Following an application for funding to the What Works Centre for Children's Social Care to work with one local authority to evaluate the impact of BERRI and additional psychology resources on the outcomes for children, we have been asked to submit a scaled up proposal, so that they can recommend it to DfE in the impending spending review. As such, we are looking for additional local authorities that might be interested in partnering in the bid.
If the application is successful, each participating authority would get free use of BERRI across their service, with technical and fieldwork support. The project will also fund two paid project implementation lead posts within the local authority (commissioning and social work) and three psychology posts to provide additional services to a sub-group of participants. The project would run for 18 months. The additional posts alone would be worth around £300,000, and free use of BERRI would save up to £200 per child, so we expect high levels of demand. However, the timeline is very tight, so you would need to submit an expression of interest form (see below) by next Wednesday, 4th August, as the updated proposal needs to be submitted by Friday 6th August.
To express your interest, please complete the short survey linked from the bottom of this page.
1. The need
Nationally £9 billion is spent on children’s social care in the UK. Placements cost £3 billion of this. Within this, over a billion pounds is spent on just 7,500 children in residential care, with many placements exceeding £150,000 per child per year, yet there is little information to help guide which child needs which placement, or what services deliver added value to commission.
Despite this huge budget, outcomes from Care are still poor. Care Leavers are more than 50 times more likely to experience imprisonment, substance misuse, homelessness, inpatient mental health stays, or their own children being removed into Care. As well as the human costs, this leads to excess lifetime costs of up to £2 million per care leaver to the public purse.
Despite very high levels of mental health problems, and recognition that unmet mental health needs are often the trigger to children coming into care, or being placed in specialist out of county placements, no reliable outcome metrics are used to identify or track needs in this population.
Children in Care have always struggled to access psychological support, particularly when they are placed out of area. Overloaded CAMH services often have referral criteria that only provide services for specific conditions or patterns of need, and are rarely able to respond to a crisis, even where this could potentially prevent a placement breakdown. During the coronavirus pandemic, child and adolescent mental health services that were already hard to access have struggled to keep up with demand and adapt to work in ways that minimise the risk of infection. Yet the additional anxiety of the disruption and the social isolation caused by the lockdown have caused many young people’s mental health to deteriorate. There are fears we are looking at a "tsunami" of mental health needs.
2. The solution: BERRI
BERRI is an innovative digital tool set provided by LifePsychol that identifies the needs of individual children, in terms of their Behaviour, Emotional-wellbeing, Risk to self/others, ability to form Relationships, and Indicators of underlying neurodevelopmental or psychiatric conditions. BERRI is based around a questionnaire that is completed on any computer, tablet or smartphone. It is evidence based and has been validated by doctoral research in the UK. BERRI also provides individualised reports with advice for caregivers that increase carer insights and help them to feel supported to meet the psychological needs of the children they care for. LifePsychol can then support carers with additional training and video consultancy, improving care and preventing placement breakdown. Our services that have not been disrupted by the pandemic, can be accessed during lockdown, and do not place carers or children at any additional risk of contagion.
BERRI has been dubbed "the new gold standard" (Independent Children's Homes Association) and "the missing link in the childcare system" (Sir Martin Narey). The DfE said "We have scoped the field and have found nothing similar. BERRI is the only tool to bring data to inform practise frameworks in children's social care"
BERRI is currently used in over 300 children's homes, as well as fostering agencies, secure units, schools and therapy services. Many children have been monitored with BERRI over time for several years, and BERRI has built a unique UK database of over 1400 children in residential care alone, meaning it provides market-leading insights about how individual children compare to the wider populations in specialist placements. Data about how children’s scores change over time when using differing placement providers and services give unique insights into the efficacy and value for money of such services. We also understand the impact of different life events, including changes to contact, other children joining or leaving the placement, or school exclusion – as well as the more recent impact of the coronavirus and related restrictions on the mental health of children in Care.
3. Data Protection and Team expertise
BERRI has been carefully designed with stringent data protection, which is why it is widely used in secure units, NHS and Local Authority services. BERRI does not record “personal data” about the children (as defined by GDPR and the Data Protection Act). This means BERRI records are anonymous strings of numbers that would be worthless to a hacker, even though carers and professionals can identify which record belongs to the child they are working with and produce individualised reports about them. BERRI staff are all DBS checked, and the clinicians behind BERRI have full professional accreditation and HCPC registration.
Dr Silver, the consultant Clinical Psychologist who designed BERRI is a national expert in the mental health of Looked After Children. Her book “Attachment in Common Sense and Doodles” is highly regarded, and she has written and contributed to numerous policy documents. She gave evidence to a recent government select committee on children’s social care. Dr Silver has led both NHS and multi-agency specialist CAMH services for Looked After and adopted children, and delivered a nationwide service development program within a major children’s residential care provider, training over 1000 staff, as well as designing and delivering a psychological care pathway for the service. She has also completed more than 250 expert psychological assessments of children and families for the family courts, and authored best practise guidelines for practitioner psychologists working in this context.
4. The evidence for BERRI
a) Improved outcomes for vulnerable children:
Scores improve by an average of 14% over the first six months of using BERRI. Carers consistently report understanding the children better and feeling more supported in their role. Concerns are identified earlier and crises can be averted. By identifying needs effectively more children get the opportunity to live within families, and there is a reduction in placement breakdowns. Improved mental health and more stable placements are likely to lead to more positive outcomes in adult life.
b) The benefits to commissioners:
Our pilots have shown local authorities can potentially save up to 20% of their residential care budget by using BERRI. This is primarily because of the opportunity to identify “step-down” candidates who can be moved from residential to family-based placements. This typically saves £120,000 per child per year - with savings realised within the same financial year and often lasting for the remainder of the child’s care journey. There is also the opportunity to contract differently with specialist/residential placement providers, building in periodic reviews in which the child can progress towards family care and/or using payment-by-results elements or renegotiating costs for children who are well-settled and no longer in crisis or requiring enhanced staffing ratios.
