care options for young people
DESCRIPTION
On behalf of the WM ADCS network, Research in Practice recently presented Care options for young people evidence to inform commissioning 2013 and you may also like to have a look at the related DfE report “Implementing evidence-based programmes in children’s servicesTRANSCRIPT
Birmingham 20 September 2013
ADCS paper
Care Inquiry report
Nice Collaborating Centre for Social Care
Care options for young peopleevidence to inform commissioning 2013
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Care Inquiry 2013In responding to the needs of all children in care, we must find:
•ways of identifying those children who can go home, and enabling them to do so safely
•ways of increasing the use of kinship care, and providing the right support
•ways of increasing the use of adoption and other legal routes to permanence, and providing the right support
•ways of recognising when long-term foster care can, and is, offering a permanent placement for a child
•ways of ensuring that all these placements are of high quality and likely to last, and ways of ensuring that the benefits of an option for a particular child will endure beyond childhood.
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making not breaking
A ‘fresh’ more flexible response is needed Permanence: ‘security, stability, love and a
strong sense of identity and belonging’ Kinship care needs… should be seen as equal to
adoption in its ability to provide attachment, continuity and identity… its use should be expanded
Long term foster placements also provide a possibility for permanence – ‘foster parenting’ rather than ‘caring’
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making not breaking
Specialist residential settings: this type of provision should be able to demonstrate that there is sound evidence underpinning their practice; that staff are trained, supervised and supported well; and that expert help and advice is available for staff and for the children in their care
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I tend to assign Sundays to be my cleaning day. I got this routine by living in the young people’s home. I took it with me when I left. Having routine gives me a sense of control. That’s something which I feel should be encouraged in young people’s lives.
20-year-old (Days after leaving care)
Children and young people’s views having a perceived choice about their future is
very important (Schofield et al, 2012)
if children do not want to be in a placement then it is unlikely it will be successful (Sinclair, 2005, Selwyn, 2010)
48% of the children and young people interviewed in a recent NSPCC study (2012) about reunification said that they were not consulted at all about returning home and 73% reported they were not ready to return home
International perspectives
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adoption will only ever be the answer for a small number of adolescents
4,600 children on the adoption waiting list 3% of those adopted aged 10-15 (adoption.org)
no children over 9 were referred to adoption register 2011/12
age at entry to out of home care (Thoburn 2009)
placements: international evidence (Thoburn 2009)
alternative models of provision: a continuum of care: examples
Weekday residential settings (Germany)
Respite through self referral (Denmark)
Open access emergency accommodation for runaways
Social Pedagogy in residential care
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Home or care: making the right decisions
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reunification 10000 a year (3050 adoptions) 67% of maltreated children who return home
subsequently readmitted (NSPCC 2012)
growing evidence that maltreated children who remain looked after do better (Wade et al 2010)
where there is strong evidence of serious emotional abuse or past neglect, these children did best in care
most returns = poorest outcomes
Children were less likely to have gone home where
Had experienced neglect
Had a learning disability
Did not want to go home
Birth parent contact was infrequent
Where parental problems at admission were still subject of ‘serious concern’
Most important predictors of return
Risk to child safety assessed as acceptable
Problems that had led to admission considered improved
For older children, wanting to return had some effect
making the right decisions (Wade et al, 2011)
Variation in LA practice was a bigger factor in determining whether a child was returned home than the needs of the child
(Wade et al 2011)
what helps reunions to last?
