Memorandum submitted by Care Matters Partnership
The Care Matters Partnership (CMP) welcomes the inquiry of the Children, Schools and Families Committee into the government's proposals to improve the care of looked-after children and the opportunity to submit evidence.
The CMP regrets the omission of the mental and emotional needs of looked-after children and young people. These needs are seen as central to educational outcomes and are facilitated by continuity of care and social work provision and by a well framed and reflective workforce.
Introduction: the Care Matters Partnership Members are:
§ The Tavistock and Portman NHS Foundation Trust
§ British Agencies for Adoption and Fostering
§ Coram Families
The Care Matters Partnership welcome the Government's recognition and drive to improve the experiences of children in care, and while agreeing in many of the plans laid out in "Care Matters: Time for Change", it does have concerns and will be focusing in the coming months on the following objectives:
§ To promote a stronger mental health and developmental perspective
§ To promote a greater focus on the psychological and emotional wellbeing of the children and young people as being key to increasing access to opportunities
§ To ensure the message of attachment, enduring relationships and quality of care in relation to resilience and emotional wellbeing are embedded in the whole strategy in a cohesive way
§ To ensure legislation promotes outreach services for children, young people, their families and carers
§ To promote the inclusion of national training for adopters as well as foster carers
§ To highlight the need to improve early detection of problems in the under-fives
§ To highlight the needs of latency aged children (5-11 year olds) and to increase interventions to prevent this group growing up in the care system
§ To highlight the need for the legislation to take account of the complexity of the care system e.g., kinship care, special guardianship, retained contact with biological parents
The Partnership will also concentrate on the following longer term aims:
§ To ensure there is future research into multiple models of care, the complexities of the care system and the experiences of service users
§ To Improve CAMHS input in the planning and delivery of services to meet the needs of children, young people, families and carers
§ To improve the quality of the children's workforce through training
§ To increase participation of service users in the care system, ensuring that the child's voice is interpreted thoughtfully and that attention is paid to the specific barriers that exist in the involvement of these children and young people
The health, development and mental health needs of looked after children
Recent statistics show that -
§ Among young people aged 5-17 years, looked after by local authorities, 45% were assessed as having a mental disorder
§ Among 5- to 10-year olds, the rates of disorders for looked after children compared with private household children were 42% compared with 8%
§ Among 11- to 15- year olds, the prevelance of mental disorders for children looked after by local authorities compared with children from the private household survey were 49% compared with 11%
§ In terms of physical health, two-tirds of all looked after children were reported to have at least one physical complaint.
§ Overall, almost a third, 32%, of the young people aged 11-17 looked after by local authorities were current smokers and only 36% had never tried smoking. Sixty nine percent of children in residential care were current smokers.
(Meltzer, Gatward, Corbin, Goodman, & Ford, 2003)
These statistics demonstrates in an unequivocal way that the health and mental health of children looked after by local authorities falls way below that of the general population. This is in spite of a universal health service, Department of Health Practice Guidance on the health of looked after children and the National Service Framework for Children, Young People and Maternity Services. In fact in the 2004 report, 'Children's health, our future' which reports on the progress of the Framework, there is not one mention of looked after children.
Care Matters sets out an objective to publish statutory guidance on the health of looked after children. While this is to be welcomed, the barriers to implementation are so significant and the problems so longstanding, we believe that only when 'PCT's have a primary statutory duty to undertake a holistic assessment of a child's health, development and mental health needs and to ensure that its services meet those needs' that sufficient priority will be given to addressing this very serious problem.
What do Children in Care need?
Three key themes underpin the CMP's thinking about social care provision for children and young people in care.
1. Emotional understanding is central to care
2. Children and their carers need stability
3. Complex needs require specialist services
These issues will be highlighted under headings linked to the government's proposals for change. Namely:
1. Corporate Parenting
2. Family and Parenting Support
3. Care Placements
5. Health and wellbeing
6. Transition to adulthood, and
7. The role of the practitioners (including training and workforce development)
1. Corporate Parenting
Social Work Practices
Local Authorities will be piloting independent social work practices. Essentially theories behind this are that by enabling profit to be made they are incentivising practices. These profits can then be fed back into services. There are positive benefits of having small, specialist agencies but the interface with Social Services will always be present. In this the Government appear to be aiming to provide an alternative coherent, stable family but in reality the situation will remain complex and instable. By developing private services the Government appear to be aiming to create flagship services that can provide a model and therefore raise standards nation wide.
