Improving the mental
health of looked after
children
A system that improves wellbeing
Pete Dwyer, Kim Golding, Tom Rahilly
Too often we describe a single response
• Each child in care has a unique history & formulation. We must avoid
simplistic accounts.
“Because she is LAC she is X…”
o Traumatised
o Attachment problems
o Anxious
o Shameful
o Without even seeing her, I can tell you she needs ‘Y’
• We cannot lump all children in care together. Histories are complex and
hard to trace, without a single pathway. We need to develop a
personalised system of support.
3
Identifying how support can be improved
• 4 local authorities and their partners
• Fieldwork
• Research review by Oxford University
• Expert Interviews
• Horizon Scanning of best practice
• Service and system design
workshops
• Prototyping approaches
We have spoken to…
42 children in care
56 foster carers
9 residential care workers
19 looked after children
social workers
6 fostering & adoption
social workers and
managers
6 leaving care workers
8 IROs
10 CAMHS professionals
4 health professionals
7 staff from education
services
1 children’s rights manager
2 placement team workers
1 Lead Member
7 voluntary sector
representatives
4
Variation in support
Things got difficult with
my auntie after 4 years and
I had to leave.
This foster care placement was
meant to be long-term. It lasted 6
months. I was really upset.
Went to live with my
auntie when I was 10
in 2009
+
Temporary foster care
placement (4-5 months).
They were nice.
Temporary foster care
placement. She was so uptight.
She said I was rude and messy
Moved to children’s home. I
really like my key worker, she
makes me laugh. I’ve got my
sparkle back.
5
How we can improve support
A review of the research identifies that:
1. Wellbeing is amenable to change
2. Early interventions are more likely to promote good mental
health
3. Developing relationships is crucial for children to make
progress
4. Carer training is a promising method for influencing
children’s outcomes
5. Continuity (permanence, stability and consistency) can
influence success
6
How we can improve support
6. Interventions need a clear theoretical base but should be
open to more than one interpretation of behaviour
7. Caregivers’ attitudes can affect the take-up and success of
mental health services
8. Efforts to improve mental health should be systematic and
sustained
9. Children and young people should be treated as individuals
10. Professionals need to listen to children and young people
7
A system that supports children in care
An emphasis on mental health embedded throughout the system
A proactive & preventative approach to supporting good emotional wellbeing
Relationships in the child’s life are supported & sustained
Children have a strong sense of voice and influence
Care leavers have access to emotional support
8
The role of
specialist
services in
delivering this
vision
9
Specialist services
Quality Standard 5: Looked after children and young
people receive specialist and dedicated services
within agreed timescales.
Multi-Agency Working
Quality Standard 2: Collaborative working
between professionals and services,
including carers, promotes high-quality and
consistent care and a stable experience of
placements for looked-after children and
young people
Quality Standards for the health and well being of looked after children and
young people. NICE, April 2014
Effective Services
• Multi-disciplinary assessments to ensure children’s mental
health needs are identified early (Tarren-Sweeney, 2010)
• Carer support as well as therapeutic interventions for the
children (Milburn et al, 2008)
• Multi-agency working with accessible and child-friendly
health services (Golding, 2010)
• Assessment and intervention are provided when needed,
irrespective of placement stability (Minnis, H. & Del Priore,
C. (2001; Vostanis, 2010)
• Indirect work such as parenting support provided
alongside more direct interventions (Anderson et al, 2004)
Assessment
•
Children and young people need specialist
assessment of their emotional and mental health needs
on entry to care and during their time in care.
•
Social Services working in partnership with carers,
health services and schools will ensure the child or
young person has access to appropriate support services
to meet the needs identified.
•
This support is needed early on in their care journey to
prevent the onset, or worsening, of mental health
problems.
Specialist services
• Children & carers need access to dedicated mental health
services with specially trained staff working within a multi-agency
approach.
• CAMHS can quickly get overwhelmed by demand, complexity
and the long-term nature of the difficulties presented.
• Combine mental health support with parenting support, good
care planning and classroom support.
• Broad focus on building resilience rather than a narrow focus on
symptom reduction.
• Creative and flexible ways of working including parenting and
emotional support for carers, and building children’s resilience and
social and emotional competence through arts and leisure activities
as well as specialist therapies.
Importance of Multi-agency working
•
Facilitates working together with more open lines of
communication.
•
Ensures shared understanding of the children and their
needs. Curiosity and reflection instead of defensive
practice.
•
Facilitates greater understanding of roles of other
agencies.
•
Enhances knowledge and expertise of professionals and
family.
•
Improves access and more appropriate referrals between
services.
•
Reduces conflicting demands and advice.
Multi-agency therapeutic support
•
Integrating and raising a child within a substitute family or a
family with a high level of social care support is a complex
process.
•
Sensitive professional involvement can increase the
chance of successful fostering.
•
Insensitive, fragmented professional involvement can
decrease the chance of success.
•
Multi-agency therapeutic networks can facilitate shared
understanding, and collaborative working that keeps the
family central.
ISLA Multi-Agency Service: Worcestershire
• An integrated service across health, education and social
care for carers, children and young people and other
professionals.
• Provide holistic health assessment
• Promote inter-agency working.
• Provide direct support to carers, children and young
people through consultation, specialist parenting advice,
specialist training and therapeutic input as appropriate.
Impact on multi-agency working
Independent evaluation of views and perceptions of service
users:
•
Improved integration across agencies had been achieved.
•
Involvement of all agencies seen as beneficial by carers and
support workers.
•
Carers felt less isolated
•
Access to ‘systems’ had improved in some cases.
•
Improved inter-agency links anticipated in future because of
intervention.
Paul McDonald, 2002
‘I have a better idea of working with people operating in other
systems’ (social worker)
‘Listening to input from other colleagues and gaining further
background information improved overall understanding and
sharing of ideas’ (headteacher)
‘I never had this access to the school before’ (foster carer)
‘An excellent point of access for advice on other services or
resources from an experienced team.’ (Residential manager)
Putting this
into practice in
North
Yorkshire
19
Why participate?
• Developing a greater understanding of not only needs but
also “what works”
• Help LAs translate those messages from research into
practice.
In addition:
• We were conscious our LAC strategy lacked real
sophistication in this area
• We were rewriting our “Emotional and Mental Health”
Strategy and the CAMHS specification
20
Proposals for improvement
Mainstream improvement priorities - not CAMHS only!
• Better assessment of emotional needs, ideally prior to
coming into care to provide better baseline
• Increasing real placement options and choice
• Proactive support to prevent placement disruption
• Greater support and on-going work with birth families
• Providing consistent trusting and meaningful relationships
with professionals
• Build resilience e.g. social and leisure opportunities.
• Improve transitions from children’s to adults
21
Proposals for improvement
I would add…
• Educational outcomes in their widest sense: CYPP
priority
• Peer relationships
• And CAMHS!
22
What will we do differently?
• Consistent assessment of emotional needs which then
trigger proportionate response: e.g. volunteer mentor or
CAMHS clinician
• Innovation Programme: supporting placements, reducing
disruption and providing professional continuity
• Improving Transition to Adults: Staying Put, improved flexible
accommodation/support options/celebrating success
• Improving contact with natural family
• Embedding strategically: CYPP/Emotional and Mental Health
Strategy and CAMHS specification
23
Thank You
24