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LGAreport Date:March2018-December2018

Localauthority:LondonBoroughofCroydon

Submittedby:CroydonBehaviourChangeHub

Projecttitle:AbehaviouralapproachtomanagingdemandinSpecialEducationalNeedsTravelServices:IncreasinguptakeofIndependentTravelTraining

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Contents Page

Synopsis 3

Challenge 3

Approach 5

Define&Diagnose 5

LiteratureReview 6

FieldResearch 7

KeyInsights 8

AnalysisofAlternativeTravelOptions 8

Design 8

Solution 9

TrialDesign 10

Results 11

Impact 11

Sustainability 13

LessonsLearned 13

References 15

Appendix 16

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Projectsynopsis:

TheCroydonBehaviourChangeHub(BCH)workedwiththeSENtravelteamtodevelopandtrialabehaviouralapproachtoreducingdemandforcouncilprovidedtransport.

Thetargetwastoincreaseuptakeofalternativetravelprovisionstoenabletheservicetomoveawayfromamodelofrationingneedthrougheligibilitycriteriaandstatutoryduties,andtowardsamorefinanciallysustainablepreventativemodelcentredonempoweringyoungpeopletodevelopresilienceandindependence.

BehaviouralinsightswereappliedtocommunicationsandaRandomisedControlTrial(RCT)testedwhetheritwaspossibletoincreaseIndependentTravelTraining(ITT)referralsfromSchools.Whilstthetrialitselfshowednostatisticallysignificanteffect,theservicesawalargeroverallincreaseinexpressionsofinterestinITTthanpreviouslyforecast.

Thechallenge:

Aswithmostlocalauthorities,Croydonhasseenasignificantincreaseoverthelastthreeyearsinthenumberofchildrenpresentingwithadditionalspecialeducationalneedsanddisabilities(SEND).Asthepopulationoftheboroughcontinuestogrow,thenumberofyoungpeoplewithEducation&HealthcarePlans(EHCP)isincreasingbyanaverageof5%p.a.,whichishigherthantheriseintheschoolpopulationasawhole.DemandfortravelsupporthasalsobeenincreasingasaresultofthenationalSENDcodeofpractice2015,whichextendedentitlementstolearninguptotheageof25.WithoutthesuccessfulimplementationofrobustalternativetraveloptionstheCouncil’sannualspendonSENDtransportwouldincreasebyaround£425,000peryearandlikelyexceed£10millionwithinthenext5years.

Totacklerisingcostsandanoverspendagainstthebudget,theservicedevelopedalong-termplanofdevelopingandgrowingtwoalternativepathways:IndependentTravelTraining,whichinvolvesatraveltrainerteachingachildtotravelindependentlyandPersonalTransportBudgets(PTB),whichinvolvespayingasetamounttoparents/carers/youngpeopletoarrangetransportforthemselves.Bothpathwaysprovidesignificantcostsavingsincomparisontodirectcouncilprovidedtransport,withsavingsof£605,000forPTBand£300,000forITTfor2017/2018.

However,therearecaveatstothesefigures:Firstly,inorderforthefullvalueofthebenefitstoberealised,thePTB/ITTmustreplacethedirecttransport.Thisisn’talwayspossibleasdirecttransportisoftensharedbyotherchildrenontherouteandregularrouteoptimisationisrequiredtorealisesavings.Secondly,thelargerpotentialsavingsfromPTB,comparedwithITTarebasedon(a)theassumptionthatstudentscanbeshiftedtoPTBataveryearlyagewhereasITTisonlysuitableforsecondaryagepupils;(b)savingsfromITTarelessintheshort-term,becauseoftheinitialinvestmentrequired,butgeneratesimilarlevelstoPTBsoverthelong-term. DespitecommercialisingtheITTofferandgeneratingahealthyinterestinITT,thecurrentprovisionisoverwhelminglyloadedtowardsprovidingdirecttransport,withonly7%ofstudentswithPTBsand5%takingupITT.Whilstsomestudentsmustreceivedirecttransportbecauseofhighlevelorcomplexneeds,asignificantproportionhavethecapabilitytomakeuseofalternativeprovisionsbutarereluctanttodoso.