In reality the highest quality staff are likely to be drawn to these practises, having implications on the Local Authority workforce and actually lowering standards.
The Partnership recognises the pivotal role of the social worker in the life of the looked after child. There needs to be adequate support and training for all social workers to ensure the whole workforce is of the highest quality.
Funding within Social Services is often not sustained. Local Authorities do not prioritise funding for social work over other demands. We welcome the drive to improve the quality of social work but are concerned of the necessity for adequate funding to ensure success of this model.
· Ring fenced funds for Social Work
· Mandatory levels of training, and continuing professional development, for all social workers
· An adequate support structure, mirroring Clinical Governance models in the NHS, with regular supervisions from senior staff and peer groups
· Guidelines on case load
Right to be Cared for
The right to stay with foster carers if the child wishes.
This is a complicated issue as a clear framework has not been outlined to deal with children reaching 18 within foster care, particularly in regards to financial support for the carers.
2. Family and parenting support
Family and Friends
Local Authorities have the power to financially support family and friends carers of a child in need. There has been a technical amendment to include an allowance for the child to not automatically lose their looked after children status if taken into kinship care.
There is no change in law regarding the assessment of the suitability of potential kinship carers, they should not automatically be considered the most suitable carer.
There are issues over funding for kinship care. If the child loses their 'looked after child' status the LA often relinquishes its financial obligations. The LA should have the same obligations financially to family carers as foster carers.
3. Care Placements
Out of Authority
There is a restriction on out of authority placements, emphasising placing the child locally.
This raises issues of resourcing as there must be sufficient resources in the local area and this may give an incentive to accept lower standards for carers in order to fully resource an area. Quality of foster care should not be compromised by the restriction on moving the child out of the locality.
It was not made clear how the areas will be assigned. Assigning the areas by Local Authority in London would not prove workable.
An improvement in the notification of private fostering to ensure private fosterers notify the LA within 28 days.
This will be difficult to enforce. Also the Partnership is concerned over the numbers of private foster carers who have no statutory duty to register so little is known of these.
Placement breakdown policy can put pressure on local authorities to maintain placements whilst it is desirable for placements to be maintained there is a risk that policy may override thinking about the best way to meet the needs of the child.
The individual emotional and developmental needs of children and young people should be central to placement planning. While for many children, in-borough placements may offer continuity there is a proportion of children for whom a move away from warring or enmeshed birth-family relationships may offer their only realistic chance of developing their own identity and life-chances. Other children may need specialist residential care not available in most boroughs.
Similarly, while ethnic and cultural matching is desirable for all children, individual needs and circumstances should be carefully assessed on a case-by-case basis. Children at risk of later mental health and emotional difficulties have a primary need for emotional continuity. They should not be moved from foster carers to whom they are attached solely on the grounds of ethnic matching /ref to Family Justice Council, Dartington conference.
Key Stage 4
Restriction of movement of children in Key Stage 4 of their education.
There is a huge implication on resources and this will increase the pressure on Social Services. While the Partnership welcomes the minimisation of disruption during Key Stage 4, more thought needs to be given to how this will work in practise.
It also needs to be highlighted that many looked after children struggle with school and may find appointments at the end of the school day exhausting.
5. Health and wellbeing
Children who enter the care system have usually been neglected and traumatised. Research shows that this affects all aspects of their development. They can 'catch up' through long term, predictable, supportive relationships. Looked After Children are under represented in those reaching Child and Adolescent Mental Health Services (CAMHS). Some local authorities have denied children access to therapeutic services during school time, decreasing their access to services further.
The CMP regrets the omission from the Bill of the mental health and emotional needs of looked-after children and young people. We agree that their educational outcomes must be improved. We think this will best be done by integrating mental health with educational, health and social work provision.
