March 14, 2014
by Annette Bauer, Gerald Wistow, Josie Dixon, Martin Knapp
People with learning disabilities have fewer chances of becoming parents and of living as a family. Those who become parents often struggle in this role and require additional support. More generally, early intervention for vulnerable parents during pregnancy and when the child is born promises good health and wellbeing outcomes for the family, linked to reduced long-term government expenditure. Advocacy, provided at a stage when a concern has been raised about the parent’s ability to look well after their (often unborn or newly born) child has recently been the focus of a SSCR funded, small-scale LSE-PSSRU study. The results have now been published in ‘Investing in advocacy for parents with learning disabilities: what is the economic argument?‘. They show that good practice advocacy is likely to achieve a range of prevention outcomes for the parent as well as the child, linked to short and long-term potential savings to the public sector.
We estimated these savings as potentially representing:
- A (short-term) net benefit of £720 to councils’ social services department from reduced safeguarding activities, care proceedings and provision
- A (long-term) net benefit of £3,130 to public services more generally because of increased access to early interventions
These values were based on unit costs for client-related advocacy work estimated at £32 per hour. On average, the advocacy interventions in our study consisted of 95 hours of client-related work and costs per intervention amounted to £3,040.
In addition, we found a range of outcomes associated with advocacy interventions which were likely to have positive impacts on children’s later lives (such as school performance and stable placements) and which were likely to prevent expensive consequences. For example, the cost of a child leaving without school qualifications has been projected at £58,000.
We identified a number of factors that were likely to impact on the levels of cost-effectiveness which might be realised, including:
- Early involvement of the advocate in the process (early referral from councils)
- Parents’ learning disabilities as the main reason preventing them from participating in the child safeguarding process (expressed in an inability to understand what is required from them and to comprehend large volumes of written documents)
- Focus on alleviating parental fears and moderating their defensive behaviours (thereby, facilitating engagement with professionals)
- Focus on awareness raising among professionals of the barriers that parents face (thereby, changing professionals’ attitudes and facilitating joint working with the parents so that professionals spent additional time with parents considering options)
- Coordination between agencies and professionals involved in the process
- Helping parents to access early intervention support for their problems, and referrals to the appropriate local agencies
- In addition, advocates are bound by the statutory requirement that all decisions are made in the best interest of the children
Our research confirmed the role that advocacy has as part of the prevention agenda and in achieving some important government objectives such as delivering better outcomes for children and families who become subject to the care proceedings.
Like many other small studies into highly complex and personalised interventions, our study has a number of limitations. Most of these are typical for small third sector projects without the budget or capacity to get involved in larger scale research. These limitations mean, however, that our findings should be interpreted cautiously. The returns or savings estimated in our economic analysis are based on a number of assumptions, and more work is required to understand how savings can be realised in practice. For example, some form of pooled funding might be required to deliver value for money across a wider system but may not be relevant from the perspective of a single commissioner.
The study was funded by the School for Social Care Research (SSCR).
Bauer A, Wistow G, Dixon J, Knapp M (2014) Investing in advocacy for parents with learning disabilities: what is the economic argument?, British Journal of Learning Disabilities (online)
About the authors
Annette Bauer is a Research Officer at PSSRU and works on economic evaluation and modelling in the area of social care.
Professor Gerald Wistow is Visiting Professor at PSSRU and has special expertise in the areas of integration between health and social care and the management of adult social care.
Josie Dixon is a Research Fellow at PSSRU and works primarily on dementia and end-of-life care.
Professor Martin Knapp is Professor of Social Policy and Director of PSSRU. His main work interests are in social care, child and adult mental health, dementia and autism. He is also Director of the NIHR School for Social Care Research.