Acriticalsuccessfactorfortheservice’salternativepathwaysistheteam’sabilitytoembedtransformationalchangeatasystemswidelevel.Thisrequiresgainingbuy-intoapreventativeapproachfromotherteams,partnersandreferrersinordertochangecustomers’behaviourtoapplyingforITTand/orPTBinsteadofdefaultingtodirecttransportapplications.

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Toachievethis,theservicerequiredacriticalshiftinmindsets,beliefsandbehavioursacrossallstakeholdersandatalllevels,inrelationtodecisionsaboutaSENyoungperson’shome-to-schooltransportprovision.

Therefore,thechallengeforBCHwastohelptheserviceidentifyareaswheretheycoulddevelopabehaviouralapproachoroptimiseexistingwaysofworkingtoinfluencedecision-makingaroundtravelprovisionchoices.

BCHwassettheobjectiveofchangingmindsets,beliefsandbehaviourstohelpre-calibrateexpectationsaboutSENtransportprovisionandchangereferralbehaviourthroughoutthejourneyfromtheCouncil’sfrontdoortoserviceuserchoices.

1,3221,687

761

558

77

75

971

712

98

96

SEN Transport: The challenge in numbers

£ 7.4 mil £ 9.5 mil5 yr expenditure growth

SENtravelsupport–overviewbyyear 2015/16 2016/17 2017/18No.SENstudents 2406 2691 2783

Receivingsupport 1200 1211 1244

Directtransport

112147%*

112742%*

115641%*

ITT 411.7%*

562.1%*

632.3%*

PTB 793.3%*

843.1%*

883.2%*

TotalSpend £7.0m £7.6m £8.2m

*PercentageofNo.ofSENstudents

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TheApproach:

Theprojectfollowedaniterativemulti-stepapproach,asshownbelow:

*A/Btestingisamethodofcomparingtwoversionsofawebpageorappagainsteachothertodeterminewhichoneperformsbetter.ABtestingisessentiallyanexperimentwheretwoormorevariantsofapageareshowntousersatrandom,andstatisticalanalysisisusedtodeterminewhichvariationperformsbetter.

*AnRCTisastudyinwhichparticipantsarerandomlyassignedtothecontrolorinterventiongroup.TheRCTisthemostscientificallyrigorousmethodoftestingavailable,andisregardedasthegoldstandardtrialforevaluatingtheeffectivenessofinterventions. 1&2DefineandDiagnose

BCHconductedaresearchprogrammeandbehaviouralaudittoidentifypainpointsandbottleneckspreventinguptakeofalternativepathways.Activitiesduringthisphaseareillustratedbelow:

DEFINE DIAGNOSE DESIGN TEST

Map service users pathways

Gatherintelligence:• Dataanalysis• Userinsights• Observations• Journeymaps

• Biases• Bottlenecks• Opportunities• Targetbehaviours

Interventiondesign• Co-design• Prioritise

• MeasureimpactØ A/Btesting*Ø RCT’s*

• Iterateandimprove• Implement&Adapt

Learn,Iterate&Adapt

TheBehaviourChangeHubModel

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Desk-basedResearch–LiteratureReview

InthisliteraturereviewwesummarisepreviousworkonapplyingbehaviouralinsightstoSENtravel.Thereappearstobeonlytwopreviousprojectsinthisarea:

Momen(2011)describesbehaviouralinsightsworkcarriedoutfortheCroydonSENtravelassistanceprogramme.Theaimoftheprogramme,whichstartedinApril2011,wastotransformhometoschooltravelbyofferinggreaterchoiceandcontrolforfamiliesandsupportingandencouragingtravelindependenceofchildrenandyoungpeoplewithSENaspartoftheirwiderlifeskillsexperience.Theprogrammetappedintotheenergyandenthusiasmofparentstodesignanddeliverbehaviouralchanges.

Keyactionstakenbythecouncilaspartofthatprojectwere:

• Establishinganindependenttraveltrainingservice,workingwithschoolstoidentifyyoungpeoplewhoaresuitablefor1:1traveltraining,withtheaimofthemtravellingtoandfromschoolindependently

• Pilotingpersonaltransportbudgets-givingfamilieschoiceandcontrolovertheirchild’shometoschooltravelarrangementsandflexibilityinhowtheycanusethemoney.

