Looked after children

The term ‘looked after’ refers to children under 18 who are subject to a Care Order, (including an Interim Care Order), or who are Voluntary Accommodated under the Children Act 1989.

Looked After Children (LAC) are one of the most vulnerable groups in society. The majority of children and young people who become looked after do so as they have experienced abuse or neglect. It is acknowledged that looked after children can be at greater risk of poorer life chances and outcomes.

A poor start in life, past experiences,  involvement in care processes and transitions between placements and services can all result in inequitable access to services at both universal and specialist level.  Looked after children can have significantly higher levels of health needs than children and young people from comparable socio-economic backgrounds who have not been looked after.

The Local Authority’s duty to meet the social care needs of looked after children is set out in the 1989 Children Act and subsequent amendments. The Local Authority has specific duties to:

  • Receive a child who is the subject of a care order into care and to continue to look after them while the care order is in force.
  • Safeguard and promote the welfare of looked after children – finding out the wishes and feelings of child/parents before making any decisions and giving due consideration to those wishes and feelings and to the child’s background.
  • Promote the educational attainment of children in its care.
  • Regularly review the needs and circumstances of a child in care and to appoint independent reviewing officers to do this.
  • Provide appropriate advocates for children in its care.
  • Continue to support young people after they have left the local authority’s care.

The duty to meet the health needs of looked after children for both the NHS and Local Authorities is clearly laid out in ‘Statutory Guidance on Promoting the Health and Wellbeing of Looked After Children’.

This guidance states that the NHS is required to make arrangements to secure appropriate health services for the child in accordance with the health assessment and the child’s health plan and need to understand the current flow of looked after children both in and out of the Clinical Commissioning Group (CCG) area and ensure that services are commissioned to meet the needs of all Looked After Children.

Children and young people in care become looked after when their parents or carers are unable to provide ongoing care in either a temporary or permanent capacity.  Children may be placed with family and friend’s carers, foster carers or in residential placements, depending on individual circumstances.

In 2002 the document Promoting the Health of Looked After Children (DoH) was published.

http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4060424.pdf

This identified children and young people in Local Authority care as being amongst the most socially excluded groups in England.   The guidance was produced in response to substantial research which indicated the health outcomes of children in care are too often very poor in comparison to that of their peers.  This guidance was revised and reinforced under Statutory Guidance on Promoting the Health and Well-being of Looked After Children (DCSF and DH) 2009 and Promoting the Quality of Life of Looked After Children and Young People (NICE and SCIE) 2010.

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_108592.pdf

http://www.nice.org.uk/nicemedia/live/13244/51173/51173.pdf

In our role as corporate parent, we are fully committed to ensuring that looked after children and young people are not only safeguarded from harm, but have a good experience in care that promotes better outcomes in all aspects of their lives. Our aspiration is for every looked after child and care leaver of Redcar and Cleveland to:

  • Experience high quality care and stable relationships.
  • Be nurtured and grow up with a sense of identity and belonging.
  • Feel their needs are given the highest priority and that they are valued and cared about not just cared for.
  • Have opportunities and support to achieve their full potential.
  • Have a successful transition to adulthood

The Strategic Plan for Children in Care outlines the vision of the Safeguarding, Children and Families division within the Adult and Children’s Directorate, for our Children in Care from October 2011 to October 2013. This is currently under review and being updated

http://intranet/intra.nsf/Web+Full+List/598BE47680BE43408025795D004E889F?OpenDocument

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1. What are the key issues?

Persistent failure to meet a child’s physical and/or psychological needs is likely to result in serious impairment of the child’s health and development, and can lead to long term harm. Children and young people in care may have higher levels of emotional need as a result of their family and life experiences. (see references to NICE and Department of Health Guidance).

Children in care can have significantly higher levels than their peers of:

  • Substance/alcohol/tobacco use
  • Teenage pregnancy
  • Disrupted education, exclusion and truancy which can lead to missed school health checks, poor academic outcomes, reduced employment opportunities and therefore low income and poor housing.
  • Mental health problems – including self-harm, suicide, high risk behaviours, anxiety, low self-esteem, attachment disorders.
  • Involvement in offending behaviours and time spent in prison.

The Department for Education and the Department for Business, Innovation and Skills tables include analysis of Key Stage attainment, attainment at KS2 and KS4 of looked after children by special educational needs status, further analysis of absence, exclusions, offending and substance misuse.

Young people leaving care can be disadvantaged in terms of their physical and mental health, educational achievement, employment prospects, housing and social status.  All have profound implications for their adult health and cost to all services.

The key sources of additional contextual data for all local authorities on looked after children are:

http://www.education.gov.uk/rsgateway/DB/SFR/s001026/index.shtml

http://www.education.gov.uk/rsgateway/DB/SFR/s000978/index.shtml

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2. What commissioning priorities are recommended?

