provide both exibility to services in dening local cohorts and the structure
necessary for further research and development in the eld.
Children and young people at risk of entering care come to the attention of services for a variety of reasons and through
a range of routes and agencies, and there is wide variation in the local oers available to them. This complexity and
heterogeneity raise challenges in developing a coherent national research and commissioning agenda, as well as in the
development of tools that may support analysis of these services. In the next section we discuss this variation in further
detail, including the range of dierent ways in which data about practice activities and outcomes for young people are
collected.

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Local edge of care services
Variance in service provision
It was reassuring to learn that across local authorities we have fairly consistent views of what ‘edge of
care’ means … but the way in which services are congured and delivered varies a lot.
(Change Project participant)
Diversity in service provision reects factors such as local area demographics and demand, local area service
development, reduction or consolidation over time, and the uneven distribution of innovation funding and activity in this
eld (Rees et al, 2017).
By bringing together strategic leaders from across 19 local authorities the Change Project aimed to gain greater clarity on
how practice activity at the edge of care might be consistently dened, recorded and analysed.
Not all of the project group had a dedicated edge of care service and those that did used locally developed referral
criteria and pathways, making it dicult to compare one service to another, much less to assess whether unit-level costs
were comparable. Each service monitors performance in its own way using a combination of local authority systems and
service-specic case management, resulting in a high degree of variation when it comes to edge of care data.
In the rst Change Project meeting, participating authorities highlighted the dierences in the types of services they were
providing. Services could broadly be grouped under the following types:
1. Services that work with adolescents who are deemed high risk for child sexual exploitation, involvement in crime,
and/or at risk of harm.
2. Services for families with multiple risk factors such as conict, domestic violence, mental health challenges, and/
or substance misuse.
3. Services for young people and their families following a previous care episode, and to prevent a future return to
care.
4. Services providing support to young people currently in care placements that are at risk of disruption.
The case study on the following page looks at two dierent edge of care services being provided by organisations that
participated in the Change Project.

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CASE STUDY: A comparison of two services
Service 1
Cohort: 70-100 cases
Cohort description: Cases that are seen as high risk of
entering care, but not those that might be exiting care.
Focus: Diverting cases from care and providing appropriate
support.
Service provision: Targeted work with young people and
their families, focusing on support, resolution and multi-
agency work.
Data: Sta manually keep records of cases and enter
data into a number of spreadsheets; however, no service
activity, service-user data, or resources are entered into an
integrated Management Information System.
Other notes: The service has a dedicated budget for this
provision which has grown over time.
Service 2
Cohort: c. 170 cases
Cohort description: Identied at a resource panel meeting
of senior and key sta who review cases of concern
brought to them by social work teams.
Focus: Diverting cases from care and providing appropriate
support.
Service provision: If a case is assigned edge of care status
then typically a family support worker will work with the
family according to their needs.
Data: Use a dashboard view of data about the cases.
Other notes: The service has found that they keep numbers
manageable by using this approach to referring cases.
Outcomes for young people
This variance between areas in terms of services and cohorts presents diculties in making a wider assessment of how
eective services are at achieving their intended outcomes. Although nancial calculations of services might focus on
the cost of delivery and resources, unless these calculations are linked with the outcomes for the cohorts in receipt of the
services, assessments of value are problematic.
So given the diversity of services, even within this sample of 19 organisations, there is a need not only for a common
denition of edge of care, but also for a common framework of outcomes for this population.
At the top level, the general consensus across organisations is that the ultimate desired outcome for an edge of care
service is a simple one:
>To prevent young people from entering or re-entering care (when it is not in their best interest to do so).
Alongside this primary outcome, however, are multiple other outcomes (identied throughout the project) which also aim
to achieve this reduction in care placements. And in addition to contributing to a reduction in the need for episodes in
care, these outcomes may themselves have wider societal benets. These might include, for example:
>Reduction of exposure to domestic violence
>Reduction of alcohol and substance misuse (young person and/or family)
>Reduction in contextual risk of harm / abuse (eg, gang involvement, going missing, etc.)