These factors had continuing resonance for stability at final follow-up, on average 4 years after decision
In addition, stability at 4 years less likely where:
•Serious concerns existed at 6 months
•Children had gone home on a care order
•Parents had continuing problems with substance misuse
•In cases of emotional abuse and neglect
Wade et al (2011)
Reunions more likely to be lasting at 6 months where:
Children had gone home slowly, over longer period of time
Planning for reunion had been purposeful and inclusive
Problems that had led to child’s admission had reduced
More social work support had been provided to the family
Parents had accessed more services to help them with their problems
Children are younger
Wade et al (2011)
Parents who overcame difficulties all did so before child was 6 months old (Ward et al 2010)
care may be the best option Outcomes (stability and well-being) for Wade’s ‘care group’
(maltreated children who remained looked after) were better than for those who went home
Most had settled well, had good relationships, were doing quite well at school and not getting into great difficulty
Many felt safer, were relieved to be away from dangerous homes and well cared for (others more ambivalent)
well-being levels were higher that those who had remained continuously at home
Problems early in reunion predicted poor well-being at follow-up
Those who had experienced one or more breakdowns at home fared worst of all
Where there is strong evidence of serious emotional abuse or past neglect, these children did best if they remained in care
(Wade et al 2011)
Home or care: decision making
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Decision makingtaking the final decision about whether a child should return home
Quality of the assessment can be improved in three ways:
Historical understanding of cases
Validated assessment tools need to be embedded into practice Structured Professional Judgement
Supervision should focus on improving the evidence used in assessments and enabling learning(nspcc 2012: 10)
RiP resources and NSPCC Project Unaided clinical judgment in relation to the assessment of risk of harm, is now widely recognised to be flawedBarlow 2012
Decision making (Brown and Ward, 2012)
At identification
Severe risk: Risk factors, no protective factors and no capacity for change
High risk: Risk factors, protective factors and no capacity for change.
Medium risk: Risk factors, protective factors, capacity for change.
Low risk: No risk factors (or previous risk factors addressed, protective factors and capacity for change. Includes two outliers
Age 3
Permanently separated from parents: two unsatisfactory placements, others showing signs of strain
Medium, high and severe risk: living at home, on-going concerns
Low risk: living at home, no on-going concerns
Almost all decisions were temporary – on average it took 14months for a definitive decision resulting in a viable permanence plan (6months more for this to be completed. Longer for adoption).
Classifying families at risk of harm (Brown and Ward, 2012)
Severe risk: Risk factors apparent and not being addressed, no protective factors apparent
Parents UNABLE to demonstrate sustained capacity for change; ambivalence or opposition to return by child or parent
High risk: Risk factors apparent and not being addressed. At least one protective factor
Parents UNABLE to demonstrate sustained capacity for change; ambivalence or opposition to return by child or parent
Medium risk: Risk factors apparent and not all being addressed. At least one protective factor
Parents ABLE to demonstrate sustained capacity for actual change. Parents and child both want return home to take place
Low risk: No risk factors apparent or previous risk factors fully addressed, protective factors apparent
Parents ABLE to demonstrate sustained capacity for actual change. Parents and child both want return home to take place
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Kinship care needs… should be seen as equal to adoption in its ability to provide attachment, continuity and identity… its use should be expanded
Kinship care
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Kinship care 173,200 children living in kinship care although 90 per
cent not technically ‘looked after children’ (Selwyn and Nandy, 2012)
no system of registration for these children
kinshsip care can enhance sense of belonging: pre-existing relationships and high level of commitment of kinship carers (Farmer, 2010) and stability (Cuddeback, 2004)
carers under much pressure – poverty, no or little financial or other support from children’s social services especially around contact with birth parents
risk that use of SGOs divert children from welfare system and support?
Kinship care: strengthening stability
recognise high rates of poverty and lack of support
Commission for family support for kinship carers
improve advice to informal kinship carers on benefits and contact with birth parents
some children experience stability but also stigma and isolation
ensure SGOs do not further penalise kinship carers
adolescent graduates and entrants (Stein 2007) different issues – different approaches (p14-15).
