Memorandum submitted by The Adolescent
and Children's Trust (TACT)
INTRODUCTION
1. The Adolescent and Children's Trust (TACT)
is a national charity for children and young people involved with
the care system. We are the UK's largest charity provider of fostering
and adoption services having nine offices through England, Scotland
and Wales. TACT provides foster carers for over 500 children.
As a service provider TACT's evidence is based on day to day contact
with looked after children, their foster carers and TACT's frontline
social workers. We also campaign on behalf of children and young
people in care and on the edge of care.
2. TACT is a member of the Special Education
Consortium (SEC) and as such we support and endorse the evidence
SEC is providing to the Select Committee on behaviour and discipline
on pupils with special educational needs (SEN). TACT would point
out that of the 43,200 children who had been in care for more
than 12 months in the year ending Sept 2009, 32,300 were of school
age and of those over a quarter (27%) has SEN. There are no statistics
to tell us the number of children who were permanently excluded
who were both in care and have SEN, but the implication of the
data available is that they will be a substantial proportion.
3. However, TACT is submitting separate
evidence on the issues of behaviour and discipline of children
and young people who are looked after by local authorities under
the 1989 Children's Act. The education of these children has always
been problematic and the issues for looked after children have
a degree of specificity that require, in TACT's view, special
consideration generally about their education and, specifically,
in terms of behaviour.
CHILDREN AND
YOUNG PEOPLE
IN CARE
AND EDUCATION
4. Children end up in the care system through
no fault of their own and yet are among the most disadvantaged.
Currently, only the children of travellers have worse educational
outcomes. Historically the educational achievements of looked
after children (LAC) have always been poor when compared with
all children in the population. In 2008, 7% of children in care
obtained 5 GCSEs A*-C. This compares with 49.8% of all children
in England.[45]
5. Many children and young people in the
care of local authorities enjoy high levels of educational achievements
and go on to make a success of their lives. However, far too many
leave care with few or no qualifications and, as such, have poor
life chances. The statistics on care leavers outlined by a report
by the Centre for Social Justice make uncomfortable reading: 55%
of care leavers suffer from depression; a third of care leavers
misuse drugs and alcohol within a year of leaving care; around
a third of those living on the street have a background in care;
and 23% of the adult prison population have previously been in
care.[46]
6. There is a high cost to this failure
of the education system both to the children and young people
(as we see above) and to the tax payer who has to support those
who have come through the care system and cannot support themselves.[47]
A disproportional number of young people who are "not in
education, employment or training" (NEET) are care leavers
which demonstrates the negative continuum of poor education outcomes
and future employment for children in care. In this respect TACT
is pleased that the Work and Pensions Secretary Iain Duncan Smith
MP is making youth unemployment a priority. As the Secretary of
State said in a recent speech, "Nearly 700,000 of the young
people [who are unemployed] are looking for a role in life, but
cannot find one…"
COMING INTO
AND BEING
IN CARE
7. Being taken into care and being looked
after by the local authority for the vast majority is traumatic.
Some children and young people develop a degree of resilience,
but for most coming into and being in care has life long consequences
and not least for their education. A recent study funded by the
Department of Health comparing the mental health of 1,500 looked
after children with a sample of children living in private households
showed the nearly 45% of looked after children has a psychiatric
disorder of some type. This compares with nearly 10% for the children
living in private households.[48]
8. These psychiatric disorders include emotional
disorders such as post traumatic stress disorder, generalised
anxiety and separation anxiety, as well as conduct disorders and
hyperkinesis. This latter condition includes attention deficit
disorder (ADD) and attention deficit hyperactivity disorder (ADHD).
Recent research has also identified that there is a substantial
overlap or comorbidity between these three groups of psychiatric
disorders (emotional disorder, conduct disorder and hyperkinesis).[49]
9. The consequences for all children with
mental health problems was spelt out by Professor Richard Layard
in his report on Child Mental Health:
— Mental problems obstruct many of our
key goals for children. They disrupt learning; encourage truancy;
increase school exclusion; and encourage drink and drugs use.
— Mental problems also generate many of
the social problems we experience with young adults—crime;
teenage pregnancy; continuing mental illness, and benefit dependence.[50]
Professor Layard also said in the report that
"The shocking thing is that only a quarter of them [school
children with mental health problems] are receiving specialist
care of the kind recommended by the NICE Guidelines."
10. For looked after children to progress
in their educational attainment it is clear that teaching staff
will need knowledge of such conditions and have available support
of the local mental health team. This was recognised by the Every
Child Matters Project with the publication of their guidance for
Children's Trusts partnerships[51]
together with the development of the National Indicator 58—emotional
and behavioural health of looked after children.
