INDIVIDUAL
CARE
PLANS
AND
REVIEWS
74. At the level of the individual child, local authorities
now have a statutory duty to draw up a plan in writing for each
child they are proposing to look after or accommodate in consultation
with the child, his or her parents and other important individuals
and agencies in the child's life. The plan should include the
arrangements to be made for the child's health and education.[77]
75. The DoH has developed Looking After Children
(LAC) materials as an aid to assessment of children's needs,
and planning and review of services for them. The LAC materials
were drawn up largely on the basis of research by a team led by
Dr Harriet Ward of the University of Leicester. They consist of
six age-related Assessment and Action Records, and a series of
standardised information-gathering, planning and review forms.[78]
These records enable a child's health, educational and social
needs to be monitored and addressed. In the case of foster care
they also require social workers to involve foster carers in the
assessment of the child's needs. In written evidence submitted
in January 1997, the NFCA claimed that "the practice of using
the records is not yet widespread, and even within authorities
which have implemented them there is a reluctance on the part
of some workers to properly use the forms and follow up on the
work involved".[79]
However, local authorities are making increasing use of the records,
and by autumn 1997 we were told that 92% of authorities were using
them.[80] The NFCA recommended
that foster carers should be routinely involved with social workers
in training in the use of the records.[81]
76. BASW commented on the potential of the LAC materials
for improving local authorities' performance in attending to the
health, personal and developmental needs of children, and called
for central monitoring of their use and outcomes.[82]
Professor Mike Stein of the University of York, told us that the
LAC materials "are beginning to make an important contribution
to improved quality for looked-after children in education and
other aspects of their lives, health care as well".[83]
77. Professor Roger Bullock, Director of the Dartington
Social Research Unit, told us that the LAC materials "really
surpassed expectations and given the state of the profession in
the 1980s, they were a major step forward". However, he added
that they need revision and updating, and that they create "a
further set of problems about ... how we can use the data from
them for other purposes, such as planning and service evaluation,
which is ... just in its infancy". He cautioned that filling
in the forms should not be treated as an end in itself: "there
is always the danger, is there not, that one fills in forms to
cover one's back and the data is not used creatively either for
the individual or for the service as a whole and these things
pile up and are not used".[84]
78. The Looking After Children materials have
the potential to contribute significantly to the process of assessing
a child's needs and keeping track of the way those needs are addressed.
However, we note that the LAC material has limitations. It
can be used mechanistically and superficially, in a way which
undermines the making of sound professional judgements. Filling
in the records can be time-consuming. As with all such aids, this
material has to be used in the context of good professional practice,
and its use must be monitored and managed. We support the NFCA's
proposal that local authorities should be required as a matter
of course to involve foster carers along with social workers in
training in the use of LAC records; funding to enable authorities
to do this should be available. We recommend that the DoH centrally
should monitor the use of LAC records and their contribution to
good outcomes. We recommend that use either of LAC records or
of a similar active planning system should be mandatory for local
authorities.
79. An SSI national inspection of local authority
fostering services in 1995-96 found that a significant proportion
of children had not been assessed comprehensively and did not
have individual care plans, despite the statutory responsibility
of local authorities to carry out such assessments and draw up
such plans. The inspection report comments that, "except
in the one authority that was piloting the Looking After Children
documentation, there was no formal expectation that each child
in foster care would have a separately documented care plan which
covered the contents set out in regulations", although the
report notes that the elements of these plans were dispersed across
different documents.[85]
The inspection also found that in a number of SSDs, "case
recording practice was often poor and there appeared to be no
routine monitoring of case records as part of supervision".
