Looked after children
PLEASE NOTE: Content yet to be reviewed by Tees Valley Public Health Shared Service and maybe subject to change.
The term ‘ looked after’ was introduced by the Children Act in 1989 and refers to children who are subject to care orders and those who are voluntarily accommodated.
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 children who are looked after are at greater risk of poor 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. LAC will 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:
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.
1. What are the key issues?
2. What commissioning priorities are recommended?
3. Who is at risk and why?
Many looked after children will have been affected by adverse experiences including physical and sexual abuse and neglect. The majority of looked after children come from families who experience hardship and are unable to provide adequate or appropriate care.
4. What is the level of need in the population?
The numbers of looked after children in England have increased steadily year on year since 2009. In March 2013, there were 68,110 looked after children - an increase of 2 per cent compared to March 2012 and an increase of 12 per cent compared to March 2009. In Stockton-on-Tees, the rate of increase has been more marked, with a 53% rise from 235 in March 2009 to 335 in March 2013 (and a further increase to 381 at March 2014 – provisional data).
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:
The following summary of the profile of LAC in Stockton-on-Tees draws from analysis of a range of benchmarked data (DfE published statistical releases). The supporting charts for this summary are attached separately.
Health and Wellbeing Issues for Looked After Children in Stockton on Tees
5. What services are currently provided?
Child Placement Team. Social workers in this team recruit, assess and train foster carers and adoptive families. They identify placements for looked after children and support foster carers and adopters throughout their placement. They also offer post-adoption services to both children and their families. When placements are not available within Stockton they secure placements with independent providers.
Social Work Teams. The duties of these teams include responsibility for the care planning and support for looked after children up to the age of 18 years. Social workers and support workers from the team are often involved with children and their families prior to them entering the care system and take the lead in protecting children as part of a multi-agency protection plan. They instigate care proceedings when children are not appropriately safeguarded and arrange permanent placements for children when there is no prospect of them returning home to family.
Complex Needs Social Work Team. This Borough-wide service has responsibility for the care planning and support of those looked after children who have a complex need. The team also supports disabled children and young people who become looked after through respite provision.
Permanency Teams. These teams focus on support for looked after young people who have a plan for permanence and support them throughout their period in and up to leaving care;
Leaving Care Team This team works with young people who have left care from the age of 16 up to 21 or 24 if they are in full-time education. They support young people in their accommodation and employment, education or training and ensure that their care plan is implemented.
Resource Team. The team manager is responsible for the management of three children’s homes within the borough. They also manage supported accommodation for care leavers. Residential placements with external providers are arranged where necessary, and these are subject to monitoring visits at least annually. The team has responsibility for the supported lodging scheme and recruits, trains and assesses families to take care leavers and vulnerable 16 /17 year olds. They also support young people who stay put with foster carers beyond the age of 18 years. Support workers in the team work with young people and providers of accommodation to ensure placement stability. The team works closely with other service providers who are commissioned to offer supported living for care leavers and vulnerable young people.
Other public sector support services available to looked after children and their families are outlined below:
Children and Adolescent Mental Health (CAMHS) Looked after Children Service. There is a dedicated CAMHS service for looked after children placed in the borough. The service offers a range of support: therapeutic direct work with children, delivered by a range of professionals; consultation, advice and guidance to social workers; and direct support to foster carers and residential staff. The service also provides bespoke packages of training for workers or carers.
Virtual School for Looked After Children. The Virtual School has adopted a structure which mirrors that of a school, and has a key role in ensuring that services in relation to the education of all looked after children in Stockton are co-ordinated effectively to raise achievement. The School has a Head Teacher and a number of staff designated to support schools and pupils, including pastoral oversight. The school has a register of all LAC pupils and tracking and monitoring systems to ensure that targeted support is given to those who require it.
Looked after Children Education (LACE) Team. The team, working closely with the Virtual School Head Teacher, is an outreach support team providing time limited and focused educational support and mentoring for looked after children. The team works directly with children and young people, their carers and schools to support them in their learning, improve school stability, promote the importance of education and raise achievement and aspiration.
Education Transport Service. This service ensures that when a child or young person has a placement move, and continuity of school placement is required, transport arrangements are made to enable this. This is particularly important for young people who are in the last two years of compulsory education and working towards their GCSE or equivalent exams.
Looked After Children and Young People Health Services. There is a dedicated Senior Nurse for Looked After Children, co-located with the Young Persons Looked After Team, who co-ordinates health services for those in care. The Senior Nurse and a team including school nurses and health visitors work directly with children and young people to undertake annual health assessment reviews, and provide support for a range of issues including smoking ,alcohol, drugs and contraception .In addition there is a part-time Specialist in Community Paediatrics who undertakes initial health assessments for looked after children.
National Youth Advocacy Service. The service provides advocacy for children and young people, to assist and support them at their review or with any complaints they may have with the council.
Bridgeway Service. Bridgeway offer therapeutic counselling service to children and young people and their families and carers where there has been sexual abuse. It also works with young people who are the perpetrators of sexual abuse.
Contact Service. This service facilitates and supervises contact for looked after children and young people with their families when necessary will supervise where it is felt to be risky.
Supported Accommodation for Care Leavers. Carr-Gomm housing association provides supported tenancies in purpose built provision for care leavers, including support for young people who are pregnant or teenage mums. They have an emergency crash pad that can be accessed out of hours. Tees Valley Housing Association are commissioned to provide a 6 bedded supported hostel for care leavers.
Leisure Services. Tees Active provides free access to leisure facilities for children and young people in care placed in Stockton and care leavers. In addition they offer a discounted rate for foster carers and their families, and for residential staff. We have a reciprocal arrangement with Middlesbrough council where we access their scheme if our children live in their area.
ACE service. Barnardos are contracted to to deliver a service for young people who are at risk of sexual exploitation.
After adoption. This service is contracted to offer support and advice to all involved in adoption including the child, siblings, birth family members and adopters.
6. What is the projected level of need?
Levels of need can be expected to remain at similar levels to current, although it is noted that during 2013-14 there has been a slight falling off in the rate of children in need and those with a child protection plan. As the Early Help Strategy is implemented, this reducing trend should begin to flow through to those becoming looked after with an eventual flattening and reduction in numbers eventually.
7. What needs might be unmet?
Key challenges will continue to be in meeting needs for:
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:
It is useful to bear in mind these three distinct groups when commissioning, delivering, measuring and monitoring services to children and young people in care and care leavers.
9. What do people say?
Content to be added at a later date.
10. What additional needs assessment is required?
No additional needs assessment required at present.