11. Unfortunately the availability of the
Child and Adolescent Mental Health Service (CAMHS), as indicated
by Professor Layard, is totally inadequate and the schools are
not getting the support they need to understand the behavioural
issues for looked after children. As such inappropriate and damaging
disciplinary action takes place. The provision of a country wide
mental health service would be appropriate to support and reinforce
the positive behaviour of looked after children in school.
12. Second to this would be teaching staff
that have a mental health knowledge base to provide support to
both looked after children and those teaching them. Unfortunately
the proposed pupil premium and the passing of the Academies Act
puts under threat both the existing support and the future support
for looked after children.[52]
[53]
FOSTER CARE
AND EDUCATION
13. TACT is an organisation run on social
enterprise principals and surplus resources are put back into
the organisation. This "added value" provides a foster
care service that is able to support looked after children who
have additional needs.[54]
TACT has two ways that support the looked after children in our
care for those who have needs that result in behavioural problems
through their education career.
14. First, and specifically in respect of
mental health needs, TACT commission therapeutic support for any
child and young person in our care who has emotional or behavioural
issues. Second, and more generally, there is the careful selection
of foster carers ensuring the match between children and TACT
foster carer is right and providing foster carers with the training
they need. TACT expects foster carers to have aspirations for
the children and young people in their care that translates into
very practical educational support.
15. This practical support includes getting
the children to the school gate ready to learn, communicating
with the school and teachers both about academic and behavioural
problems, providing space and the encouragement to do homework.
In short, doing the things that aspirational parents do for their
children.
16. TACT's own data shows that the GCSE
results of the children in TACT care are much higher than the
average for looked after children, attendance rates for school
are very high (98%) and absence from school of over 25 days and
exclusions are very low (8%).
17. There is another crucial part of the
foster care equation—that of a long term stable placement.
It is a well researched and logical idea that living in a stable
foster home where the child is settled for a long period of time
will have positive effects on many aspects of behaviour and development.
The results of longitudinal research commissioned by TACT, and
carried out by Professor Bob Broad of the London South Bank University,
demonstrated that in those children in TACT's care who enjoy long
term placement showed the highest level of improvement in educational
attainment during the first 18 months of their placement. After
this period there is still an improvement but at a lower rate.[55]
18. It is clear that commissioned therapeutic
services when needed, placement stability, and suitably matched
foster carers with the right attitude and training improve both
the educational outcomes and the behaviour and attendance at school
for looked after children.
FOETAL ALCOHOL
SYNDROME DISORDER
AND BEHAVIOUR
19. In the past few years TACT has become
increasingly aware of a growing problem among the population of
looked after children that will, inter alia, have an impact
on behaviour at school. Foetal Alcohol Syndrome Disorder (FASD)
is an umbrella term that describes a number of effects that can
occur in a child whose mother drank alcohol when she was pregnant.
FASD is a lifelong, incurable condition. The effects may include
physical, mental, behavioural and/or learning disabilities. However,
with early diagnosis, and effective mitigation strategies, the
impact can be greatly reduced.
20. Alcohol is a teratogenic[56]
compound that can readily cross the placenta. If this does happen
it can cause brain damage leading to a number of disorders. These
disorders range in diversity from the full presentation of Foetal
Alcohol Syndrome (FAS), to a set of conditions—including
Partial Foetal Alcohol Syndrome (PFAS), a Alcohol-Related Birth
Defects (ARBD) and Alcohol-Related Neurodevelopmental Disorders
(ARND)—that show some, but not all, of the features of FAS."[57]
21. A BMA Board of Science report on FASD
says that there is no reliable evidence of the incidence of FASD
in the UK,[58]
but much of the data on drinking habits in the UK shows a marked
increase in alcohol consumption among women and therefore points
towards FASD as an increasing problem. The report further says
that "In the light of the recent increasing levels of alcohol
consumption in women of a child bearing age in the UK it is reasonable
to suggest that this will lead to an increased risk of heavy drinking
during pregnancy and subsequently an increased risk of having
a baby who is affected by pre-natal alcohol exposure."[59]
22. The relevance of all this to looked
after children is that many of the children who come into care
come from families where parents regularly misuse drugs and alcohol.
TACT has become increasing concerned that a disproportionate number
of looked after children may have some form of FASD. This has
consequences for all parts of these children's lives including
their education. As the BMA study implies, the knowledge base
of FASD in the UK is underdeveloped and as a consequence there
are limited clinical diagnosis and very little understanding of
FASD by key professionals supporting children and children's services
including those supporting schools.
23. The net result of this is that looked
after children who have FASD are misdiagnosed, with their behaviour
often attributed to learning disabilities meaning incorrect behaviour
modifying strategies are used. There are many behavioural characteristics
which differentiate children with FASD from those with other learning
disabilities. Socially, they tend to be very outgoing and engaging
yet they are frequently seen by others as intrusive, overly talkative,
and generally unaware of social cues and conventions. They are
children who struggle with concepts like understanding money and
time. Poor social judgment and poor socialization skills are common:
many children crave extra attention, even if this is negative.