Increase local placement options through recruitment of local foster carers and developing the market for independent placements and work together with providers to develop the foster carer skill base to help prevent placement breakdown

Ensure that children in care are supported to access education, training and employment opportunities, removing barriers and providing financial support to do so

Ensure that looked after children and care leavers have timely access to mental health services and specialist support to support progress and prevent placement breakdown

Work with housing providers and care providers to develop appropriate housing pathways for care leavers

These intentions will be carried out with the following approaches

Integrating commissioning of education, health and social care provision where looked after children and young people require support from all three agencies, including exploring the benefits of pooling budgets

Improve the range and volume of emotional health and wellbeing services to prioritise looked after children and care leavers by developing the market via a framework agreement and practitioner forum

Working collaboratively with other local authorities to achieve economies of scale and greater influence over quality and costs in low-volume, high cost provision such as residential care and Independent Fostering placements

Strengthening quality and compliance monitoring of all services, both in-house and externally, and using the information to provide a more responsive approach to making savings, efficiencies and to challenge underperformance and drive up quality of placements

Maximising new funding opportunities

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3. Who is at risk and why?

No content at present.

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4. What is the level of need in the population?

Nationally there were 69,540 looked after children as of 31 March 2015, an increase of 1% compared to 31 March 2014 and an increase of 6% compared to 31 March 2011. This rise is not just a reflection of a rise in the child population: in 2015, 60 children per 10,000 of the population were looked after, an increase from 2011 when 58 children per 10,000 of the population were looked after.  The number of looked after children has increased steadily over the past seven years and it is now higher than at any point since 1985.

Whilst the reasons why children start to be looked after have remained relatively stable since 2011, the percentage starting to be looked after due to family dysfunction has increased slightly (16% of children in 2015 compared with 14% in 2011).The majority of looked after children – 61% in 2015 - are looked after due to abuse or neglect.

Most looked after children are placed with foster carers and the number of children in foster care has continued to rise in 2015. The number of children placed with their parents, and the number placed in the community has also risen in 2015; this is a reversal of previous downward trends. However, the year-on year changes are relatively small and the percentage of looked after children in these placement types has stayed relatively stable over the last 5 years. The number of children placed for adoption at 31 March has fallen for the first time since 2011, and number placed in children homes has also fallen slightly in 2015.

Across Redcar and Cleveland, the total number of looked after children has increased steadily since 2008.On 31 March 2015 there were 183 looked after children.  In 2008 there were 138. Family dysfunction,        family in acute stress and abuse and neglect are the main reasons for children coming into care. Within Redcar & Cleveland there have been 5 young people in Secure unit or Young offender institute/prison since 2008. 36% of the children who came into care in 2014/15 are aged 0-2, and we are able to meet the high demand for placements predominantly through in-house foster provision.  2% of children looked after are from a black and ethnic minority background but all of our in-house foster carers are of white European origin. Placements for young people aged over 11 are more likely to be provided by the independent sector (either IFAs or residential placements). 11% of looked after children are in residential placements  but the majority have to live out of borough and sub region due to a lack of local provision. As of April 1st 2015, 12 children are awaiting adoption, and 12 children were on placement orders as of 31st March 15.

The reasons for the increasing trend nationally are complex. Work in 2010 by the Association of Directors of Children’s Services put forward a number of hypotheses for the increase in safeguarding work, including the increase in numbers of looked after children. These included:

  • Uncovering of unmet need through improved multi-agency working concluding that the increase in social work activity is appropriate.
  • A reduction in early intervention pre-statutory social work activity resulting in increased workload at a higher tier of intervention.
  • Central government recommendations, change in social work practice and other effects which may be associated with the Baby Peter Connelly case.
  • Increased recognition of domestic violence and referral of these cases by police.
  • Better understanding of thresholds across a range of organisations.
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5. What services are currently provided?

The locality social work teams support children in need to stay within the home and prevent them from coming into care.  However, sometimes, due to safeguarding issues there is a need for a child/young person to come into care. The locality social work teams work with looked after children until a permanency plan is agreed if appropriate, at which point a transfer of the case is arranged with the looked after children team.

Many children will have been affected by distressing and damaging experiences, including physical and sexual abuse and neglect.  Some may be in care because of the illness or death of a parent.  Others may have disabilities and complex needs.  The majority of young people in care come from families who experience difficulties and are separated from them because their family was unable to provide adequate care.

The looked after children unit includes the fostering, permanency, looked after children and leaving care teams.  The aim is to improve the outcomes for our children and young people in and from care; raise aspirations, and improve life chances.  The looked after children unit works in partnership with several agencies including Health, Education, Youth Offending, (YOS), Children & Adolescent Mental Health, (CAMHS), and others.  There are joint procedures with YOS to support children and young people at risk of or involved in criminal activities.  There is a joint protocol with Coast & Country housing to support young people leaving care.  The looked after children unit works to support placement stability as part of the monitoring of all relevant performance indicators. 

