Memorandum submitted by Professor June
Thoburn CBE, University of East Anglia
EXECUTIVE SUMMARY
In order to provide the best possible service
to these most vulnerable children who need the state to become
involved in providing out-of-home care, it is essential to learn
what we can from best practice in other countries. But in the
past in the UK we have been overly narrow in limiting our gaze
to the USA and other English speaking countries and have missed
out on learning from the more positive approaches to out-of home
care in other European countries, for example, the way in which
France and Scandinavian countries seek to retain challenging adolescents
(including those who commit offences) within their child welfare
and out-of-home care systems. It is also important not to undervalue
the progress that has been made in the UK—the policies that
we can recommend to other countries. In particular, we have reason
to be proud of the progress we have made in placing children for
adoption and the steps we are taking towards finding a range of
alternative routes to permanence and family membership without
requiring children to give up links with their birth families.
In looking across national boundaries, it is
essential to understand the context in which apparently successful
policies and practices in other countries have been developed.
Taking policies and interventions "off the peg" from
other countries may result in costly mistakes, especially for
the children involved.
Research from the UK and abroad supports the
general direction in the Children and Young Persons Bill—
to improve services for children on the thresholds of care, and
at the same time to improve the service provided to children who
are looked-after by the local authority.
"Success" should be measured not only
in terms of numbers in or out of care, but in terms of ensuring
that those children who can remain with their families are enabled
to do so, and those who need out-of home care come into care in
a planned and timely way and remain for as long as is needed.
An approach to the place of the care system
within child welfare services and to the evaluation of outcomes
needs to be differentiated in terms of age, type of difficulty
and type of care service.
Specific areas for further research and development
are:
— support foster care for families
under stress;
— more appropriate arrangements for
the support of kinship carers;
— reducing the number of "predictable
emergency" admissions to care;
— appropriate out-of-home care services
for teenagers;
— reunification practice; and
— ensuring that more long term foster
families become "families for life" for the children
in their care.
INTRODUCTION
1. I am an Emeritus Professor of Social
Work at the University of East Anglia. This memorandum is based
on over 40 years of experience as a child and family social worker
and team leader in England and Canada, and as a social work academic.
Since 1980 I have researched and published on most aspects of
the social work service to vulnerable children and their families
and carers, but have focused especially on children who may need
out-of-home care, and on placements and outcomes for looked-after
children. This memorandum particularly draws on a recent Leverhulme
Foundation funded study of children in out-of-home care in 14
"first world" countries in Asia, Australasia, North
America and Europe (including the four UK nations). I have continuing
links with policy makers, researchers, data analysts and practitioners
in these countries. My comments are of relevance to some of the
clauses of the Children and Young Persons Bill and to the broader
issues listed especially: corporate parenting, family and parenting
support, care placements, transition to adulthood, the role of
the practitioner. (I shall use the term "in care" alongside
"looked-after" as this is the term in general use in
the other countries to which my memorandum relates.)
FACTUAL INFORMATION
2. The research on outcomes for young people
in care is often over-simplified and gives a misleading impression
of care outcomes. (See summary of international evidence on outcomes
by Bullock et al which presents a more realistic overview
of outcomes—this article has subsequently been published
in refereed USA and UK journals.) Global statements about outcomes
of care are unhelpful since they lump together different ages
of children, entering care for different reasons, who stay for
different lengths of time and exit care in different ways.
3. A valid authoritative research study
on outcomes would need to have a longitudinal design, include
all children entering care during a given period, and retain within
the study those who return successfully home, those who are successfully
placed for adoption and those who are successfully placed with
long term foster families or relatives and are provided with stability
and loving care well into adulthood. Such a study does not exist
anywhere in the world, although there are some longitudinal studies
of smaller samples in France, the UK, the USA and major population-based
studies in Sweden. The UK birth cohort studies have some data
but were not set up to provide large enough numbers or collect
sufficiently robust data on the care experience. The England Children
Looked- After (903) data set is the envy of many countries,
and is beginning to provide robust data on those who stay long
in the system, or re-enter (although it does not provide comprehensive
data on children adopted from care who re-enter the care system
since these have a different name and identifier).
4. Too much of the "evidence"
of poor outcomes is based on what have come to be known as "care
leavers"—young people moving into some form of hostel
accommodation or "independent living" environment sometime
between the ages of 15 and 18. Many of these entered care because
they were already showing troublesome or troubling behaviour (including
poor school performance) when over the age of 10. Many, as demonstrated
by their evidence to the Care Matters consultation, the
Children's Rights Officer and our survey of the views of over
700 looked-after young people (Timms and Thoburn, Your Shout
published by the NSPCC—available if it would be helpful),
make progress in care and value the experience, even though on
the outcome measures used such as GCSE results, they do not measure
up well to the "average" child. For children who enter
care with serious difficulties a "value added" measure
of outcome is needed, alongside the standard measures, if we are
to know whether being in care has resulted in gains to or deterioration
in their wellbeing.