24. Due to their social immaturity, children
and young people with FASD have difficulty establishing friendships,
especially with children of the same age. There is a potential
for both social isolation and exploitation of individuals with
FASD. Hyperactivity is frequently cited as a problem for young
children who characteristically have short attention spans. Many
also have memory problems, thus creating further setbacks to adaptive
functioning and academic achievement later on. Children with FASD
are often on the autistic spectrum and have symptoms of ADHD.
If undiagnosed, it may lead to disrupted school experiences, alcohol
and substance misuse, dependant living, difficulties with employment,
inappropriate sexual behaviour and crime.
25. TACT is naturally concerned that looked
after children in the education system who have FASD are not getting
diagnosis or appropriate support services. Further, with reference
to the comments from the BMA about increased alcohol assumption
among women of child bearing age, there might well be increasing
incidences of FASD in the general population, with obvious impact
on children in school and on pupil behaviour patterns. TACT, along
with other charities, is raising awareness of FASD and also developing
services for looked after children with FASD. TACT is also working
with medical professionals on research into developing a robust
diagnostic methodology for FASD.
26. If there is a lack of awareness of the
incidence and consequence of FASD in health and social services,
this is likely to be greater in education services. A teacher
with a class of 30 pupils to attend to is unlikely to be aware
that a child who seems to pay little attention, or who is disruptive,
suffers from FASD. There will be no appreciation or understanding
that "bad behaviour" is caused by brain damage. Punishments
intended to correct that behaviour will be ineffective as the
FASD affected child will not understand why they are being punished
and will be incapable of altering their behaviour without appropriate
interventions. TACT believes that a basic level of education concerning
the nature and impact of FASD is essential for all education professionals.
SUMMARY OF
MAIN POINTS
27. Looked after children often have complex
mental health needs that arise from being taken into and being
in care.
28. There is a lack of Children and Adolescent
Mental Health Services to support both looked after children and
teaching staff in schools.
29. TACT as a social enterprise organisation
uses surplus resources to provide services to meet the mental
health needs of the children our care.
30. Careful matching by TACT of children
to foster carers improves educational outcomes and behaviour.
31. Long term stable placements are essential
to improve educational outcomes when it is not possible to return
a child to their family.
32. TACT is concerned that Foetal Alcohol
Syndrome Disorder is a growing problem among looked after children.
33. The reason for this is that many children
are taken into care from families who abuse alcohol.
34. FASD diagnosis is rare, resources available
for diagnosis are insufficient and there is a lack of awareness
among key professionals of the characteristics of children with
FASD.
35. This means that incorrect behavioural
strategies may be used.
36. Education professionals need basic training
in FASD awareness.
37. Increased alcohol consumption among
women of child bearing age could mean a general increase in FASD
in the general school population.
September 2010
45 Department of Children, Schools and Family (now
the Department for Education). Back
46
Couldn't Care Less: A Policy Report from the Children in Care
Group, Centre for Social Justice 2009 p 153. Back
47
In a report by the DCSF in 2008 on Multidimensional Treatment
Foster Care the estimated of the cost of supporting a young person
in care with challenging behaviour and complex needs into their
30s is between £500,000 and £2 million per person. Back
48
Quoted in Multidimensional Treatment Foster Care Annual Report
2008 p19 Table 3. Back
49
Howe D ADHD and it's comorbidity: an example of gene-environment
interaction and its implication for child and family social work
Child and Family Social Work Vol. 15 No 3 pp 265-275. Back
50
Layard R Child Mental Health: Key to a Healthier Society LSE
2008 http://cep.lse.ac.uk/textonly/_new/staff/layard/pdf/RL502A_ChildMentalHealth_15082008.pdf Back
51
Promoting the emotional health of children and young people Every
Child Matters DCSF Jan 2010 http://publications.education.gov.uk/eOrderingDownload/01125-2009DOM-EN.pdf Back
52
See TACT briefing on the Academies Bill and looked after children
at http://www.tactcare.org.uk/data/files/resources/24/academies_bill_second_reading_committee_house_of_commons_160710.pdf Back
53
TACT's response to the consultation on the Pupil Premium at www.tactcare.org.uk
(forthcoming). Back
54
The types of child or young person that get referred to TACT by
local authorities tend to be the ones that they cannot place themselves.
These tend to be both older children and those with higher levels
of need. Back
55
Broad B Higher Aspirations Three Years On: The perspectives of
young people who are fostered and their carers (working title)
TACT/LSBU 2010 (forthcoming). Back
56
Teratogenic compound is a substance that interferes with the normal
development of the embryo or foetus. Back
57
Fetal alcohol spectrum disorders: A guide to healthcare professionals,
BMA 2007 p 1. Back
58
Ibid p 2. Back
59
Ibid p 5. Back
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