BERRI can also help with sufficiency planning by mapping the needs of the population in (and at the edge of) care, and helping to identify the services and placements that can address children’s needs most effectively.
It can also compare the efficacy of different providers or interventions in terms of the value added compared to the cost - some providers help children to change 3 times as fast as others!
BERRI can help to prevent placement breakdown and carer attrition, helping carers to feel supported with insights about the child’s needs and how best to care for them. We have very high levels of user satisfaction from professionals and carers, and coupled with training and consultancy our services have been described as “life-changing”, “extraordinary” and “the most useful input I’ve had in 13 years of doing this work”.
5. The opportunity
The current cost of an annual BERRI subscription for a public sector or non-profit organisation is £200 per child. Whilst this is significantly cheaper than a psychological assessment or a course of therapy, and insignificant compared to the cost of a foster placement, let alone the £150,000+ cost per child for most placements in residential care, we are well aware that public sector budgets are overstretched and any new money is hard to find.
However, we have been asked to submit a proposal for a project where BERRI will be implemented with an additional psychology service across several partner local authorities. If the proposal is funded, we will launch projects with local authorities between April and September 2022, and they will each run for 18 months. The service will include full funding for the implementation. That means each site will have funding for:
- a BERRI subscription for use with every child (including training, onboarding and technical support)
- a fieldworker to support the roll out of BERRI
- a project lead in the local authority commissioning service
- a project lead in the local authority social work service
- some project lead time plus a qualified clinical psychologist, assistant psychologist and therapist in the psychology service (which can sit in the local NHS trust, or in the local authority, or be delivered by us)
- all evaluation costs, as there will be an independent evaluation commissioned
We will also provide FREE project support. We will provide briefing sessions for local leads within your agency to help plan the project. Partner local authorities will receive access to our online BERRI training materials, unlimited technical support, practical on the ground support from our project field workers to implement the project in your locality, plus an evaluation report showing the needs of children in your care and the degree to which these are being met by current placements and services.
BERRI is very simple to use. Our walkthrough training video takes only ten minutes and is sufficient for users who have never seen the system before to complete the questionnaire reliably and gain the benefits of the various outputs available. Prior projects have shown that the staff time commitment is about 60-90 minutes per child over the course of the year, and this is more than repaid in the high quality reports that BERRI produces, which can be printed on your letterhead, used in LAC reviews or referrals and form part of the child’s records. Every service that has used BERRI has concluded that it saves time for professionals rather than taking time, as well as making the data you enter immediately useful - unlike the experience of other outcome measures!
6. Project Design
The project design is to evaluate the use of BERRI to identify and support psychological needs of children and young people across your children's social care service. The funding allows us to work with any child with a social worker, so you can use it with children in need, children at the edge of care, children in care, adoption, SGO/kinship, care leavers, SEMH, SEND etc.
All children will have a BERRI completed about them at 6 time points (every 3 months). During the first 12 months, half of the carers and professionals will receive the BERRI reports and be able to see the charts and tables to map their progress, whilst half will not (we hope to open up the access to everyone after 4 time points). Of those who get to see the BERRI reports and tools, 20% will get access to an additional psychology resource that will be providing training, consultancy and where necessary detailed assessments and direct therapeutic support for the young people.
As well as BERRI data, the project requires anonymous data about the type and cost of placement, services provided, the age the child entered Care and the number of past placements for all participating children, along with information about any placement breakdowns. There will also be an independent evaluation, which will require some information about the children, and some feedback from carers and professionals about the impact on practice.
The primary aim of the project is to improve the mental health of children known to social care. However, based on our pilots we believe it can also reduce the numbers of children needing to come into Care, reduce the numbers of placement breakdowns, and identify and support step-downs from residential care where this is possible – saving considerable amounts of money (our prior pilots have saved over £2million per authority). We also hope to improve outcomes in adult life for the children, by meeting their mental health needs earlier and giving them a more positive journey through care where this is required. We will also gain lots of information about the psychological needs of the children known to social care, what is working well, what are the risk and resilience factors for placement breakdown, and whether additional psychology input can help to improve outcomes. We hope to use this data to improve outcomes for all children known to social care.
7. How to apply
We expect a high level of interest in this offer, and we must note that places are limited and will be allocated on a first-come-first-served basis to local authorities who sign up to the project (see below).
Please complete this to formally express your interest in the project.
If we are successful in securing funding, which we will hopefully know before xmas, we will then need to formalise the partnership before we submit your details to the funder. At this point we will email you a copy of your survey answers in the form of a contract to be signed by a senior manager. This signed contract must be emailed to us before we sign off the formal funding offer.
We will determine project partners on a first-come-first-served basis, depending on the suitability of your application. In event of multiple suitable expressions of interest, the funder has given us guidance to prioritise partner authorities in the North/Midlands, or from rural areas with high social deprivation.
Please remember that we can only partner with up to 3 more local authorities and we need to have the expression of interest completed by Wednesday 4th August to consider you as a potential partner in our bid.
Thank you for your interest and we look forward to working with you to improve outcomes for vulnerable children in your area.
Note: This funding would be for a project starting between April and September 2022, so it would follow after the Innovate project for any authorities participating in that project (in which case we would be willing to defer the commitment for paid subscriptions).