ProjectedfinancialsavingsfromtheSENtravelassistanceprogrammewereintheregionof£870,000overthreeyears,14percentofthebasebudget.

AbehaviouralchangemodelwasusedtoassessthevaluesofparentswhosechildrenuseSENtransportandtodevelopabetterunderstandingofthemasacustomergroup.Theseinsightswereusedtotailorcommunicationsandinformthedesignofalternativeoptions.

AsimilarprogrammewasundertakenbyiMPOWER(2011)forCoventryCityCouncil.Thisprogrammesetouttoradicallychangethecouncil’sapproachtoSENtransportandtherelationshipswithparentsandcarers.Itsoughttounderstandtheparentcohortbetter,communicatewiththemmoreeffectively,re-emphasisetheirresponsibilitiesandincentivisethemtobecomemoreinvolvedintheirchild’straveltoandfromschool.Theaimsoftheprojectweretoreducetransportdemandandrelatedcostsforthecouncilandtoimprovethequalityoflifeforthechildrenandparentsinvolved.

Overviewofcurrentcouncilprovisions,understandserviceuserpathwaysandoperationalprocesses

ProcessmappingDeskresearch FieldresearchStakeholderinterviews• Jobshadowing• Processmaps• Userjourney

Toidentifytheinternalprocesses,paintpointsandbottlenecksthatleadtodifficultyinmanagingdemand

Why?

• Policiesandpastresearch• Establishbaseline• Literaturereview

Why?

• Widerteams&partners;• SENteammanager&

Coordinator,• Schools• SENCOandFamilySupport

Officer

Tounderstandtheuserjourneyandprovideanoverviewoftheoveralluserexperience,anddevelopmentalmodelsofserviceusers

Why?Why?Tounderstandthekeyinfluencersinthisprojectwhomakereferralsorinfluenceparentsandyoungpeople’sdecisions

• Promotionalevents• Travelplanningmeetings• ITTmeetings• 1-1interviewswithparents

Identifyingtheproblem– ResearchProgram

DataAnalysis• Scopeofinfluence• Usersegmentation• Quantifybarriers&impact

Why?Toidentifybottlenecksininformationprovisionandapplicationprocessandidentifypotentialforimprovement

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Akeyandinnovativeaspectofthisworkwastheintroductionofthe‘ValueModes’behaviouralmodelthatsegmentedparentsintodifferentattitudinalgroups.

Keyinsightsfromthisworkincluded:

• Theimportanceofnothavingtheone-size-fits-allmodelandunderstandingthedifferentnatureoftheclientgroupandbreakingthatdown

• Ensuringthatallthestakeholdersworktogetherandsharedinacommonpurpose

• TheimportanceofembeddingthechangesintheSENteam’swayofworking.

Theprogrammewasexpectedtogeneratesavingsofaround£550,000p.a.onanannualbudgetof£4.5m.

ThisprojectaimedtobuildontheearlierpioneeringworkinCroydontoincreasetheshiftfromtraditionaltoalternativetravelinordertomaintainmomentumintermsofmanagingdemandandcosts.Italsosoughttopickupontheneedtoputthechildatthecentreandpromoteindependenceandimprovedlifechances,inlinewiththecouncil’sincreasingfocusonpreventionandearlyinterventionstrategies.

FieldResearch

ByembeddingaBehaviourChangeConsultantintotheSENTravelTeam,conductingethnographicresearchwithawiderangeofstakeholdersandengagingwithserviceusers,BCHwasabletomaptheprocessfromtheperspectiveofmultipleserviceusersincludingstaff,partners,carers/parentsandyoungpeopleinordertoidentifygaps,painpointsandopportunitiesforchange.OurinitialresearchrevealedthatthestandardreferralprocessforITTinvolvedsixkeysteps.Fromanalysisoftheprocessesinvolvedineachofthesestepsweuncoveredseveralfactorswiththepotentialtoundermineeffectivenessofeachstep.Thesearesummarisedinthereferralmapbelow.

Thereferralmapalsohighlightsthefrustrationsadedicatedteamcanexperienceasaresultofresource,capacityandtechnologylimitations,andtheabsenceofastandardisedandstreamlinedapproachtoservicedesign.