5. More, of course, must and can be done
to improve outcomes for this group of young people, but outcomes
for late entrants to care (eg educational attainment) should be
measured when they are in their early 20s and have had time to
benefit from what a good experience of being in care can offer
them. They need time to recover from whatever trauma led to them
entering care before they can really start to make substantial
gains.
6. In contrast to the mixed evidence coming
from the research on long-stayers, research on children who enter
care for a shorter period of time (usually accommodated for a
specific purpose) or provided with a support foster care service
(at times of family stress as well as for disabled children) reports
high parent and child satisfaction rates, some evidence of improved
wellbeing, and few negatives.
7. The generally negative view held of out-of-home
care as a child welfare intervention is a characteristic of English
speaking countries, as is the drive, coming from this view, to
keep the numbers entering or remaining in care down. Although
there is no actual target to reduce rates of looked-after children,
there is generally perceived to be one (keeping children out of
care is often used as an outcome measure for pilot interventions
and CSCI reports have tended to report positively on those authorities
which reduce the rates of children looked-after).
8. In contrast, in most European countries
and in New Zealand, there is a much more balanced view of the
benefits as well as the negative consequences of out-of-home care,
and greater differentiation about the types of children who may
benefit from different sorts of out-of-home care experience. The
result is that rates of children in out-of-home care are generally
higher in the non Anglo-phone countries. Whilst the rate for England
and for the USA state of Illinois is 55 per 10,000 children under
18, those for Denmark, France, Germany, Norway and Sweden are
respectively 104, 102, 74, 68 and 63 (there are particular issues
for Alberta around the high proportion in the child population
of very vulnerable native Canadian children). The explanations
for these differences are complex but confidence in the ability
of the care system to have a positive impact on children's lives
is an important part of the explanation.
9. In summary, all countries seek to put
in place a range of services to prevent the need for out-of-home
care, but some would argue, and I consider that the UK and international
research supports this, that a "keep them out at all costs"
interpretation of legislation and guidance results in some children
who should be provided with an accommodation service, or have
their need for care considered by the family courts, being left
to suffer at home for too long. When they do enter care, (especially
those who enter beyond infancy) their problems are more severe.
The "goal-keeping" approach also results in too many
"predictable emergency" admissions, ie admissions which
could have been planned for to minimise trauma and avoid a quick
change of placement because the first one was unplanned. (I could
cite evidence to support these points.)
10. The least safe and the least stable
"permanence" outcome in the UK is return to the birth
parents, indicating that the lack of confidence in what a good
care system can provide results in some children being returned
home too quickly or inappropriately.
11. Higher rates in care in some European
countries are also explained by children staying longer in care.
In part this is because only the USA, UK and Canada use adoption
without parental consent as a route out of care (except in a very
narrow range of cases). This results in some young children who
in England would exit care through adoption remaining in the care
statistics (often in the same foster family) until adulthood.
12. The major explanation for better outcomes
in some EU countries is lower thresholds for entering care, and
therefore those in care having fewer problems at the time of entry.
Greater stability in care is achieved because there is not the
same drive to get children out of care when it is sometimes inappropriate
(leading to repeat admissions). Much higher use is made of long
term residential care or boarding education, with good family
contact, which, for these less troubled children, provides more
placement stability than foster care or residential care in the
UK.
13. The other important factual point emerging
from my international study is around age at entry and exit from
care. Other EU countries make more use of their care system as
part of their child welfare service to children aged 14 or 15
and over. In most, a young person may remain "in care"
until the age of 21 or 22 and in some, eg Sweden and Denmark,
a young person can actually enter care at the age of 20. (The
over 18s have been left out of the above "care rates",
but is should be noted that 11% of the official "in care"
population in France and 28% in Germany is 18 or over).
14. Only 4% of those starting to be looked-after
in England in 2005 were aged 16 or over compared with almost 50%
in Sweden and Denmark. This is largely explained by the fact that
the child welfare systems in these countries (including the out-of-home
care service) plays a larger part in their services for children
who offend than is the case in the UK.
15. The large drop after the 1989 Act in
entry into care for those aged 15 plus is explained by the removal
of offending and non-school attendance as reasons for the making
of a care order. However, there is some (mainly anecdotal) evidence
that an unintended consequence of the otherwise very positive
Children Leaving Care Act was that local authorities sought to
save resources by being very reluctant to accommodate or apply
for a care order for a young person aged 15 or over. This may
have had an impact on the increase in the numbers of homeless
teenagers and those entering youth custody, and (again anecdotal
evidence) entering private psychiatric establishments under a
mental health section.
RECOMMENDATIONS
16. The above facts support the general
direction in the Children and Young Persons Bill—to improve
services for children on the thresholds of care, and at the same
time to improve the service provided to children who are looked-after
by the local authority.