>Reduction in oending and police involvement
>Improvements in physical and mental health
>Improvements in family relationships and communication
>Improvement of self-ecacy and coping with a crisis
>Improvement of educational outcomes for young people.
To summarise, edge of care practice encompasses a range of diering services working with a range of dierent cohorts
of young people and seeking a range of dierent outcomes with young people and their families. A multi-area view of
edge of care is impeded by a lack of uniformity in the available evidence. Just as services vary in this non-statutory setting,
so too does the data collected in terms of people supported, services provided, outcomes achieved, and resources used.
So although it is relatively easy for organisations to monitor and demonstrate changes in the number of placements over
time (eg, via mandatory data returns from looked aer children teams), the direct monitoring of edge of care services and
outcomes poses a challenge.

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Data for the edge of care
Child-level data at the edge of care
Tidy datasets are all alike, but every messy dataset is messy in its own way.
(Wickham and Grolemund, 2016)
The variety in services and referral channels poses signicant challenges for the development of generic tools for
understanding needs, costs and outcomes at a strategic level. But without such tools, realistic comparison (both
for internal organisation use and for benchmarking purposes) between costs, impacts and eectiveness of dierent
approaches can be dicult.
In an analyst’s ideal scenario, there would be a single data record for each child that contains consistent data items
(demographic information, services received, contact with multi-agency partners, changes in their circumstances over
time, etc.). This single record would be uniform across all areas and would travel with the young person if they moved
geographically or between services.
The single record would give a simple (two-dimensional) picture of that person’s life. When analysed with similar records
for children across the country, it would provide practice leaders, analysts, commissioners and researchers with a starting
point both to examine the complex interactions between services and outcomes, and to apply economic models to better
understand (for example) the true costs of services.
Case study: Data-sharing in North Yorkshire to provide the best support to young people
When No Wrong Door was operationalised, it was quickly established that not all the necessary data items relating to
needs, support, services and outcomes were routinely recorded or extractable from the case management system.
Therefore, No Wrong Door, in conjunction with the Centre for Child and Family Research at Loughborough University,
who were evaluating the service, designed a child-level data tracker that was used in addition to the case management
system.
This tracker was invaluable for the evaluation process and showed the impact of the specialist roles and the portfolio
leads from the No Wrong Door service. As the tracker has developed, the team at No Wrong Door and North Yorkshire
have looked at ways to ensure that the tracker and case management system are communicating, and that data are
being updated in parallel.
This work is part of a larger process developed by No Wrong Door – the RAISE (Risk Analysis Intervention Solution
Evaluation) process. This is a multi-agency, intelligence-led approach to assessing how best to support young people
with the most complex needs and reduce their risk of harm. RAISE is also being expanded to others areas of North
Yorkshire County Council, as it is seen as a good practice example of multi-agency problem-solving and a means to
ensure that the best services are provided by a range of agencies to meet the needs of young people.

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While there are many local examples of good practice in gathering and using data in non-statutory services, in reality even
linking children’s social care data with early help data is not straightforward. There are several key issues that prevent a
detailed analysis of support services, particularly when looking at multiple areas and services:
>Lack of uniformity in data sets: The original Cost Calculator tool for looked aer children was built to utilise the
SSDA903 (the DfE’s statutory looked aer children data return). Although there are diculties and limitations to
utilising this data set (such as annual upgrades, changes to variables, and some local variance in data reporting),
the standardised format enables a single tool to be used across areas.
However, in the absence of a generic ‘edge of care data return’ or any nationally agreed data framework being
adopted by local services, there is not a single point of reference where analysts or researchers can begin their
analyses. Instead, analysts are faced with the task of identifying multiple relevant indicators from available, routinely
collected data, which will provide a limited view of some, but perhaps not all, of the edge of care cohort.
