Education and Adoption Bill

Written evidence submitted by the NSPCC (EAB 03)

Executive Summary

1. Revelations about Jimmy Savile and recent headlines about the Goddard Inquiry have brought historical child abuse to the forefront of the public consciousness. But it’s also vital that we do not forget children who are suffering now.

2. Children entering care have frequently experienced abuse or neglect. It is therefore unsurprising that they have significantly higher rates of mental health disorders. Around 45% of children in care have a mental health disorder, compared with 10% of the general child population.

3. The NSPCC welcomes the Government’s intentions around adoption via the Bill. However, adoption is one of numerous possible permanent solutions for children in care. What is more important is ensuring that all children in care receive the right support to help them overcome issues of mental ill health, improve their life chances through better educational achievements, and ultimately become happier children.

4. Currently the mental health needs of children in care frequently go unassessed and unsupported. We urge the Government to include measures in the Education and Adoption Bill to improve the emotional wellbeing of all children in care, not just those who are adopted.

5. All children entering care should receive an automatic specialist assessment focussed on mental health, immediately followed by any necessary support to help them deal with issues of mental ill health identified in the assessment.

6. As well as a clear moral case for action, there is a compelling economic argument as there are significant associated cost-savings.

7. We would be happy to give oral evidence to the Committee should that be helpful.

Solutions of permanence for children in care

8. The NSPCC welcomes the Government’s intentions around adoption. Adoption can provide children in care with a loving, stable placement that improves their outcomes later in life and their emotional wellbeing. However, in order to attain those outcomes for children in care the necessary mental health support must be available.

9. Before the Queen’s Speech the Minister of State for Children and Families stated that ‘more than 3,000 children remain waiting to be matched with their new parents, with more than half having spent 18 months in care despite there being adopters readily available’. [1]

10. The Department’s own data though, as of 31 March 2014, showed that there were over 68,000 children being looked-after in England. Out of all placements during the year ending 31 March 2014, only 6% were for adoption, whereas 57% were foster placements. [2]

11. Adoption is not the only solution for children in care. We believe it is crucial that the scope of the Bill is widened to provide support for all children in care.

Mental health of children in care

12. Children in care have frequently experienced abuse or neglect. For 62% of children, or 42,460, who were in care in England in 2013/14, the primary reason was because they had suffered abuse or neglect. [3] In other categories though, such as absent parenting or family dysfunction, the child may also have suffered abuse or neglect but it might not have been categorised as the primary reason. Overall, the vast majority of children who enter care have experienced abuse or neglect.

13. It is therefore unsurprising that children in care have significantly higher rates of emotional and behavioural disorders and difficulties than their counterparts in the general child population. Around 45% of children in care in Great Britain are clinically rated as having a diagnosable mental health disorder, compared with 10% of the general child population aged 5-15 years. [4]

14. Although not all children in care are destined to have or develop a mental health disorder or difficulty, and not all children who are abused suffer the same consequences, children and young people in care are likely to have lived with trauma and difficulties over and above those experienced by their peers. A sizeable proportion of children enter the care system with pre-existing emotional and behavioural difficulties.

Lack of mental health assessments and support for children in care

Failure to assess

15. Despite the significant prevalence of mental health issues among children in care, these needs frequently remain unassessed and subsequently unidentified.

16. Children entering care undergo a health assessment and review. This is normally conducted around 20 days after entering care by a paediatrician or GP. It is usually not someone with specialist expertise concerning looked-after children. Emotional wellbeing should be part of that assessment but our research has found that this is not strong enough and focuses on physical health, contrary to existing guidance. Inspections by the Care Quality Commission also found that in many local authorities, wellbeing and mental health are often neglected.

17. Since 2008, local authorities in England have been required to ensure all children in care between the ages of 4 and 16 inclusive, and who have been in care for at least twelve months, have a screening test to measure their emotional and behavioural health, using Strengths and Difficulties Questionnaire (SDQ) scores from parents or carers. The SDQ is a brief behavioural screening questionnaire that can examine emotional symptoms, peer relationship problems, hyperactivity/inattention, conduct problems, and prosocial behaviour. We do not propose abolishing the SDQ, but there are several reasons why this does not achieve the same benefits as a specialist mental health assessment:

· It often does not happen until children have been in care for at least twelve months, meaning mental health needs go unidentified when children enter care

· The data is analysed on a macro level, meaning children’s individual needs are not sufficiently considered

· The data is analysed by looking at average scores across local authorities. By failing to assess year on year within local authorities it is impossible to see if improvement has actually taken place

· Research suggests the SDQ is less good at identifying emotional problems [5]

· The completion rate of SDQs in English local authorities also varies substantially. In 2014, a quarter of local authorities had a completion rate of 90 per cent or above, while 8 per cent of local authorities had a completion rate of 30 per cent or lower [6]