Overview of current council provisions and the socio-economic trends that impact their appropriateness.

• Desk research- policies and past research

• Establishing baseline through open source data

Why?

Define – desk research

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KeyInsights

Themainpain-pointsidentifiedbytheresearchwere:

• Assumptionfromtheservicethatschoolsandparentshadgoodknowledgeaboutalternativeprovisionswasnotverified

• Lowlevelsofawarenessandknowledgeamongstbothparentsandschoolsdespiteextensivecampaigns,suggestingabiasedsampleof‘engaged’parents/schoolsParents:

- Sampleofparentscontacted,knewlittleabouttheexistenceofITT- ParentsreferredbyschoolsknewofITTexistencebutlackedunderstandingofhow

itworkedSchools:

- GapsinunderstandingaboutthereferralprocessfromSchools- AbestpracticeschoolinterviewedexhibitedknowledgegapsabouttheITTofferand

itsbenefitsforpupils• Difficultiesinnavigatingwebsite• Userissuescompletingtheonlineformanduserdropout• Perceptionthatteacherslackedmotivationwasnotborneoutbytheresearch–

independencewasastatedcorevalueofschoolssampled

AnalysisofAlternativeProvisionOptions:

AcomparativeanalysisofthecostsandbenefitsofITTandPTBprovisionswasundertaken.OnthebasisofthisanalysisITTwasdeterminedtobethepreferredpathwayfortheRCTforthefollowingkeyreasons:

• PTBrequiresadditionallayersofethicswhenconsideringarandomisedcontroltrial,giventhathandingoverafinancialbudgettooneindividualinthehouseholdmightleadtounintendedconsequencesshouldthebudgetholderhavelowfinancialliteracyorinappropriateintentions,suchasusingtheprovisionasaformofcontrolagainstothermembersofthehousehold.

• ITTisexpectedtogenerateabiggerROIthanPTBoverthelonger-term• Sustainablebenefits• Promotesindependence,increasedself-esteemandconfidenceprovidingyoungpeoplewith

valuablelifeskills• Empowersyoungpeopletomakepositivechoicestowardstheirownselfdevelopment• Fostersagrowthmindsetwhichiscorrelatedwithacademicoutcomes• ITTisbetteralignedwiththecouncil’swiderstrategicfocusonprevention/earlyintervention

measurestomanagingdemandonservices

3.Design

BCHworkedwiththeservicetoidentifyarangeofopportunities(seetablebelow),whichwereanalysedusingtheAPEASEframeworkfromtheBehaviourChangeWheel(Michieetal,2014)toassesspotentialideasforaffordability,practicability,effectiveness,acceptability,safetyandequity.Followingthefeasibilityanalysis,theopportunitieswereprioritisedusingtheMoSCoWmodel(Must,Should,Could,Won’thave - https://www.projectsmart.co.uk/moscow-method.php),todeterminequickwinsandlongertermgoalsatbothasystemandbehaviourallevel.

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Themainfindingssuggestedthegreatestbehaviouralopportunitieswereinoptimisingcommunicationsatvarioustouchpointsthroughoutaserviceuser’sjourney,fromtheCouncil’sfrontdoortothepointofapplyingfor/acceptingtransportsupport,withafocusonearlyengagement.Thegoalofoptimisingcommunicationswouldbetogenerateincreasedawarenessofthealternativeoffers,providemorecomprehensiblematerials,reducedropoutofformcompletionandinfluencedecisionsinordertoincreaseuptakeofalternativeprovisions.

Thefinallistofinterventionopportunities,alongsidethedesignanddeliveryofasuiteof behaviourallyinformedcommunicationstoimproveuptakeofITT,included:

- BehaviouralinsightsworkshopstoupskillstafftoapplyBItocommunications

- Revisionoftheapplicationprocess,includingredesignofapplicationform,usingBI- RevisionandredesignofthewebsiteusingBI

- LeafletredesignofITToffer,tobeusedbothformarketingandasaconversationguideduringconsultations

- IncreaseawarenessofITTofferinschoolstoincreaseappropriatereferrals- ITTreferralinvitationcampaign

