Memorandum submitted by the Care Matters
Partnership
SUMMARY
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; and
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 eg, 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-thirds
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 demonstrate 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:
2. Family and Parenting Support;
6. Transition to adulthood; and
7. The role of the practitioners (including
training and workforce development).
1. CORPORATE
PARENTING
Social Work Practices
Summary
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 nationwide.
Concerns
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.
Recommendations
— 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
Summary
The right to stay with foster carers if the
child wishes.
Concerns
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
Summary
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.
Concerns
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
Summary
There is a restriction on out of authority placements,
emphasising placing the child locally.
Concerns
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.
Private Fostering
Summary
An improvement in the notification of private
fostering to ensure private fosterers notify the LA within 28
days.
Concerns
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.
Breakdown Policy
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.
4. EDUCATION
Key Stage 4
Summary
Restriction of movement of children in Key Stage
4 of their education.
Concerns
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% 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
cannot 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 addressed.
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)
Summary
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.
Concerns
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.
Recommendations
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.
Visits
Summary
This places a statutory duty on social workers
to visit all children in care. This includes all children in youth
custody.
Concerns
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.
Recommendations
— Adequate space for reflective thinking
for social workers.
— Continuity of placements of children
with social workers.
Personal Adviser (PA) to 25
Summary
Statutory right to personal advisers for looked-after
children.
Concerns
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.
February 2008
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