17. "Success" should be measured
in terms of ensuring that those children who can be provided with
loving, stable and safe care with family members should be enabled
to remain with their families, and children who need out-of-home
care should come into care in a planned and timely way and should
remain for as long as is needed. Measuring whether these aims
are achieved is difficult, but should be tried, eg through case
audits, and should replace seeking to achieve an "optimum"
rate in care, and keeping children out of care as a "stand
alone" outcome measure.
18. An approach to the place of the care
system in child welfare services needs to be differentiated in
terms of age, type of difficulty and type of care service.
19. As part of the family support services,
there should be an increase in support foster care (series of
short term episodes) for children whose families are under stress,
children who need therapeutic input because of their challenging
behaviour as well as for disabled children. There is also still
an important place for small specialist residential units to be
available in such circumstances. For those emergency cases when
the need for care can not be predicted and planned for, "crash
pad"/emergency assessment facilities for the different age
groups should be available to provide a "breathing/taking
stock space"—sometimes for combinations of family members.
This may involve a peripatetic team of foster carers, residential
workers, social workers and a facility that can be brought into
use when needed. There are examples in several countries (including
the UK) of such services. If care then becomes necessary, there
will have been time to plan the placement. Increased use of Family
Group Conferences is also a positive step towards planning entry
to care when this is needed as well as preventing it, so preventing
entry to care should not be the major outcome measure used when
FGC's are evaluated.
20. The research evidence that return home
for those who have been in care for more than a few weeks is the
most risky and unstable permanence option should lead, as the
Care Matters working papers suggest, to a better resourced
and differentiated set of reunification services and support for
families when children return home (including children who have
been accommodated as well as those returned following a care order).
21. For children and young people who do
need a long term care service and for whom adoption is inappropriate
either because they do not want it or because of their range of
needs, this should include being encouraged to remain part of
their foster family (even though they may be helped to set up
home elsewhere when they are over the age of 18). This is an area
where we can learn from Europe and some USA states, although there
are many examples in England of foster families becoming "families
for life". The term "leaving care" should be replaced
by a different way of expressing the aim of providing continuity,
family life and flexible continuing support to these vulnerable
young people at this stage of transition into adulthood.
22. Similarly, if young people are well
settled in a group care facility, they should not be moved on
at the age of 16. There is (anecdotal but sound) evidence of this
happening at the moment, demonstrating a need for better advocacy
services to ensure that the young people can make strong representations
if this is contrary to their own view of their best interests.
For those who do not have "good enough" links with family
members who can provide them with some emotional support (alongside
that of their social worker and residential worker) as they move
into adulthood, supported lodgings linked to the residential facility
for them to move into around the age of 18 should be developed
(eg "foyers" linked in with group care facilities).
23. The data on the comparatively small
numbers of children aged 15 plus being provided with an out-of-home
care service should be carefully looked at. There needs to be
a consideration of why there are such big discrepancies between
policy in England and in Europe. A rethink may be needed about
the place of a child-welfare based out-of-home care service for
some teenagers who are "unwelcome" in the family home,
become homeless, or whose parents or schools are struggling to
manage challenging behaviour, or who are starting to offend. It
is possible that in such cases more use should be made of the
provision of section 20 accommodation or consideration by the
family courts as to whether a care order would be appropriate.
At the time of the 1989 Children Act it was argued that a "cross-over"
provision could be appropriate for a child or young person found
guilty of an offence by the Youth Courts to be referred across
to the family courts for consideration of whether a care order
was needed. I understand that there is still support for such
a move so that particularly vulnerable children could be considered
in terms of whether a care order, or Section 20 accommodation
might be more appropriate than a custodial sentence.
24. The education of children looked-after
is not one where I claim detailed expertise, but, from my knowledge
of the data on children entering care, the attention being given
to ensuring that they have the highest quality education, specifically
tailored to their needs, is greatly to be welcomed. However, there
is an argument to be made for "measuring"; the educational
outcomes of looked-after children in terms of the "value
added" from when they entered care and to take the measure
at around 20. Longitudinal research indicates that after a rocky
period in their teens a proportion settle down to recoup lost
time by taking GCSEs at FE colleges in their late teens or early
20s.
25. On workforce issues, the message from
research in the UK and overseas is that successful child and family
practice requires continuity of relationships with trustworthy,
reliable, committed, skilled and knowledgeable social workers
and carers, working in partnership with other professionals and
the courts, as well as with the parents and children themselves.
Exercising discretion and making or recommending decisions are
central parts of the social work role, which require considerable
knowledge about the context of a particular case and the likely
outcomes of a range of placements.
26. Arrangements that maximise the availability
of professionals with these characteristics are those which must
be strenuously supported. I remain to be convinced that the proposed
model of Social Work Practices is an answer to the need to increase
the numbers of skilled social workers and increase continuity
for young people in care. Certainly they will need to be very
carefully evaluated.
27. Whilst it is important to learn from
other countries (for example, about the role played by social
pedagogues/educateurs specialisés) the different contexts
in which they work and the different characteristics of the children
in care should be carefully considered before interventions and
practices from other countries are incorporated into UK workforce
policy.
January 2008
| 