Itwasrecognised,however,thatwithinthetimescaleandbudgetoftheproject,realisticallyitwouldonlybepossibletotrialoneoftheseinterventions.Whilstwerealisedthatdesigningandsimultaneouslyimplementinganumberofinterventionsmightcloudmeasurementfortheinterventionchosenfortrial,webelievedthatincreasingITTuptakebywhatevermeanswasagreatergoal. Solution:

Contentdesignforbehaviouralpromptsacrossthesuiteofcommunicationsincludedsomeofthefollowingevidence-basedinsights:

Intervention Ideas Aaffordability

Ppracticability

Eeffectiveness

Aacceptability

Ssafety

Eequity

Ssustainability

MoSCoW

Training all SEND children across the borough ü W

Identifying eligibility for ITT using data ü S

Targeted communications to parents ü ü ü ü ü C

BI scripts for 1-2-1- parent visits ü ü ü W

Targeted communications to teachers ü ü ü ü ü ü ü M

BI scripts for 1-2-1 school visits ü ü ü ü C

ITT suitability decision trees for teachers ü ü ü W

ITT suitability decision trees for service ü ü ü ü ü C

ITT suitability questionnaire into EHC review documents ü ü ü ü W

Including ITT suitability check box promptinto EHC review documents ü ü ü ü ü ü ü M

Align co-ordinated ITT/PTB approach across all teams from council front door ü ü ü ü ü S

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4.Test-Trialdesign:

Forthetrial,theITTinvitationtoschoolswasredesignedusingbehaviouralinsightswithaviewtoincreasingthenumberofexpressionsofinterest.

DesigninganRCTprovedchallengingduetotheverysmallsamplesizes,ad-hocreferralsandinconsistentdatasets.Basedonfeasibility,anemailITTinvitationcampaignwasdesignedforthepurposesofanRCTtotestwhetherbehaviourallyinformedemailscouldincreasereferralsfromschools.

ThesamplesizefortheexperimentwascalculatedutilisingthepreferredmethodforperformingapoweranalysiswithcategoricaldataasspecifiedbyCampbell,Julious,Altman(1995).Althoughtherewasnorigorousdataavailabletoestimatethelikelyresponseratesofschools,anestimate

Behavioural insights to optimise ITT uptake

Social Effects (minority influence) Send letters to schools that are under referring pupils for ITT: ‘You are not referring pupils to ITT, whilst other similar schools in Croydon are’‘To help you decide who can benefit from ITT you can try…’

â3%

73,406

Evidence of Social EffectsGP’s sent over-prescribing letters:‘You are prescribing more compared to your colleagues’‘As an alternative to prescribing Antibiotics you can try…’-

Making the Application EasyAttaching forms to the comms with email address to send them to can minimise perceived difficulty and confusion, encouraging referrals.

Evidence of Application EaseHMRC found that sending the user to the form instead of website increased tax return completion

Use of User Stories (prototype decision making)Using ITT success stories of children with complex needs can motivate teachers to refer.

Evidence of User Stories (prototype decision making)Parents of minority communities in the states were more likely to enrol their children in school if they were contacted with stories of similar families with children successfully enrolled.

Minimising risk perceptionInforming teachers that the risk the child faces is low can increase referrals

Evidence of Minimising perceived riskPeople are more likely to attend health screenings, if they are provided with statistics that demonstrate they overestimate mortality rate of the disease.

250 pupils

23 schools

23 schools Treatment Group

Control Group

Population SizeFrom 13,000 students, 600 identified within target age group.350 students excluded due to severity of need/distance to school. Therefore, population comprised 250 children across 46 schools.

Trial designAn invitation email was redesigned using behavioural insights with a view to increasing the number of expressions of interest for ITT from schools

Sample SizeA power analysis showed that a sample size of 30 would be sufficient but as the cost difference between running a trial on sample of 30 or the universe of 46 schools was minimal we decided to run the trial on the full universe in order to eliminate any possibility of sample bias.

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wasmadeat10%throughinitialinformalresearchanddiscussions.Subsequentlyaminimallyinterestingproportionalchangewassetto10%(i.e.anestimatedchangefrom10%to20%).Basedonthistherequiredsamplesizeforeachgroup(at80%poweranda5%significancelevels)was89.ThiswasthencorrectedforthesmallpopulationsizeusingtheformulaspecifiedbyIsrael(1992).Thecorrectionshowedthattherequiredsamplesizetobearound30.However,asthedifferenceincostsandefficiencybetweenrunningthetrialonthefull46schoolsandasampleof30wasminimalitwasdecidedtorunthetrialonthefulluniverseof46schools.