Lack of support

18. The mental health needs of looked-after children frequently remain unmet, which puts them at risk of further harm. The shortage of therapeutic services for children in care is well documented, and something that children in care, foster carers, and social workers have specifically articulated as an issue. [7] One study found that 49% of children in care with a mental health problem were not receiving or accessing a service from CAMHS. [8]

19. However, it is not just that services do not have sufficient capacity. Children in care often struggle to access mental health support due to:

· A failure to make appropriate referrals, whether due to workload pressure or the expectation that the referral will not be accepted

· Inappropriate restrictive eligibility criteria for services mean referrals are often turned down, e.g. CAMHS refuses to provide a service to a child not in a stable placement

· There is a lack of services for children who do not meet the CAMHS threshold

· Young people only receive support when they are at the point of crisis

· Long waiting lists for specialist services

· Long delays for young people who are placed out of area while health services negotiate the cost of their mental health assessment and treatment

· Support services are not accessible and fail to engage children and young people

· The majority of CAMHS models lack statutory resources

Deficiencies of recent measures

20. We welcome measures in recent years to address the lack of mental health support for some children in care, but they have not gone far enough.

21. In September 2013, the Adoption Support Fund was introduced to provide new funding worth £19.3 million to help children recover from their previous experiences, bond with their adoptive families and settle into their new lives. However, the Fund can only be used to pay for therapeutic services that can benefit children in care under adoption.

22. In June 2015, £4.5 million in new funding was provided for regional adoption agencies to help place children to be adopted, which was intended to end delays for children awaiting adoption. But as already stated, in the most recent year that data is available, only 6% of placements in England were for adoption compared to 57% that were foster placements.

23. With the right support, children in care can overcome issues of mental ill health, improve their life chances through better educational achievements, and ultimately become happier, more content children who can move beyond the traumas that might have caused them to go into care in the first place. We urge the Government to take immediate action to better support the mental health of all children in care. The Education and Adoption Bill is a clear opportunity that should not be squandered.

The solution

24. In England:

· All children should receive an automatic specialist assessment focussed on mental health upon entering care

· Children in care then have a right to receive any necessary support immediately to help them deal with issues of mental ill health identified in the assessment

· There should be regular monitoring of children’s mental health outcomes, which feeds into what support the child receives, to ensure that it contributes to the improved emotional wellbeing of the child

25. Although the Bill is applicable to England and Wales, the draft Care Planning, Placement and Case Review (Wales) Regulations 2015 and the draft Code of Practice on the exercise of social services functions under Part 6 (looked-after and accommodated children) of the Social Services and Well-being (Wales) Act 2014 is the appropriate legislative vehicle to achieve this solution in Wales.

What could an assessment look like?

26. It is difficult to estimate an average mental health assessment both in format, because every child’s needs will be different, and in cost because the average costs of a CAMHS or other type of assessment for a child in care are not available in the public domain. Based on consultation though with mental health services in various local authorities, we anticipate the following description of a mental health assessment would be suitable for the majority of children in care:

· 1 hour consultation with the child’s social worker (and/or other members of the child’s professional network)

· 1 hour reading previous reports about the child (e.g. core assessment)

· 1.5 hour(s) consultation with the foster carer and/or the child or young person

· 2 hours report writing

What does support look like?

27. It would be wrong to prescriptively outline what therapeutic support should look like. Children in care with mental health disorders will present with individual symptoms that require tailored support. There are lots of types of services that might improve young people’s wellbeing and mental health. A local authority could employ two trained counsellors and offer a counselling service, or they could employ a team of therapeutic social workers, or the best solutions might lie in CAMHS.

28. We are not simply calling for more CAMHS though. Children in care should have a right to the necessary mental health support, which is why the legislative framework needs to be strengthened. The system must be improved with effective, evidence-based mental health treatment for looked-after children to provide the right kinds of services, not just more CAMHS. We want commissioners to be more open-minded and creative about what local mental health support is provided. If there are evidence-based and accessible services that are effective, it does not matter who provides them.

29. Spending must be balanced towards early intervention rather than crisis intervention. Early support for looked-after children and their carers is likely to be more cost-effective, as well as preventing the distress caused to children by placement breakdown.

30. It is critical that local commissioners provide a spectrum of integrated services and support that meet the needs of looked-after children and young people in their area. The Government’s recent ‘Future in Mind’ report called for "A step change in how care is delivered, moving away from a system defined in terms of the services organisations provide (the ‘tiered’ model) towards one built around the needs of children, young people and their families." [9]

31. An early intervention approach to promoting the emotional wellbeing of looked-after children will require effective joint commissioning arrangements between health, social care and education to design integrated services for looked-after children, their carers and birth families.