It found that there could be difficulty in identifying whether
statutorily required visits had been made, and 10% of the children
covered by the inspection were not visited as regularly as the
law requires.[86]
80. The then Parliamentary Under-Secretary, Mr Burns,
giving evidence on behalf of the previous Government to our predecessors,
was invited to comment on these SSI findings. He said that it
was important that, having "having identified problems and
areas where a service that is being provided is not being provided
to the highest standards ..., to seek to plug those leaks by making
sure that that service is provided in a far better way than it
may be at the moment. I do not think that just throwing money
at it ... will serve a great deal of purpose". He added that
the Government would seek to persuade local authorities to comply
with statutory requirements, and would only contemplate using
its "default powers" to compel authorities to comply
as a very last resort.[87]
81. A major academic study of the implementation
of those sections of the Children Act which relate to care plans
and reviews has recently been carried out by the Research Department
of the National Children's Bureau.[88]
The findings were summarised for us by Dr Ruth Sinclair, Director
of Research at the NCB:
(1) Most local authorities
studied had established local procedures that complied with the
Act and which set new standards for child care planning and reviewing.
Other agencies were only rarely involved in or informed about
these procedures. Few authorities provided information on care
planning and reviews to children or families.
(2) In comparison to findings from pre-Children
Act research, there were significant improvements, although there
are still areas of practice which need to be enhanced. Most parents
and children were consulted before plans were made; a majority
of children overall attended their reviews, rising to 97% for
those aged 16+. Four out of 10 mothers and two out of 10 fathers
attended their child's review.
(3) Children and young people reported that while
they see reviews as very important, they also find them difficult
and at times distressing or irrelevant.
(4) Few children or parents received written
copies of their care plans or reports of reviews.
(5) Over 60% of decisions taken as part of the
planning and review process were implemented within the year—most
often those related to legal issues and placements; the least
successful decisions related to contact with parents.
(6) There was evidence of education and health
input into decisions. About three-quarters of children had education
and health assessments of some kind; the quality and range of
these assessments was limited.[89]
82. Dr Sinclair said that the findings indicated
that there was need for greater clarity about what constitutes
a care plan. The plan should be comprehensive, encompassing both
overall long-term objectives and shorter-term executive arrangements,
covering all a child's needs, and including all review and planning
decisions. Dr Sinclair argued that this would enable planning
and reviewing to be brought together into a more continuous process
with less emphasis given to the single, set-piece review meeting.
She also said that young people should be involved more meaningfully
in planning their own future, through better preparation, smaller
and more focused meetings, and better follow-through and implementation.[90]
83. Our witnesses commented on the process of assessment,
placement and review. BAAF emphasised the crucial importance of
the initial decisions in each case. Long-term planning and choice
of placement, they observed, "must be based on a thorough
assessment of the child's individual circumstances and needs;
within this assessment the identity needs, current age and existing
attachments of the child all must play their part. Relevant circumstances
include an assessment of the relationship between an individual
child, their birth parents and extended family, and between siblings;
research has demonstrated improved outcomes where siblings are
kept together.[91]
84. Ms Hedy Cleaver of the University of Leicester
made a number of observations arising from recent research. With
regard to teenagers, she said that "assessment should not
be a one-off diagnostic event but should be flexible and continuous,
with plans which take account of the volatile nature of teenagers".
It was important to maintain links between foster children and
their families: "retaining contact with the family in the
widest sense, as defined by the Children Act, is essential because
when this is lost young people tend to be more confused about
their past and suffer from low self-esteem".[92]
BAAF pointed out that the majority of looked-after children will
return to their families, and "even in permanent substitute
placements, children will retain a need for either knowledge of
or contact with their birth family".[93]
Professor Roger Bullock, Director of the Dartington Social Research
Unit, said that research from the 1980s showed that "unless
cases were well managed, some looked-after children were likely
to 'drift', lose contact with relatives, become dependent on social
services, under-achieve educationally and face identity problems".[94]
85. We deal in the next two sections of this report
with the arguments for and against a choice of foster or residential
care. We counsel against any automatic assumption that foster
care is preferable to residential care, although in many cases
this may be so. A variety of options should be available to SSDs
so that placements can be suited to the needs of the individual
child.
