Evaluating Services & Expenditure in Social Sectors Approaches supported by The Atlantic Philanthropies Gail Birkbeck Feb 1, 2013

2 o Introduction to The Atlantic Philanthropies o Evaluation at Atlantic o Some examples Overview

3 o Atlantic has made grants to advance opportunity and lasting change for those who are unfairly disadvantaged or vulnerable to life's circumstances. o A limited life foundation, we make grants through our Ageing, Children & Youth, Population Health and Reconciliation & Human Rights Programmes. o We are active in Bermuda, Northern Ireland, Republic of Ireland, South Africa, the United States and Viet Nam. o We have made grants totalling over $6.1billion o At the heart of our work is the belief that all people have the right to opportunity, equity and dignity. About Atlantic

4 o Informing strategy and implementation o Assessing impact and context o To enhance capacity, facilitate learning and share knowledge Evaluation and Learning - Purpose

5 o Grounded in questions critical to understanding effects and impact o A ranges of methods are used o Different level of analyses – individual, community, programme, Atlantic, philanthropy o Some approaches are more helpful in the early development stage, others more suited to ongoing programmes, others still where information is needed quickly Evaluation Design and Approaches

6 Children & Youth Programme Promote Prevention & early intervention o Demonstrate effective practice leading to policy reform o Inform and influence policy and practice o Develop capacity & infrastructure for the sector International trends towards increasing emphasis on prevention strategies to cost-effectively address social problems

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12 o Selecting services based on the evidence of specific community needs o Selecting services models or interventions with evidence of effectiveness o Testing their effectiveness in local communities Evidence-based Service Design

13 o Significantly improves teachers’ competencies and their management of disruptive behaviours in the classroom. o Benefits pupil behaviour and socio-emotional adjustment. o Reductions in child conduct disordered and hyperactive-type behaviour. o In total, 71 per cent of children showed improvements in behaviour. o Parents reported reduced distress and improved well-being. o Substantial decline at follow-up in the use of primary care and social work services in the intervention group Incredible Years - RCT of Teacher Classroom Management and Parent Training programmes.

14 Sample (n=103) ServiceBaseline6 month follow-up12 month follow-up GP Nurse852 Speech Therapist24159 Physiotherapist Social Worker Community paediatrician530 SNA11 13 Casualty department (A & E) Outpatient consultant appointment Overnight stay in hospital786 Service Utilisation Proportion (%) using health and social care services at baseline and follow-up 12 Month Follow-On Report (IY Parent Teacher Programmes) McGilloway et al Positive changes in child and parenting behaviour were maintained at followup in the context of reduced support from primary health care and social care services.

15 Cost Analysis Calculating Costs of Individual Services o Unit costs for key services identified in the SUQ was collected o Cost of service use at the 12-month follow-up (€626.91) amongst the intervention group was reduced to 60% of baseline expenditure on formal services (€ ). Cost per child at baseline and follow-up (ITT) o Primary Care € €68.61 o Hospital Services € € o Special Education € € A cost-effectiveness analysis of the Incredible Years Parenting Programme in Reducing Health Inequalities ; O’Neill et al (2013)

16 o Ireland – Comprehensive Review of Expenditure (DCYA, 2011), detail on expenditure but does not account for Health expenditure o US - Urban Institute releases an annual report on child expenditure o 2011 federal expenditures rose overall but fell for children from 10 to 8% o UK - LSE reports on public expenditure on children in the UK - 'The way in which budgets are currently constructed across the UK makes it very difficult to identify what is actually spent on children…‘ o Trends - education, social security & social services Spending is being tracked although not connected to outcomes Accessing Cost Data

17 Palliative Care o A systematic review of palliative care o Patterns & Costs of deaths in Ireland o Cost and Cost effectiveness of alternative models of palliative care CARDI – Centre for Ageing Research & Development in Ireland TILDA Ageing Programme

18 o Track record of evidence based service design o Outcome and economic data in social services o Communication of results o Evaluation findings influenced our programmes o The findings and lessons from our work will be one of our most tangible legacies In conclusion