>Variation in infrastructure: Local authorities use various management information and case management systems.3
Typically, a sub-section of data is extracted from these systems and converted into mandatory national data returns.
At a local level, there is a lot of variation in how key information is recorded (such as how edge of care services are
coded in nance data). As such, even if similar frameworks are being used, the exports from dierent information
systems are unlikely to be similar enough to enable simple comparisons without signicant ‘wrangling’ of the data.
>Real time or retrospective data: National data returns (such as the SSDA903 and the Children in Need Census) are
produced annually and as such provide a retrospective picture. At a local level, their use in between the reporting
timeframes is variable. They are therefore of limited use in ‘real time’ when analysing current caseloads and
costings, and only provide a snapshot of local services. In order to generate the data necessary to ‘fuel’ an eective
EoC CC, organisations would need to generate regular reports of the relevant child-level data which could be
uploaded into the EoC CC as oen as required for analysis and reporting.
Currently available data
Despite the variability between local approaches, it became increasingly evident throughout the project that many
participating organisations had considered how best to utilise their data at a local level and were able to provide examples of
local area data-linking and the matching of child-level data between agencies. So, although a single record of edge of care
data might not exist, organisations are recording and analysing data related to young people who may be dened as edge of
care, whether or not the organisation is providing a dedicated edge of care service.
The majority of local authorities had carried out additional secondary analyses of statutory Children in Need Census and
SSDA903 data and had linked their child-level data with other multi-agency data. However, only around half the authorities
tracked children between child in need and looked aer systems, and only half linked child-level data with their nance
systems.4
Whilst local analyses and data sets might currently vary too much to enable a wider analysis, the nationally reported data
sets (made up of statutory data returns to Government departments) may assist in analysis at a macro level in the shorter
term. The Change Project group agreed upon and discussed where data related to the edge of care cohort might already
exist. Relevant data sets included:
>The SSDA903 return for looked aer children
>The Children in Need Census
>The Schools Census
>The Troubled Families outcomes data
>Youth oending data
>NHS data.
The Change Project group agreed that the Edge of Care Cost Calculator tool should make use of these pre-existing data sets
to create a child-level record that draws together key factors related to outcomes.
However, it was also acknowledged that none of these national data sets will exclusively include young people who are on
the edge of care. Therefore, a more appropriate approach might be to: (1) lter cases based on denition criteria; and then
(2) extract relevant data for each young person from across all data sets.
3 Within our sample of 19 local authorities, seven dierent systems were reported: Capita One’s Integrated Children’s System (ICS),
CoreLogic’s Frameworki, Servelec’s Mosaic, Servelec’s Synergy EIS, System C’s Liquidlogic, CareWorks’ RAISE, and Northgate’s e-Swi.
4 Based on a sample of 14 of the 19 (74%) local authorities involved in the Change Project.

14
Finance data
Within this report we have summarised and assessed the availability and quality of data pertaining to the needs of young
people on the edge of care, and also relevant outcomes data. The other key component of data necessary for a cost
calculator tool relates to expenditure. Recent and current debates have focused on expenditure within Children’s Services
(Thomas, 2018; Kelly et al, 2018) and, in particular, pressures on public sector budgets as a consequence of austerity and
increased demand for Children’s Services. Spend by local authorities is reported annually and is broken down by services
for looked aer children, child protection and safeguarding/family support, as per the categories dened for the purposes
of reporting.5
Previous research has highlighted the limitations of children’s social care expenditure data (Beecham and Sinclair, 2007;
Ward et al, 2008; Holmes and McDermid, 2012). The expenditure returns provide data for a very specic purpose and
can facilitate ‘top-down’ estimates of unit costs, when expenditure gures are divided by the number of children (and/
or families) who receive the service. A further limitation of organisations’ nance data and systems is that they are oen
not linked to data about children and families. Yet in order to understand the value of any service or intervention, it is
necessary to ascertain who has received the service and link this data to information about needs, circumstances and
outcomes.
