• By Dartington SRU
  • Posted on Monday 04th July, 2011

System contact does not equal service provision

Many children are referred to public systems, such as child welfare, juvenile justice or mental health services, but relatively few get anything more than an assessment. Yet the distinction between service contact and service provision is often lost in research that investigates the outcomes of children in contact with services. And, since the outcomes of children in contact with services are often so poor, this muddle should be particularly worrying for system leaders and policy-makers. To illustrate, approximately 1.6 million children have court petitions for delinquency in the U.S. each year, says Melissa Jonson-Reid, Professor of Social Work at Washington University. Of these 1.6 million, 43% are put on probation, 22% are placed out of home in detention or some other facility, and 15% are placed in an out-of-system program, pay a fine or do community service. Aside from the fact that the large proportion on probation may receive no service other than monitoring, what about the other 20% who presumably receive no form of intervention? One study cited by Jonson-Reid even places the proportion of girls receiving any form of intervention after their contact with juvenile court at a measly 13%. Similar pictures emerge for those children in contact with child welfare, mental health or special education services. For example, despite rising numbers of children designated as “emotionally disturbed” and requiring special education, only 60% of schools provide any form of psychological intervention, the quality of which is extremely variable. Visible contacts and invisible provisionSo why does this lack of distinction between contact and services provision matter to policy? Jonson-Reid argues that system contacts are visible statistics to policy-makers, while the day-to-day decisions about subsequent routes to service provision are invisible. This conflation of service contact and service provision has the effect of obscuring the effect that public systems have on child outcomes. The consequences are twofold. First, if the high number of visible contacts is confused with the much lower level of service provision, it looks as if children are not underserved. Yet epidemiological data show that children are indeed vastly underserved by public systems. Second, the confusion makes it look as if serves are ineffective. A large number of children appear to have been served, but the overall outcomes look relatively minimal. In fact, good information about outcomes following service provision is very hard to come by. Three areas for improvementSo what is to be done? Jonson-Reid suggests three areas for policy and research improvement. First, public systems and researchers need to get smarter about mapping service provision rather than system contacts. “Services research has not yet reached the stage where sufficient information is available to bridge the gap between policy makers and local system functioning,” she says.Second, public systems need to share and make available information about referrals within and across public agencies and to smaller non-profit, community-based interventions. There needs to be greater clarity surrounding the flow of children in, across and out of services.Third, once children can be effectively followed through systems, it is important to link service participation to relevant outcomes. Jonson-Reid argues that in the past, public systems were reticent to monitor outcomes of children following service provision, for fear that they would be held accountable for improvements in outcomes that systems were not originally designed to address. But times are changing. The functions of public agencies have morphed and changed since their inception. Pressure from policy, the evidence-based movement, greater inter-agency working and a financial climate demanding greater accountability for scarce resources are driving change. Wide-scale system reform and more open data systems are now needed to allow policy-makers to see through the murky waters of system contact and service provision. Reference:Jonson-Reid, Melissa. 2011. “Disentangling system contact and services: A key pathway to evidence-based children’s policy.” Children and Youth Services Review 33: 598-604.

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