Benefits of providing support

32. To estimate the costs of providing a mental health assessment and support to children in care, we rely on the ‘Unit Costs of Health & Social Care 2014’ report, and research by the University of Loughborough. The former is compiled by the Personal Social Services Research Unit at the University of Kent and commissioned and funded by the Department of Health and Education, with the intention of providing authoritative cost information about health and social care services. The latter was commissioned for an NSPCC report on ‘Achieving emotional wellbeing for looked-after children’ to be published on 6 July 2015. If helpful, the NSPCC can provide more detailed cost breakdowns.

Cost of assessment

33. Based on the assessment described in paragraph 26, we estimate the cost of assessment per child at £480.50.

34. The annual cost of providing mental health assessments for all children entering care in England is £14,621,615.

Cost of support

35. In 2013-14 in England 17,348 children were in care, had a diagnosable mental health disorder, and were not receiving support. [10] The cost of providing mental health support to children in care not already receiving it is £67,865,376.

36. Therefore the total estimated cost in England of providing mental health assessments to all children entering care, and support to those children with mental health disorders not already receiving it, would be £82,486,991.

Saving by providing support

37. We appreciate this could be perceived as unrealistic in times of reduced government spending. However, as well as the moral argument already set out, there is a clear cost-saving argument.

38. The 2010 Demos report ‘In Loco Parentis’ provides forecast calculations of the later life costs of young person ‘A’ who had a stable experience of care and left with good mental health and good qualifications, and young person ‘B’ who had ten separate placements and left care with mental health problems and no qualifications. [11]

39. The report calculates the cost to the state of each of these young people between ages 16 and 30, estimating that:

· Young person ‘A’ may cost the state £20,119.10 by age 30 if she went on to university and secured a graduate job

· Young person ‘B’ may cost the state £111,923.99 by age 30 if she experienced unemployment, underemployment and mental health problems

40. Young people who are poorly supported in care continue to be at risk of poor outcomes throughout the rest of their life and increased costs to the state may also continue throughout that young person’s adult life. Using 2013-14 as an example, 30,430 children entered care. Between the ages of 16 and 30, if the state overspent by £91,804.89 on each child due to placement issues and the child leaving care with mental health problems and no qualifications, there is an unnecessary cost to the state of £2,793,622,802.70 over the 14 years when those children are aged 16 to 30.

Conclusion

41. There is a clear moral and economic case for ensuring all children in care receive the necessary mental health support to enable them to rebuild their lives. The NSPCC urges the Government to widen the scope of the Bill to consider solutions beyond adoption to improve the emotional wellbeing of children in care.

About the NSPCC

The NSPCC fights to end child abuse in the UK by helping children who have been abused to rebuild their lives, protecting children at risk, and finding the best ways of preventing child abuse from happening. We achieve this through a combination of service provision, campaigning and public education.

June 2015


[1] Timpson, Edward (2014) New measures to end delay for children awaiting adoption, available at https://www.gov.uk/government/news/new-measures-to-end-delay-for-children-awaiting-adoption

[2] Department for Education (2014), Table B4 in ‘Children looked-after in England, including adoption’, National tables: SFR36/2014, available at https://www.gov.uk/government/statistics/children-looked-after-in-england-including-adoption--2

[3] Ibid., (2014) Table A1

[4] Green, H., McGinnity, A., Meltzer, H., Ford, T., & Goodman, R. (2005) Mental health of children and young people in Great Britain, 2004. A survey by the Office for National Statistics. London: Palgrave

[5] Goodman R., Ford T., Gatward R., and Meltzer H. (2000) Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. The British Journal of Psychiatry , 177, pp.534–539

[6] ‘Outcomes for children looked-after by local authorities’, SFR49/14, Local tables, Table LA7 ‘Emotional and behavioural health of children looked-after continuously for 12 months at 31 March for whom a Strengths and Difficulties Questionnaire (SDQ) was completed, by Local Authority’.

[7] Bonfield, S., Collins, S., Guishard-Pine, J. & Langdon, P. (2010) ‘Help-seeking by foster-carers for their 'looked-after' children: the role of mental health literacy and treatment attitudes’, British Journal of Social Work, 40(5):1335-1352

[8] Ibid., (2010)

[9] Department of Health and NHS England (2015), Future in mind, available at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/414024/Childrens_Mental_Health.pdf p. 16

[10] Ibid., (2014) Table A1; Meltzer, H., Gatward, R., Corbin, T., Goodman, R., & Ford, T. (2003). The mental health of young people looked-after by local authorities in England. London: The Stationary Office.

[11] Bazalgette, Louise, Hannon, Celia, and Wood, Claudia (2010) To deliver the best for looked-after children, the state must be a confident parent... Demos: London, available at http://www.demos.co.uk/files/In_Loco_Parentis_-_web.pdf?1277484312

Prepared 30th June 2015