The original Cost Calculator for Children’s Services (the CCfCS) utilises ‘bottom-up’ unit costs based on activity data about
the amount of time spent on specic activities, such as an assessment or a review. The advantage of this approach to
facilitate an exploration and explanation of cost variations has been well documented (Beecham, 2000; Beecham and
Sinclair, 2007).
There was a clear appetite from participating organisations within this project to be able to understand variations in costs,
and for these to be linked to needs and outcomes. The sessions also included discussions about the impact of austerity
budgets on early help services and the concomitant increased demands on statutory children’s social care.
Costs of support
Throughout this report we have made reference to ‘bottom-up’ unit costs, whereby time-use data for dierent activities
carried out by children’s social care personnel are estimated and translated into unit costs (see Beecham, 2000; Ward et
al, 2008; Holmes and McDermid, 2012).
To move towards a ‘bottom-up’ unit costing approach for integration into the EoC CC, existing time-use data from
previous research (Holmes and McDermid) were shared with the groups. The consensus was that these gures provide a
useful starting point to understand time spent and costs associated with the support oered to all Children in Need (CiN),
those who are the subject of a child protection plan and children looked aer. The corresponding processes for Children in
Need are detailed below.
Child in Need social care processes
Process CiN 1
(includes no further action variation) Initial contact and referral
Process CiN 2 Single assessment
Process CiN 3 Ongoing provision (per month)
Process CiN 4 Close case
Process CiN 5 Section 47 enquiry
Process CiN 6
(includes child protection variation) Planning and review: CiN
Process CiN 7 Public Law Outline
5 Section 251 of the Apprenticeships, Skills, Children and Learning Act 2009 requires local authorities to submit statements about their
planned and actual expenditure on education and social care.

15
How data might be used to dene the edge of care cohort
As per the earlier discussion, dening edge of care cohorts should combine service-led intelligence and data-led
information. So a local area’s edge of care population might be dened as:
1. All those identied by the local edge of care service(s), and
2. All those identied by professionals as at risk of entering care and/or meeting eligibility criteria for local edge of
care services
3. All those identied by a set of evidence-informed criteria applied to local data sets.
Given the availability of several uniform data sets that contain relevant information, the EoC CC might be used to assist
in a more generic identication of an edge of care population. As well as enabling benchmarking and analyses across
multiple services, this may also enable organisations to identify young people at higher risk of entering care but who are
not yet ‘on the radar’ of local services.
During the early stages of this Change Project, we asked local authorities to consider a long list of factors available from
routine data sets which, when drawn together for analysis, might be used to help identify this population. The following
dra list of key data indicators was agreed:
The child or young person:
>Is currently the subject of a child protection plan
>Meets the criteria for statutory services as a child in need
>Has recently le care
>Has been recorded as ‘missing’ recently
>Is currently in a foster placement
>Is absent from school more than 10 per cent of the time.
>Domestic violence incident(s) have been reported in the family/carer home.
>There are known to be substance misuse issues in the family or for the young person themselves.
The project group reached consensus that a combination of these risk factors was relevant, but that further investigation
into exact thresholds for each factor was required. However, what this early exercise provided was a starting point for using
readily available data to create a single denition of the edge of care population, based on agreeable data cut-o points.

16
Case study: Alternative identications of the edge of care cohort
Some scoping work was conducted by one of the Change Project teams (from North Yorkshire) using the combination of
approaches to dening the cohort, as discussed above:
Service-driven
This rst exercise looked to identify young people who had been referred to prevention services and three dierent edge
of care services1 in the county, and then to identify commonalities between these young people based on their data.
Of the referrals to prevention, 95 per cent did not get referred to an edge of care service and were dealt with by
prevention services. Of the 5 per cent who were referred (542 young people), nine young people were subject to
intervention by all three edge of care services (IFS, NWD and MST) and therefore deemed most at risk of becoming
looked aer.
