The Mismatch Between Needs and Services

Introduction: It is generally hoped that targeted services for children and young people are provided to those that need them. However, it has long been hypothesised that this may not necessarily be the case. The research team has explored this issue over many decades and is now able to report on robust empirical data on children’s well-being, service use and the degree to which services meet needs.

Methods: We have contributed to the development of a suite of survey instruments designed to measure the well-being of children and young people at a local population-level. Survey instruments are comprised of standardised and valid instruments that produce reliable indicators of children’s physical and mental health, behavioural and social development, as well as a wide range of associated risk factors: contexts or experiences in the home, school, peer or community environment that increase the likelihood of poor outcomes.

These survey instruments were administered to all children aged 9 to 15 in all state schools across three local authorities in Scotland (n = 26,100; with a 86% response rate). These survey data were then confidentially matched to existing administrative data on service use (child welfare, youth justice, special educational support or mental health services).

Results: We drew thresholds to identify the proportion of children from across the local population – not just those in contact with services – that had high levels of need (i.e. multiple likely impairments to their health and development). Across the three local authorities the proportion of children in this ‘high need’ group was approximately 23%. The proportion receiving targeted services was approximately 12%. The proportion of those in the ‘high need’ group that were receiving targeted services was approximately 26%.

Implications: These data have profound implications for policy and practice. They indicate that the level of high need within a population is likely to be far greater than public systems have the capacity to meet. Strategies to mitigate this situation include: (a) greater investment in prevention and early intervention to reduce the proportion of children within a population with high need; (b) a better alignment of existing targeted services to meet the needs of the population, either by expanding reach of services (which is unlikely in the current economic climate) or by more effective processes to ensure that the limited resources of services are targeted to those most in need.