86. One problem which appears to be very widespread
is that of instability in children's lives caused by the
sheer number of separate placements an individual may experience.
Professor Dorothy Whitaker, formerly of the University of York,
commented on how frequent moves from one care setting to another
are damaging to children. She told us that:
"some case histories show that fostering is
tried repeatedly, with each placement breaking down after a period
of time. The child then returns to residential care for a shorter
or longer period of time. Some children are moved from one children's
home to another because a change in departmental policy means
that the child no longer fits new criteria for placement in the
home, or because a place has been found in a children's home nearer
to the child's own home ... . Some children and young people have
experienced 20 or 30 or more moves from one place to another.
Such young people are deprived of opportunities to form stable
relationships with caring adults, and tend to experience a personal
sense of failure or unworthiness."[95]
87. Support for this view came from the panel of
young people who had formerly been in care from whom we took evidence.
Mr Paul Kefford told us that
"I think we all have experience of people who
were moved from home to home. Certainly I heard the case of somebody
who had something like 42 different placements during their time
in care. That is a big change and anybody who moves house knows
how traumatic that can be. If you are not sure where you are going
or what your next placement is going to be, does this mean you
are going to move school? What stability is there? Well, there
is none. There is no one person who is going to say: 'Actually
I have a concern for you. I think you have a need'.[96]
Mr Michael Henry, another member of the panel, added
that in these circumstances
"it is hard to build up a relationship with
people. ... It is almost subconsciously at the back of your head
that that person may not be there tomorrow. You might be moved.
... That sustainable relationship is difficult because you move
around constantly. The decisions social workers make in terms
of why they move somebody so many times are unacceptable."[97]
88. Mrs Sue James, a foster carer with many years'
experience, wrote to us that children who have been moved on repeatedly
"often lose contact with mementoes, information, belongings
and memories—good and bad; they receive mixed messages as
to past events and future plans, due to the ever-changing personnel
in their lives, and suffer all that goes with a lack of continuity".[98]
89. We asked Sir William Utting, former Chief Inspector
of Social Services, to comment on these and similar comments we
had received. He replied that such frequent moves usually did
not arise as a result of a series of considered decisions:
"It will be a combination of lack of thought,
lack of process, inadequate assessment, resources not being available
so that the next best thing, or perhaps the only thing, has to
be done within the particular circumstances of the day. There
will be a combination of factors, very few of them objectively
justifiable, which contribute to situations like that. I think
that it is absolutely devastating ... . Although children are
pretty resilient by and large, they do need continuity and security
if they are actually to thrive. One of the things that affected
us most about what we were told about young children was they
felt they were being treated as parcels with people turning up
on the day and saying 'pack your things, you are going off somewhere
else'. That does not seem to be the way to treat a child or any
other human being."[99]
90. Instability is often caused by the fact that
placements have to be made at short notice. Although some children
and young people are accommodated as part of planned respite care,
others are moved to a children's home or a foster home in emergency,
having experienced abuse or other trauma. For such children the
most appropriate placement may not be available, and they have
to be placed where there is a bed. Such placements pose problems
for staff, the children already in homes and the newly placed.
The latter bring with them their disturbance and distress, and
are likely to disturb those already living there. Foster carers
and residential workers are faced with very unhappy children,
often in their adolescent years, with whom they have to make a
relationship very fast. Because of their age and earlier experiences,
these children are often resistant or hostile to overtures of
help from adults. Building a trusting relationship with such young
people is a very difficult task which requires special aptitude
and skills, and sound understanding of child development. It is
also important for staff and foster carers to be able to work
with families of the children and young people to facilitate their
return home.