It was interesting to note that these names, when shown to senior leadership at North Yorkshire, were not the names
that the management would have anticipated being subject to all of this intervention activity, due to the specic nature
of cases. This highlighted that even an exercise utilising only service-related denitions might identify cases that are
going under the radar despite repeat referrals to edge of care services.
Data-driven
This exercise looked to identify those young people who had been in multiple edge of care services or who had moved
between dierent risk registers. The analyst then excluded cases of young people currently in care and identied those
who have been in care previously. They then looked at crossover between this edge of care population and markers
from national data sets: child in need status, child protection, and child sexual exploitation (CSE) markers.
Of the 542 young people who had been in multiple edge of care services (5 per cent of total prevention cases), 488 were
currently not in care and might be dened as ‘edge of care’ by service thresholds. Of these 488 young people, 71 (14.5
per cent) had been in care previously; 426 (87 per cent) were currently or had been a ‘child in need’; 163 (33 per cent)
were or had been on a child protection plan; and 33 (7 per cent) had a CSE marker.
In the context of the EoC CC, clearly dened data thresholds could be used to lter whole data sets. Furthermore, using
the balanced approach to dening the cohort suggested earlier in this report, it would be possible to compare outcomes
between young people who are and are not receiving support from edge of care services.
The project group discussions enabled shared understanding and denition of the edge of care, sharing of practice,
local context and desired outcomes, and the exploration of data related to edge of care services. This progress laid the
foundations for the project team to begin the development of the EoC CC, which we will describe in the nal section of
this report.
North Yorkshire were able to identify several cases which could be deemed ‘closer to the edge’ than others, based on
their movement between multiple services and multiple risk factors. We also saw that some of these young people
were not the expected ‘high-risk’ young people in the eyes of practitioners, highlighting the potential of a combined
approach to identifying the cohort.
Prevention 312
5
9
8
13
14
35
39
60
MST
IFS Integrated Family Support
Multi-Systemic Therapy
No Wrong Door
NWD

17
The Edge of Care Cost Calculator tool
Purpose of the tool
The most appropriate conceptual framework and methodology for the EoC CC is one that is exible and can include a
variety of available relevant data. A fundamental component is to oer alternative approaches to the data inputs, whereby
the model builds additional assumptions if certain data items are not available. It is these principles that underpin the
current version of the original Cost Calculator for Children’s Services (CCfCS) for children in care.
An eective tool will serve two distinct purposes: (1) it will enable local services to evaluate their own provision; and (2)
more widely, it will enable multi-area and national comparisons of services and benchmarking.
Data required
In the absence of a national edge of care data set, there are two options for the process of analysing edge of care data:
1. Organisations complete a custom data entry document using data from their own internal systems.
2. The tool utilises generic, statutory data returns and extracts relevant information.
Perhaps due to limitations on capacity and resources (and understandably so) the Change Project participants supported
the option of a tool that uses currently available data sets with minimal need for adaptation. Discussions also focused on
the use of supplementary child-level data (where it is available and can be linked by individual identiers). This approach
has been utilised for the development of the original CCfCS, essentially distinguishing between a ‘core’ set of data to
provide meaningful analyses, and then supplementary data items.
Finance data
At a minimum, existing ‘top-down’ expenditure data can be used. These can subsequently be supplemented, or replaced
by the research-based time-use data, as detailed above and/or additional nance information that exists in organisations.
Next steps
As detailed in this report, this Change Project enabled us to gather a wealth of information from the participants. It also
highlighted the complexities associated with bringing together dierent types of data, variability in existing data, and
diering perspectives about how the tool might be used.
To move forward, we plan to work in 2019 with a smaller group of Children’s Services organisations to test the pilot tool.
