Systematic ReviewsSystematic reviewsHigh Cost High Harm Systematic REA
A systematic rapid evidence assessment: interventions to improve the coordination of service delivery for High Cost High Harm Household Units (HCHHHU)

What do we want to know?

Between June and August 2006 the EPPI–Centre and the Government Social Research Unit completed a Systematic Rapid Evidence Assessment (SREA) for HM Treasury.

We want to know whether, for families with persistent multiple problems spanning more than one generation, improving the coordination of service delivery improves family outcomes.

Who wants to know and why?

Budget 2006 announced the Children and Young People’s (CYP) Review, to be led jointly by HM Treasury and the Department for Education and Skills. The CYP Review was tasked with considering how to embed the three principles identified in Support for parents, the best start for children – rights and responsibilities, progressive universalism and prevention – to improve outcomes for children and young people. One strand of this Review focused on the subgroup of families and children who are at risk of becoming locked in a cycle of low achievement, high harm and high cost

What did we find?

The volume of literature identified indicates that improving service coordination is a common feature of service development across the public sector internationally. However, there appear to be comparatively few evaluations of initiatives that seek to coordinate services for the particular subgroup of interest. Those studies that were identified were mainly of ‘low’ quality, reducing confidence that the results can be attributed to the initiative evaluated. Two higher quality studies suggest that such interventions improved school attendance and attainment but the costs and benefits of such approaches do not appear to have been rigorously evaluated, nor is it clear how generalisable these findings are.   

How did we get these results?

We searched a number of bibliographic databases and did a limited search for unpublished literature. We identified 3,441 papers of which 89 were identified as meeting the initial inclusion criteria. Of these papers 28 reported linked studies and 7 were unobtainable; 54 studies were coded for the map. Papers were published between 1994 and 2006, with 45 (83%) published from 2000 onwards. An additional criterion was applied to these studies to identify only those studies in which the participants were families in which multiple problems spanned more than one generation of family members of secondary school age or above. Ten studies meeting this criterion were included in the in-depth review.

What are the implications?

The results do not provide evidence to either support or refute the claim that improvements in service coordination will improve outcomes for the targeted group. The apparent paucity of robust empirical evidence in this area suggests that the main implication of this review is that any policy or practice initiatives of this type should be accompanied by rigorous evaluation.

The EPPI-Centre’s reference numbers for these reports of this review are 1508R (Report) and 1508T (Technical Report). The full citations is:

Newman M, Bangpan M, Brunton J, Tripney J, Williams T, Thieba A, Lorence T, Fletcher A, Bazan C (2007) Interventions to improve the co-ordination of service delivery for High Cost High Harm Household Units (HCHHHU). A systematic rapid evidence assessment. In Research Evidence in Education Library. London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London.

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