Theinterventionemail:

Results:

Followingimplementation,responseratesweremeasuredoveratwo-weekperiod.Thereweresimilarlevelsofresponsefromboththetreatmentandcontrolgroupsandsothereappearedtobenostatisticaldifferenceinthenumberofemailresponsesfromschoolsforthecontrolandtreatmentgroups.

ForcompletenessthedatawasanalysedusingaChisquaretestofindependencetoexaminetherelationshipbetweenthetreatmentandcontrolgroup.Therelationshipbetweenthesevariableswasfoundnottobesignificant,X2(1)=0.0,P=1.0.Inconclusion,therewasnosignificantdifferenceintheresponseratebetweenthecontrolgroupandthetreatmentgroup.

Impact:

FinancialBenefits

Althoughthetrialdidnotproduceastatisticallysignificanteffect,theservicedidexperienceagreaterthanexpectedincreaseinexpressionsofinterestinITT.DuetoservicecapacityconstraintsithasnotsofarbeenpossibletotranslatetheincreasedlevelofinterestintomoretangibleITTapplications.

Sincethebeginningofthetransformationprogramtheservicehasseenasteadyincreaseinthenumberofstudentstakingupalternativetravelsupportoptions,withacorrespondingdecreaseinstudentsreceivingcouncilprovideddirecttransport,whenadjustedfortheoverallincreasein

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studentswithEHCPs.Weestimatethatthecostavoidancesavingassociatedwiththisrelativereductioninstudentsreceivingdirecttransporttototalmorethan£1moverthelastthreeyears.

Thechartbelowshowsthedatafor2018/19todate,followingtheinterventionsimplementedinthisproject.Whilstthesenumbersdonotshowamajorchange,theserviceisexpecting,andplanningfor,asubstantialpickupinITTfor2019/20andbeyond.TheservicebelievesthatearlyinterventionsupportprovidedbythisprojectandotherinitiativeswillbekeytokeepingcostsundercontrolandpromotingmoreindependentlivesforSENstudents.

Non-FinancialBenefits

Inadditiontosignificantfinancialbenefitsandchallengingthetraditionalandinstitutionalisedcultureofcouncilprovidingdirecttransport,alternativetravelsupporthasmanyothernon-financialbenefitsforstudentsandtheirfamilies,suchas:

• Promotingandsupportingindependenceanduseofowninitiative

• Helpingyoungpeopleandadultstoachievetheirfullpotential

• Improvingthelifechancesofsomeofthemostvulnerablepeopleinsociety

• Openingopportunitiesforlearningandsocialinteraction;developingsocialskills

• Improvingjobprospects

• Providinggreaterfreedom–lessrelianceontheCouncil,friendsandfamily

• Raisingself-confidence

*AdjustedforoverallSENgrowth

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Sustainability

ThebenefitsoftheBCHapproachtoembedabehaviourchangeconsultantintotheserviceteamandco-creatematerialsinbehaviouralinsightworkshopsisthatitequipstheworkforcetoiterativelycontinuewithabehaviouralapproachattheendoftheproject.

Havingiteratedandrevisedcommunications,theteamhasimplementedafullsuiteofnewbehaviourallyinformedcommunicationsacrosstheresidentjourneyandtherippleeffectsareevidentinclienttestimonials:

‘Withregardstothetrainerhehasbeenreallypatient,expressedandempoweredmysonthroughhiswordsofencouragementandcontinuestoencouragehim.Heallowsmysontoreflectandtalktome,whentheymeettheydiscussandhegiveshimthatspacetogrow,whichisreallyimportantformysonandhowheprocesseshistraining.’

TheTravelteamhavealsocommercialisedtheirTravelTrainingofferandarehelpingtoleadthewayinhelpingotherlocalauthoritiesbenefitfromprovidingITTasapreventativealternativeSENtravelprovisionsothatotherLAsmightalsoindirectlybenefitfromthebehaviouraloptimisation.