91. Ms Hedy Cleaver of Leicester University told
us that one way of avoiding teenagers being subjected to a series
of short-lived placements was to draw up for them flexible plans
which anticipate change. She called for use of 'multi-plex' placements
where the plan would incorporate a number of identified 'known'
home bases between which the teenager could move at different
times or when he or she had different needs. Such placements,
she claimed, would offer stability, allow resources to be pooled
and responsibility for and knowledge about the young person to
be shared.[100]
92. The example of Wigan Metropolitan Borough Council
shows that a high degree of placement disruption can be avoided
with good planning. They told us that only 2% of children they
looked after changed placement three or more times during the
year, compared with an average of 13% amongst other non-London
metropolitan authorities.[101]
93. The degree of instability in other authorities
raises questions about the reviewing procedures for children's
placements. Regulations made under the Children Act require that
such reviews be held for each individual child at least every
six months.[102] The
NCB research team, as we have seen, found that children frequently
feel dissatisfied with their reviews. The team comments that "from
interviews with young people it is clear that they take reviews
seriously, but they find meetings difficult—they report
feeling ill-prepared, 'put on the spot', unable to really say
what they feel; they see meetings as repetitive and boring, focusing
too much on their behaviour, rarely achieving anything significant".
The team added that, contrary to regulations, only a minority
(38%) of the children they surveyed received a copy of the review
decisions afterwards.[103]
94. During our visit to Birmingham, we held discussions
with the Birmingham Young People's Forum, composed of young people
who had formerly been in care. They criticised the current system
of reviews, expressing resentment of the way they had no choice
but to meet with their parents or teachers as part of the review
process. They were also dissatisfied with the services provided
by the social workers given the task of assisting them and acting
as a 'link' with other agencies such as education. One member
of the Forum said that, although he personally had had a friendly
relationship with his 'link' worker,' looked-after young people
in general "hate their social workers with a vengeance".
This was because they hardly ever saw them—perhaps only
once in several months—although he conceded that this might
be because of the pressure of the social workers' workload.
95. When we took formal oral evidence from a panel
of young people who had formerly been in care, similar views were
expressed. Ms Kuburat Tijani said that
"For me personally reviews were not about me.
They were never about me. It was never ever, it was about money,
it was about everything else but me and then when it was about
me it was all negative. ... I was not well informed about the
reviews, what they were about, how to use it to my advantage.
Also I was not asked whether I wanted to talk about personal issues
with the foster carer, with the head of department and the social
worker and anybody else for that matter who wanted to come along.
Also I was not asked if I wanted support from anybody else like
an advocate or mentor to voice out my feelings and needs. At the
end of the day it seemed like a waste of time ... . 'Ms Tijani,
how about plans for leaving school, how is your health, personal
development, relationships', nothing like that was talked about.
There was no aim in it, it was just a review for the sake of having
a review."[104]
PLANNING,
ASSESSMENT
AND
REVIEW:
CONCLUSIONS
96. We welcome the evidence showing that, overall,
there have been improvements in planning, assessment and review
for children looked after in recent years. However, there remain
grounds for real concern. We are particularly worried by the SSI
findings that a significant proportion of children still are not
being assessed comprehensively and do not have individual care
plans, despite local authorities' statutory responsibilities in
this regard. We believe that this is an area where the DoH centrally
has a positive duty not only to monitor but, where necessary,
to intervene, to ensure that local authorities are not in breach
of the law by neglecting their responsibilities. We look forward
to receiving the DoH's proposals as to the action it intends to
take with regard to such authorities.
97. We support the recommendations made by Dr
Sinclair and the NCB research team as to ways of improving the
current process of assessment and review (these are briefly summarised
in paragraph 81 above, and set out in full in an Annex to this
report[105]).
Sensitive, objective assessment of a child's needs and wishes
is essential. Wrong decisions at this initial stage may have particularly
serious consequences.
