Looked after children and young people – actions for

local multi-agency partnershipsImplementing NICE/SCIE guidance

2010

NICE public health guidance 28

What this presentation covers

Background

Scope

Areas for action by local multi-agency partnerships

Costs and savings

Discussion

Find out more

Background

• More than 60,000 children and young people are looked after in England at any time. The main reasons for becoming looked after are abuse, neglect and family dysfunction

• About 60% of looked-after children and young people have mental health and emotional problems

• In adulthood, a high proportion experience poorhealth, educational and social outcomes

Scope

• The guidance covers children and young people from birth to age 25, wherever they are looked after

• The recommendations cover strategy and policy, commissioning and delivery of services, and inspection

Areas for action

• Strategic planning of services

• Care planning, case review and placements

• Supporting babies and young children, and siblings

• Assuring the quality of foster and residential care

• Personal preferences, identity and diversity

• Health records and information

• Improving educational outcomes

• Preparing for independence

• Training

• Assess needs during the joint strategic needs assessment and show how these will be met in local plans

• Provide dedicated multi-agency services for looked-after children and young people on one site

• Publish a directory of local services and resources

• Reflect issues raised by the children-in-care council in the yearly ‘pledge’ to looked-after children and young people

Strategic planning of services

Care planning and case review

• The multi-agency team should have access to a consultancy service to support collaboration on complex casework

• Any concerned professional should be able to request a review of the care plan

• The looked-after child or young person should also be able to request a review

• Develop an information-sharing protocol

Planning placements

• Develop a placement strategy

• Placements with family and friends should be promoted as a positive choice

• Ensure there are pooled budgets for specialised care placements

Placement changes

• Base decisions on changing placements on an assessment of the current needs of the child or young person, and consider their wishes and feelings

• Monitor the number of decisions where placement moves are made against the wishes of the child or young person, including the reasons

• Monitor the number of emergency placements to understand why they happen and how they can be reduced

Supporting babies and young children

• Carry out a comprehensive assessment

• Specialist services should:– provide support and training to carers and frontline practitioners – work with the child and carer to support secure attachments

• Put the impact of loss of attachment at the centre of the decision when deciding on placement change

• Use ‘twin tracking’ when appropriate

Siblings

• Siblings should have the same social worker if possible

• Place siblings together unless assessments or the wishes of the child or young person suggest otherwise

• When decisions are made to separate siblings:– record the reasons and explain them to the children– plan for ongoing contact if appropriate

Assuring the quality of foster and residential care – 1

Training should cover:

• Parenting skills, child development and attachment

• Transitions, stability and how to manage change

• Meeting needs for physical affection

• Educational stability and achievement

• Good health and healthy relationships

• Joint working with all agencies

• Extracurricular activities

Assuring the quality of foster and residential care – 2

Support for foster carers should include:• emotional support and parenting guidance • advice as part of the team ‘around the child’ • child care to help them attend training• additional support until training is complete, and when there are additional challenges • their own children in all support• help with stress and for emergencies• health promotion advice• information about leisure activities

Individual preferences and personal identity

• Promote continued contact with people important to

the child

• Ensure access to hobbies and interests

• Offer assertiveness training to promote esteem and safety

• Promote life-story work

Diversity – strategic actions

• Produce a local diversity profile, and use this to commission services

• Consider setting up a multi-agency panel

• Ensure the children-in-care council discuss children and young people with particular needs regularly

• Consult looked-after children and young people

• Share good practice with similar areas

• Appoint a local diversity champion

Diversity – actions for service delivery

• Consider cultural, religious, ethnic and language issues in core assessments and care plan reviews

• Create links with community and peer support

• For unaccompanied asylum-seeking children and young people, ensure access to specialist psychological services

• Provide support and training to professionals and carers about diversity issues

Health records and information

• Collect data on the child’s and parents’ health using forms such as those provided by the British Association of Fostering and Adoption

• Share health information about the child as appropriate and ensure that the personal health record follows the child up to the age of 18

• Obtain appropriate consent for all healthcare interventions

• Obtain appropriate permission to access healthcare information

• Put a system in place to monitor, and address failure to obtain, permission or consent for health matters

Improving educational outcomes

• Appoint a virtual school head to work with schools to maximise the educational potential of looked-after children and young people

• Ensure designated teachers are involved in preparing and monitoring PEPs, IEPs and PSPs

• Support young people to apply for and attend college and university. In particular provide: – help finding accommodation, including holidays– advice on financial support

Preparing for independence

• Ensure there is an effective and responsive leaving-care service. Consider a one-stop shop

• Establish protocols with housing, health and adult social care to identify care leavers as a priority group

• Enable young people to remain in their foster or residential home beyond the age of 18

• Ensure young people are not moved from a secure or custodial placement into independence too soon

Training for supervisors

Ensure social workers and managers who supervise carers have training on:

• identifying support needs

• how to support carers

• recognising stress or secondary trauma

• when to refer a child for professional assessment or intervention

• the additional needs of carers of children with vulnerabilities

Independent reviewing officers

• Provide independent reviewing officers with training on:– the education system and the importance of a

stable education– evaluating health assessments and education

plans– holding professionals accountable– how to motivate other professionals – the importance of creative and leisure activities

• Monitor the quality of independent reviewing officer service

Costs and savings

• Likely immediate costs to the NHS, arising from:– delivery of and providing earlier access to services to promote emotional wellbeing and mental health

• Possible cost savings in the short and long term, arising from:– avoiding placement breakdown – reduced risk of mental health problems – reduced rates of offending – increased employment opportunities

Discussion

• How can we ensure access to a consultancy service for complex casework?

• How comprehensive is our placement strategy?

• How effective are we at managing placement moves?

• What support and training do we need to provide for professionals and carers?

• How can we improve education services for looked after children?

Find out more

Visit www.nice.org.uk/PH28 for:

• the guidance• the quick reference guide• costing report• self assessment tool• guide to resources

Visit www.scie.org.uk for Social Care TV films about looked-after children and young people