AsadirectresultoftheincreasedinterestinITTtheserviceiscurrentlyrecruitingadditionalITTstaffinordertomeettheincreaseddemandexpectedoverthecomingyears.Inaddition,theserviceisintheprocessoflaunchinganinnovativenewtraveltrainerapprenticeshipscheme,whichwillbuildonthebehaviouralinsightsdevelopedandutilizedinthisproject.Theschemeshouldalsobeapowerfulconduitforhelpingtopropagatetheuseofbehaviouralinsightsmorewidely.

Lessonslearned:

Whistthetrialitselfresultedinnosignificantdifferencebetweenbehaviorallyinformedandcontrolemails,theservicesawasignificantincreaseinthenumberofapplicationsforITTduringtheperiodofsupportfromthebehaviourchangehub.Itshouldbenotedthoughthatthereweresomeotherfactorsthatmayhavealsocontributedtotheincreaseinreferrals.

Inparticular,theservicecameunderscrutinyin2015,withtheoverspendonSENtransportbeingbroughttotheattentionofcabinetmembers,whichresultedinaclearplanofactiontoadopt‘investtosave’earlyinterventionandpreventionmeasures.

Gainingbuy-inatleadershipleveltothisplanwasacrucialstepindrivingforwardearlyintervention/preventionstrategiesfortheservice.Itdemonstratedanappetiteforinnovation,whichfosteredacultureofagileprojectmanagementandcalculatedrisktaking.Italsodemonstratedthevalueofbeingpatientandwillingtotakealonger-termview,asthebenefitsfromearlyintervention/preventionstrategiesarerealisedoverthelongertermratherthanyieldingmanyimmediatebenefits.

Overthelast2-3yearsanumberofbehaviourallyinformedinterventionshavebeenimplementedandtheincreaseininterestthisyearislikelytobedueinparttotheseinterventionsbeginningtobearfruit,incombinationwitharaisedlevelofawarenessasaresultofourextensivecontactswithstakeholdersinthecourseofthisproject.

Otherkeylearnings/takeawaysinclude:

1. Engagestakeholders:Ensurestakeholdersatalllevelsareengagedwiththeprojectfromthebeginning

2. Agileapproachrequired,acceptinggoalsmightchangeasnewintelligenceand/orobstaclesarerevealed.Planprojectsovershorttimeperiodsandensuretheclientiskeptinformedandunderstandstherationalebehindchangesthroughouttheproject

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- Projectmanagement:Theprojectwasspreadoverayearinordertocarryoutin-depthresearch,toexploreawiderangeofpossibleopportunitiesandtorunarobustRCT;however,withhindsightthepaceofchangeexperiencedovertheyear(e.g.changingcorporateandservicepriorities/focus,staffturnover,fluctuatingdemand)resultedinchangingscopewhichhadaknock-oneffectonthegoalsandimpactofthetrial

- Inparticular,theoriginalgoalsandobjectivesofthisproject,namelytoreducecostsbymanagingdemandcameoutofa“ManagingDemand”programmethatwasacentralthemeofCroydon’sstrategicplanatthattime.Theadoptionofanewoperatingmodel,withitsincreasedfocusonpreventionandearlyinterventionmeasuresandshiftawayfromdemandmanagementprogrammesmeantthatprioritiesandfocusoftheservicechangedsignificantlybetweentheapplicationforfundingandinceptionofthisproject.AsBIprovidersBCHonlybecameawareoftheimpactofthesechangesincorporateprioritiesduringtheinitialscopingphase,aftertheprojecthadkickedoff

3. Conductapre-mortemtoidentifyrisksandplanmitigatingactions

- ServiceexperiencedunexpectedlyhighvolumeofrequestsforITTduringtrialimplementationphasewhichrequiredachangetoprojectgoals(fromincreasingITTreferralstoincreasingITTexpressionsofinterest,duetotheservicehavingnocapacitytodealwithanincreasednumberofreferrals);apre-mortemmayhaveidentifiedthisrisk

- UnexpectedincreasecouldhavebeenasaresultoftheHawthorneeffect(sometimesknownastheObservereffect),wherebyindividualsmodifytheirbehaviourinresponsetotheirawarenessofbeingobserved