This test and pilot phase will focus on the mechanisms for importing data and the tracking of cases between dierent
parts of the children’s social care system (both in terms of ‘step up’ and ‘step down’).
This pilot phase will also focus on the development of new analyses, in the form of ‘dashboards’ that are informed by
users, to inform strategic and operational planning at the local level.
Another aspect of the work that will be explored further is the applicability and usefulness of providing benchmarking
data and analyses for comparisons between areas. Data for benchmarking purposes emerged as a key theme in this
Change Project. However, given the complexities in terms of comparability of cohorts and data highlighted in this report,
benchmarking would need further consideration and would require transparent caveats to avoid misinterpretation.

18
Conclusions
The scoping of both service provision and data collection undertaken for this Change Project provide valuable evidence for the
onward development of the EoC CC. The practical insights of the Change Project group highlighted the level of exibility needed
for the EoC CC tool, and that further strategic thinking is needed around edge of care services to support sector-wide research.
In the real world landscape of a diversity of edge of care services and concomitant variance in available data, the key functions
of an EoC CC tool are:
>
To oer two modes of identifying the edge of care population (dened by local service, and dened by agreed data
cut-o points).
-
The option for services/local areas to adjust the tool’s thresholds to support their own internal analyses, plus
default thresholds to support comparative analysis across local areas/services.
>
To incorporate data from multiple sources, including the CiN Census, Schools Census, SSDA903, and Troubled Families
data set, to assist with the identication of the cohort and to support more detailed outcomes mapping for those
identied.
-
This will need to create a single record for each child by using persistent identiers to link multiple data sets
together.
>
Capacity built in to allow for the recording of outcomes from edge of care services.
-
A template table might oer a exible solution – where the user can input a shortlist of service outcomes for their
own edge of care service.
-
This may involve a change in internal monitoring systems, which might be at odds with current case management
systems.
Beyond the development of the Edge of Care Cost Calculator tool, the Change Project posed several questions and highlighted
areas that require further investigation:
>
There is no agreed upon denition of the edge of care, and a common understanding would greatly assist further
progress in this area. It is also worth bearing in mind that, since the term refers to young people and practice activity
at the cusp of clearly demarcated statutory services, it may always be a somewhat nebulous concept.
>
The eld would benet from a national service mapping exercise for edge of care services – summarising what is
available, the population and referral criteria, and the intended outcomes.
>
An additional piece of strategic work to help standardise edge of care recording and reporting across authorities – for
instance, minimum requirements for data collection and a standard recording format.
>
The sector should consider issues posed by the diversity in case management systems. It may be that some national
development of case management would be more benecial to good data practice.
Recommendations
Data
Edge of care services evolve in local contexts and in a competitive market for case management and information systems. This
has led to a piecemeal environment for performance monitoring which poses challenges for independent research and for any
benchmarking comparisons of edge of care provision. Further development of bespoke, local IT solutions may further challenge
joined-up data processing and analysis.
Our recommendation is that a more eective and cost-eective way forward would involve a number of organisations pooling
resources to develop a prototype standardised (but exible) framework for gathering and analysing data. In the short term,
there are some potential commonalities between local authorities that could be used to develop deeper service understanding
at the edge of care.
Dening cohort/thresholds
While the Change Project focused on opportunities to improve the identication of children and young people on the edge of
care using routine data sets, identication can never rely on data alone. Data sets cannot provide the narrative depth, evidence
from direct observation, nuanced knowledge of family and community context, nor an understanding of the issues from the
child or young person’s perspective. These are gained though good relationship-based practice and strong critical thinking and
analysis. Nevertheless, there are clear gains to be made by supplementing human judgement with data-driven insight, and
taking a balanced approach to dening the edge of care as highlighted in this report. To achieve this aspiration, using data
available in all children’s services organisations and based on the practice experience of multiple edge of care service providers
would represent a signicant step forward in the use of data to support safeguarding and protection of children and young
people.

19
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Authors:
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