Child placement costs and cost drivers: Isaacus Kuopio data lake project

Abstract

Background: Finnish government has aimed at responsive and efficient use of healthcare data [1]. An essential part of efficient real-world data use is the process consisting of data – analysis – knowledge management – communication. For that purpose, the Finnish Innovation Fund Sitra funded Isaacus pre-production projects [2] that were aimed at preparing the national Isaacus service operator providing wellbeing data and open data on a one stop-shop basis.

City of Kuopio initiated the pre-production project “Well-being information on children and young people” in 2017 and extended it in year 2018. During the initial pre-production project, a data lake covering health and social care (1/2013–8/2017) data was developed. The data included the ‘information packs’ data of the social welfare and healthcare reporting system as well as client and guardian data. Remote-use platform for the data lake was developed to support efficient and safe secondary data use. [3] During the extension phase of the pre-production project, the data set covered also year 2017 in full and unit cost data was implemented more accurately.

Aim: To assess the costs and cost drivers of child placement decision based on the extended Isaacus data.

Methods: The data consists of the family social services arranged by the city of Kuopio (2013–2017) for individuals aged 0–17 years. The social care was complemented by primary care data and included key client and caretaker characteristics. To maintain the track of RAD process (request for inquiry, assessment of need for support, decision), the analysis was restricted to clients with at least one request for inquiry to the social or child protective services based on child welfare notification in the data. The first inquiry in the data was the index event.

Multivariate log-OLS regression modelling for the placement costs was done with Stata statistical software.

Results: 48.1% of the clients included in the analysis (total N 387) were male, 80.1% of 366 clients with residence information were Kuopio residents, and 8.5% of the clients had been taken into custody before the index event. At the time of index event, the clients were on average 9.0 (SD 5.7) years old.

The average payer undiscounted cost per placed child in year 2017 real value for the analysed client group was 64 052 € (n 387; SD 85 780 €; range: 61 – 453 149 €; median 26 563 €) during the time spent in placement after the index event (326.73; SD 445.69; median 124; range: 1 – 1775 days). Drivers increasing or decreasing the placement costs were recognized.

Statistically significant predictors for child placement costs were prior placement (+141%), new client status (-61%), later placement (-24%), child welfare notification by the police (-66,3 %), and certain inquiry reasons (self-destructive behaviour +373%, conflicts between child and parent +453%, psychological wellbeing of the child +177%, substance abuse by the child +327%, insecurity +157%, violent behaviour by the child +327%, family conflicts +577% and domestic abuse +109%).

Conclusions: Child placement costs were estimated based on the data and cost drivers were found.

References:
[1] Finland, a land of solutions. Mid-term review. Government Action Plan 2017–2019.
[2] Isaacus pre-production projects. https://www.sitra.fi/en/projects/isaacus-pre-production-projects/.
[3] Soini E, Hallinen T, Kekoni A, Kotimaa J, Tirkkonen J, Tervahauta M. Efficient secondary use of representative social and health care data in Finland: Isaacus data lake, analytics and knowledge management pre-production project. Value Health 2017;20:A777.