4. Data&informationprovidedshouldbeindependentlyverified

OurresearchshowedthatthemainbottleneckstoITTuptakewerenotthesameasperceived‘apriori’(i.e.beforethefieldresearchwasundertaken)bytheclient

5. Usecustomerexperiencemapsandpersonastodemonstratepainpointsinexistingpractice

- Articulatingfeedbackcanbechallenging,asitcanbeperceivedasnegativeorcritical.Presentinginterviewfindingsbackduringworkshopsbyusingcustomerjourneymapsandcustomerpersonasallowsfeedbackofpainpointsinaclearandconstructiveway

6. It’simportanttoestablishdataavailabilityandqualityatoutset

- It’simportanttoestablishclearbaselinesandmeasuresofimprovement.Wheretherearedatagaps,thereshouldbeanappointedSROwithagreedcapacitytocreateandmanageanynewdatarequirements.Buildincontingency,intermsofresourcesandtime,tocollectandmanagekeydata

- Whenavailabilityandqualityofdataislimiteditsnecessarytoadoptapragmaticapproachwhendesigningtrials.

7. Importanttoagreewhatthepriorityisforbehaviouralscienceprojects

- Considerwhetherthegoalistogeneraterobustlonger-termevidenceorquickwinimprovements

- Someofthebiggestopportunitiesidentified,suchasoptimisingone-to-oneconsultationsbetweenserviceandparentswerenotsuitableforarandomisedcontrolledtrialduetothesmallsamplesize

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8. Projectgovernanceisimportant

- Getdirectorbuy-intoactifthingsgetstuckordelayed

9. Difficultiesanddisappointmentssometimeshavesilverlinings

- workwiththeserviceandusersoverasustainedperiodgeneratedunexpectedinterestinITT,reducingtheneedforBIinterventionsasgoalswereachievedindirectlythroughraisedawareness

10. Unanticipatedbenefits

- inadditiontolonger-termbenefits,theprojectwilladdvalueby(a)deliveringa“quick-win”ofhelpingtheservicetobettermanagefuturesupplyanddemand(b)deliveringkeyserviceimprovementsthroughupskillingstaffandoverhaulingITTcommunications

References Campbell,M.J.,Julious,S.A.andAltman,D.G.(Oct.28,1995).EstimatingSampleSizesforBinary,OrderedCategorical,andContinuousOutcomesinTwoGroupComparisons.BritishMedicalJournalVol.311,No.7013pp.1145-1148

IMPOWERCoventryCityCouncil(2011),https://www.impower.co.uk/wp-content/uploads/sen-transport-coventry-city-council.pdf

Israel,G.D.(1992).DeterminingSampleSize.UniversityofFloridaFactSheet MichieS,AtkinsL,WestR,TheBehaviourChangeWheel(2014)http://www.behaviourchangewheel.com Momen,R(2011),MakingBehaviourChangeWorkforCouncils

Contact:

AmyJones-amy.jones@croydon.gov.uk

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Appendix

Selected extracts from qualitative research – interviews:

Persona of typical pupil referred Who refers?

Independent Travel Training

More Independence

Lower Costs

Early Intervention

Parents ….HecantellyoutheroutetoLondon.(But)Hewillgivehispackedlunchtoabeggarifhesaysheishungry.

Iworryaboutpeoplethatmightwatchhimandrealiseheisvulnerableandtakeadvantage

What’sitfor?

Knowledgegaps

Presentdaybias

Riskavoidance

TeachersSowheredoIgetthereferralform?

Parentsareoftenscaredtolettheirchildintothe'bigwildworldonhisown

Councilneedtobefirmerwithfamilies

Knowledgegaps

Diffusionofresponsibility

Punishmentavoidance

Typical Pupil Referred

Hey!I’m Chris and I am 16 years old.

Top Three Needs

• Autism Spectrum Disorder

• Moderate Learning Difficulties

• Mental Health and Behavioural Difficulties

ITT Referrals

Eligibility Criteria

ü Is their journey to school over 3 miles?

ü Are they over the age of 11?

ü No behavioural concerns?

Who refers Travel team 65%

School/ college

27%

Parents/ Carer 7%

Others eg Social Work 1%

Complete application

ITT Review Make appointment

Information Sources

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Website ammendments

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Form changes

Intervention designs