But underlying issues may be very similar
child protection/family breakdown
stability all need consistency and stability
all types of placement are challenged by adolescent developmental factors
however - 54% of moves are initiated due to delayed and precipitate entry or over-optimistic expectations of swift reunification (not relationship breakdown with carers) (Ward 2009)
3+ placements in a year down from 13% in 2007 to 11% in 2009-2010. 2012 still 11%
movement is avoidable and supporting stability is cost effective
stability age: Farmer and Lutman’s ‘unstable group’ were
the oldest (mean 11.5 years)
proactive case management: ‘unstable group’ characterised by passive case management
changes at home: if the child was returned to a changed household odds of stability increased by a factor of nearly 3.5
local authority performance: those not in the poorest performing LA were 10 times more likely to be in stable placement (Farmer and Lutman 2010)
evidence-based interventions
implementation issues – Wiggins et al checklist
need for robust evaluation in English settings
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long term foster ‘parenting’
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long-term foster care 75% of looked after children are cared for in a
foster placement (DfE, 2012)
stable long-term foster care can have very similar outcomes to stable adoption (Biehal et al, 2010)
offers a route to permanency for those who want to maintain a strong sense of identity and contact with their birth families (Ward et al, 2004)
problems associated with long-term foster care
may not ‘feel’ very permanent – always possibility of legal challenge or change of care order
Special Guardianship Orders (SGOs) introduced 2005 to enhance stability but reduction of financial and other supports is major concern for many foster carers and deterrent to their take-up (Schofield and Ward, 2008)
Some local authorities provide financial support with SGOs but this appears to be rare and is currently discretionary (Wade, 2011)
Children often have highly complex needs but despite this, lack of mental health and therapeutic services (Selwyn et al, 2006)
Leaves young people vulnerable at the time of transition to adulthood
strengthening stability in long-term foster care
reduce unplanned placement moves through: reduction in the use of emergency placements improving decision making concerning reunification more recognition and support for the complex needs
of children increasing the pool of foster carers to avoid over-
stretching existing carers
NICE Collaborating Centre for Social Care
The new role of NICE
From April 2013 developing guidance and quality standards for social care in England
Topics referred by the DoH and DfE
apply an evidence-based system to decision-making in social care, similar to that provided for the NHS
guidelines and standards, based on best evidence ensuring quality and value for money for those responsible for commissioning and professionals
promote better integration between health, public health and social care services
Planned topics Health and Well-being of Looked After Children
and Young People (Publ. April 2013)
Transition between children’s and adults’ services (Publ. March 2016)
Abuse and neglect of children and young people (Publ. May 2016)
How does it fit in the sector? Not mandatory - aspirational and examples of best
practice
NICE is in discussion with OFSTED about how social care quality standards might inform and support the inspection of children’s social care services
Stakeholder consultation for each guideline
Involvement during guidance development groups: invitation for expert evidence
commissioning a continuum of services
permanence as the focus
be informed by children and young people
Local needs analysis
from:
care as last resort
emergency placement
repeated returns home
towards:
planning for stability and wellbeing
Support to overcome consequences of earlier experiences - building therapeutic alliances
support to 18+
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planning
support packages
therapeutic alliances
evidence-based models
step down from intensive support
transitions
Counting what counts Beyond existing data collection, what else
would you want to know to understand whether you are achieving improved stability/permanence?
Where might savings be made/costs avoided if placement stability / permanence was improved?
research in practice resources Evidence Matters in Family Justice (Erlen
and Lewis 2012)
Engaging resistant, challenging and complex families (2012)
Analysis and critical thinking in assessment (Brown et al 2012)
Children experiencing domestic violence (Stanley 2011)
Safeguarding in the 21st century (Barlow and Scott 2010)
Parental Mental Health Problems: research review (Tunnard 2004).
Signposts
Frontline briefings
Parental substance misuse (forthcoming 2013)
West Midlands Research in Practice Partners Birmingham
Coventry
Dudley
Herefordshire
Sandwell
Solihull
Staffordshire
Stoke-on-Trent
Telford & Wrekin
Walsall
Wolverhampton
Worcestershire
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