98. Later in this report we draw attention to problems
in gaining access for children in care to psychiatric services.[106]
We describe the current arrangements for provision of such services
as "grossly inadequate". It is important that specialist
mental health services are not only provided during the course
of children's placements but that, where appropriate, there should
be psychiatric or psychological input at the crucial initial stage
of assessment. The fact that this is usually neglected at
present almost certainly leads to errors in placement, and to
mental health problems becoming much more severe by the time they
are eventually diagnosed.
99. We believe that the problem of over-frequent
moves between placements must be tackled. Nothing contributes
more to low self-esteem and under-achievement on the part of children
than the sense that they are uncared-for parcels to be passed
from one social worker or foster carer to another. We endorse
the suggestion by Professor Whitaker that "if one placement
after another breaks down, then the reasons for breakdowns should
be examined carefully and taken into account when deciding on
future action".[107]
Ms Cleaver's suggestion of 'multi-plex placements' should be given
serious consideration. The recommendations we make later in this
report, that more capacity is needed in the residential sector,
and that greater effort needs to be made to recruit and retain
foster carers, will, if implemented, assist in reducing the amount
of avoidable instability in young people's lives.
100. The conduct of reviews ought to be re-examined
in the light of the strong dissatisfaction with them expressed
by young people, both those whom we met during our inquiry and
those whom the NCB research team interviewed. Reviews should be
seen as part of a process rather than as one-off events imposed
by bureaucracy. Young people should be prepared for involvement
in them and should be given the opportunity to see relevant paperwork
in advance. Their preferences as to who should attend the review
meetings should be taken into account. Above all, young people
must be given the opportunity for their opinions and wishes to
be fed into the decision-taking system and, wherever feasible
and reasonable, heeded. Young people should be present when their
review is concluded, and outcomes of reviews should always be
notified in writing to them and their parents. We recommend that
the DoH should consult with local authorities and the NCB, as
well as with other well-informed bodies such as the Who Cares?
Trust, and should then issue revised guidance to local authorities
on the conduct of reviews. A sustained effort is needed by local
authorities to improve monitoring of the quality and regularity
of the decision-making process in reviews, which should then be
reported to the DoH and subject to inspection by the SSI.
71 Audit Commission, Seen But Not Heard: Co-ordinating
Community Child Health and Social Services for Children in Need
(HMSO, 1994), p 13. Back
72 Children's
Service Planning: Guidance
(DoH, 1996), p2. Back
73 The
Children Act 1989 (Amendment) (Children's Services Planning) Order
1996, explanatory note. Back
74 Ibid.;
HC (1996-97) 307-III, Ev p 120, 223, Q15. Back
75 Q665. Back
76 Q922,
925, 937. Back
77 Ev
p 120. Back
78 Ev
pp 161-165. Back
79 Ev
p 75. Back
80 Ev
p 161. Back
81 Ev
p 75; Q232-33. Back
82 Ev
p 90. Back
83 Q523. Back
84 Q540-41. Back
85 SSI,
Inspection of Local Authority Fostering: 1995-96 National Summary
Report, p 28; see also Q360-64. Back
86 Ibid.,
p 16. Back
87 Q363-64. Back
88 Roger
Grimshaw and Ruth Sinclair, Planning and Reviewing under the
Children Act 1989: Research Messages for Local Authorities
(1997). Back
89 CLA21A. Back
90 Ibid. Back
91 Ev
pp 70-71. Back
92 Ev
p 160. Back
93 Ev
p 71. Back
94 Ev
p 185. Back
95 Ev
p 189; see also Ev p 163. Back
96 Q771. Back
97 Ibid. Back
98 CLA
34, para 5. Back
99 Q871-72. Back
100 Ev
p 159; see also Q503. Back
101 Ev
p 222. Back
102 Review
of Children's Care Regulations 1991, [ref]. Back
103 Grimshaw
and Sinclair, op. cit., pp 4-5; CLA 21A, Annex B. Back
104 Q789. Back
105 Pages
lxxxii-lxxxiv below. Back
106 See
para 269 below. Back
107 Ev
p 189. Back