There are a range of in house and independent foster placements and residential homes, within and outside the borough that meet the needs of our children and young people.  The numbers of children that come into care fluctuates but is generally on an upward trend.  This together with the reduction of in house placements and lack of foster carers and adopters puts increasing pressure on our resources.

Looked After Children Team

Social workers from the looked after children team undertake statutory visits to children in their placement to ensure that the carers are meeting children’s needs to a high standard.  Social workers ensure that Health Assessments are undertaken within timescales in liaison with the Designated Nurse and other health professionals and ensure that concerns highlighted are addressed.

Fostering and Permanency Teams

Supervising social workers have the responsibility for identifying appropriate foster carers and adopters, in order that a child can be matched to the most appropriate placement for their needs.  Potential adopters and foster carers attend Preparation Training which covers all aspects of caring for a looked after child.  This carer will promote the child’s overall health and well-being leading to placement stability and improving outcomes. 

TARGET Leaving Care Team

The leaving care team provides social work and leaving care personal adviser support to looked after children aged 16 and care leavers aged 16 – 21, (up to 25 years if still in education or training).  The Staying Put Supported Lodgings Scheme gives care leavers the opportunity to remain in their settled, foster care placement as a boarder, post 18 years and up to 21 years.  This gives young people the stability to continue to develop healthy lifestyles and to enhance their independent living skills in preparation for adulthood. Stability has a positive impact on emotional well-being and any mental health issues can be addressed whilst getting the support that a staying put arrangement provides, helping the young person reach their full potential.  A bursary and support package is available to encourage and support young people to access higher education.  TARGET provides financial incentive to those engaged in education, training or employment.  The leaving care team works in partnership with accommodation providers and agencies to identify suitable accommodation for care leavers.

Education

Each child and young person in care, of statutory school age, has a Personal Education Plan (PEP) which will identify current levels of attainment and support needs and promotes strategies to improve these.  This Plan is monitored by the Designated Teacher, Social Worker and the Virtual School Head.  Looked after children 16+ and care leavers have a Personal Education, Employment and Training Plan, (PEET) to continue to support and review their opportunities. Better educational outcomes leads to better employment opportunities and the associated financial benefits of this, reducing the risk of poverty in the future and adult health problems.

Health – amended

Initial Health Assessments (IHA) of children in care is provided within the Paediatric Department based at James Cook University Hospital.  Statutory Review Health Assessments (RHA) which include the creation of Personal Health Plans for each child, take place annually for those aged 5 years and over and bi-annually for those aged under 5 years. 

Health Assessments for those young people leaving care are provided by the Specialist Looked After Children Nurse, at the request of the young person. 

In addition, Initial Health Assessments are undertaken by a Community Paediatrician as are ongoing reviews for those children with complex medical needs with input from other Consultants where necessary.

The Local Authority Commissions TEWV to deliver mental health services to children in care as a priority, which has developed to co-locate mental health workers with the children in care social work team.  The purpose of this is to promote improved joint working, and fast track access for children, young people and their carers.

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6. What is the projected level of need?

Levels of need can be expected to continue to rise as seen more recently.   New research from the Fabian Society revealed the prospect of significantly sharper inequality heading Britain’s way. And with cuts falling disproportionately on single parents, this means the number of children living in poverty will rise from 2.5 million (19%) to 4.4 million (28%) by 2030.  Child poverty will disproportionately affect our more deprived communities within the borough. 

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7. What needs might be unmet?

Key challenges will continue to be in meeting needs for:

  • placement stability through local placement options
  • in house foster care for older children
  • education, employment and training opportunities
  • access to specialist health services.
  • Suitable accommodation for care leavers
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8. What evidence is there for effective intervention?

There is a wealth of published research on this subject – one example is the research undertaken by Professors Mike Stein at York and Bob Broad at Loughborough Universities which shows that, although many children in care start from poor starting points:

  • the majority of children and young people will successfully move on from a stable care experience when they have consistent and relatively low level support
  • many more will do well in adult life if they receive skilled and intensive support while in care
  • only a vulnerable minority will continue to need targeted support well into adulthood.

It is useful to bear in mind these groups when commissioning, delivering, measuring and monitoring services to children and young people in care and care leavers.

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9. What do people say?

Within Redcar & Cleveland, we use a programme called Viewpoint to gather information on the views and feelings of children and young people who are looked after.

Overall most of the children seen via Viewpoint consider themselves to be happy and speak positively about their new living arrangements, and feel that they have a good relationship with their carer’s. They regularly say that they receive the support they feel they need from their carer’s, whether this is emotional support or with everyday activities.

Although many of the young people are positive about their placement, some of them who are placed out of the borough, but still attend school within Redcar & Cleveland, feel that as they are living away from home they are unable to keep contact with their friends as much as they would like.

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10. What additional needs assessment is required?

No additional needs assessment required at present.

Last updated: 06/04/16

Key contact: Sharon McBride

Job title: Service Manager Looked After Children

e-mail: Sharon.McBride@redcar-cleveland.gov.uk

Phone number:

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