The complex mental health needs of children in care are best met by specialist multi-disciplinary teams of highly qualified, experienced professionals working alongside social services and mainstream CAMHS. For those children who do not have access to appropriate services, their emotional and mental health difficulties can have lasting and damaging consequences. It has been estimated that 90 per cent of children who have experienced sexual abuse receive no substantial support. Untreated children who suffer from abuse - up to 60% of those who enter care - can be of increased risk of adult depression, post-traumatic stress disorder, relationship difficulties, participation in harmful activities, negative self-image and attitudes towards other people. Looked after children now have priority for school places and this has made a significant difference to their educational attainment. However the situation as regards their mental health needs is very different. Many, perhaps the majority, of looked-after children, do not receive the treatment they need. Most mainstream CAMHS can not provide treatment for children in short term foster placements, who may be going through court proceedings or waiting for long-term placement, adoption or rehabilitation with their family. This is a period when a therapeutic intervention can make a crucial difference.
Local Authorities have set up designated multi-disciplinary mental health teams for Looked-After children. In order to meet the complex needs of this vulnerable client group, these services draw on behavioural, systemic and psychodynamic perspectives to provide interventions in line with findings from child development research and attachment theory that childrens' paramount need is for secure, continuous and stable relationships.
These services provide fast response multi-disciplinary assessment; placement support; treatment; consultation to carers, social workers and professional networks; training, audit and research. Good practice guidelines should be drawn up by existing specialist CAMHS to inform the extension of these services across the country so that there is equity of opportunity for all children in all regions.
6. Transition to adulthood
The CMP regrets the framework for post 18 years of age care. Former care adults also have needs not addresses. They often have a very partial picture of their past, family and friends. We would welcome a framework for this group seeking knowledge to enable them to explore questions about their past.
7. The role of the practitioner
IROs (Independent Reviewing Officers)
The Bill will introduce powers to strengthen and externalise the Independent Reviewing Officer. Currently IROs are low to mid-level management, and are held by the Local Authority.
IROs are currently part of the Quality Assurance mechanisms for Local Authorities and there are complications to externalisation.
While the Partnership think it is right to use independent bodies to hold Local Authorities to account it is concerned that there are many of the clauses in the Bill which emphasise increased independence and scrutiny. There are reservations about this as it is not clear that this is helping improve public services.
Models of good practice need to be gathered.
We agree that a more clearly designated co-ordination role is needed to facilitate effective joint working between professionals working with children and young people in care - who can number over 45 for a single child. IRO's will need to work closely alongside CAMHS and specialist CAMHS. They will need to be well-qualified practitioners with relevant recent experience.
For children and young people who have experienced family breakdown, the professionals working to support them in different areas of their lives have to join together like parents to carry out their responsibilities. But the disturbance and distress of family breakdown can lead to further breakdowns between professionals and agencies unless the psychological processes at work are understood and addressed. The IRO will need substantial experience and training from mental health professionals in understanding the complex dynamics around broken families and mental health difficulty. The IRO's role should include regular liaison with CAMHS.
This place a statutory duty on social workers to visit all children in care. This includes all children in youth custody.
The resilience and emotional wellbeing of children is largely dependent on enduring relationships and the Partnership is concerned that often children do not have access to stable social workers throughout their journey in the care system. Recognition needs to be given to the complex nature of the relationship between the child and the social worker, with the social worker being subject to a great deal of emotional stress.
· Adequate space for reflective thinking for social workers
· Continuity of placements of children with social workers
Personal Adviser (PA) to 25
Statutory right to personal advisers for looked after children.
The origin of these personal advisers is not clear. There are issues in how these advisers are recruited and trained.
Children and their carers need stability
We need to ensure that children have stability so that they are able to form supportive emotional attachments with their carers and make use of educational provision and opportunities. The quality and continuity of relationships with carers and social workers is central to recovery and future development. Services for children in care need to be stable and sustained so that children have enough continuity in their relationships to form a secure base from which to develop and thrive.
There is a duty to promote the continuity of relationships between professionals and looked-after children and young people. At a stage when continuity is what is most needed, many children in care have to manage repeated and damaging endings.
Stable relationships can only be provided by organisations with stable staffing. Rigorous monitoring of the Bill's provisions for delegated services will be needed to evaluate its effects on continuity of professionals and placements for looked after children and young people.