Changing Needs – Changing Responses for Children in Care

Harriet WardCentre for Child and Family

ResearchLoughborough

Key Questions

• What do we now know about the needs of children in out of home care?

• How far do the services they receive meet their needs?

• What needs to change?• What are the key messages for policy?• What are the key messages for

practice?

Sources of information• CCfR cohort studies of children looked after

between 1996 and 2002• CCfR study on babies and young children in

care• CCfR study of children’s views of care and

accommodation• CCfR study on costs and consequences of child

care placements• International association for outcome based

evaluation and research• International working party on transitions to

adulthood for care leavers• National returns

Children looked after in UK/Australia(2004-5 data)

England• 11 million children (0-17)24,500 entrants 60,900 in care (0.6%) • 68% in foster

placements (12% kin)• 13% residential homes3,800 adoptions • 300,000-400,000

children in need

Australia• 6.8 million (0-24) 12,531 entrants 23,695 in care (0.4%)• 54% in foster placements

(40% kin)• 5% residential homes 585 adoptions

Concerns about care

• Most children are best with their families

• Abuse while in care• Low expectations and poor outcomes• High costs (17% of children in need

absorb 61% of resources)• Not enough placements (c. 10,000 too

few foster placements)

Consequences• The system is geared to providing short-term

placements for children who will quickly return home

• Those who do not may receive an inadequate service

• Vast majority of first placements (90%) are unplanned

• Increasing numbers of children are placed at a distance

• Pressures to end care episodes through adoption/premature independence

• High costs of care mean too little is spent on earlier, less intrusive interventions

• Entry is delayed, with adverse consequences for children’s wellbeing

• Fewer entrants but with more extensive needs

What do we know about the children?

• Children first and foremost• Care is one response within a continuum• Not a homogenous group• Needs relate to factors within:

– Environment– Families– Children themselves– Combinations of the above

Wider risk factors (1980’s)

• No income support

• Two or more adults

• Less than four children

• Owner occupied

• More rooms than people

• White

• ODDS 1 in 7,000

(Bebbington and Miles, 1989)

• Income support

• Single adult household

• Four or more children

• Privately rented home

• One or more persons per room

• Mixed ethnic origin

• ODDS 1 in 10

Parental Risk Factors (1990’s)

• Learning disabilities• Physical disabilities/ health problems• Mental ill health • Drug abuse• Domestic violence• Combinations of the above

Consequences for children’s well-being

• Physical, sexual, emotional abuse or neglect (Primary reason for 48% entrants in England)

• Health and development issues• Frequent changes of domicile, carer and

household• Insecure or ill-formed attachments• Frequent changes of doctor, school

Frequent changes of domicile, carer and household

• In a sample of 42 babies who entered care before their first birthday, 7 had had two or three and 11 four or more addresses before admission. Five had had four or more carers.

• In a sample of 242 children in long-term care, one in three (33%) had experienced one and one in eight (12%) had experienced two or more previous admissions

Frequent changes of domicile, carer and household

‘Well my Dad took me to live with him and my stepmother and then after two weeks he gave me to my Granny and he said ‘Here, you have him, I don’t want him’, and then after a week he came down and took me to my Nana’s and then after six weeks I was at my Dad’s ….and then after four days I was living with my Auntie for three weeks and then I started living with my Nana again’

(Gary, aged 12)

Frequent changes of school

• School One: 5-9 years (house move)• School Two: 10 years (routine change)• School Three: 10-12 (house move)• School Four: 12-13 years (house move)• School Five: 13 years (house move)• No school place for two months• School Six: 13 years (parents request change)• School Seven: 13-14 years (poor attendance)• Age 14 enters careGina, age 16 at interview

What do we know about entrants to long-term care?

• 19% have physical and /or learning disability • At least 50% have emotional or behavioural

problems• 17% have criminal convictions • An unknown number have fallen behind with

their education• An unknown number have led transient lives• Between 20% and 30% show no evidence of additional needs

Outcomes for children in care in England

• 60% leave school with 1 GCSE (vs 96%)• 61% FTE post 16 (vs 75%)• 20% unemployed three months after

school (vs 6%)• 9% cautioned or convicted in each year

(vs 3%)

OC2 data 2005

Looked after children basic qualifications by length of time in care

0

10

20

30

40

50

60

70

<6 months 12-23months

48-71months

96months+

% w

ith q

ualifica

tions

boysgirls

Some children have

– Stable placements– Good opportunities for contact– Continuity of education– Good educational outcomes– Extra help with education/ emotional and

behavioural problems BUT

These are most likely children with no additional support needs

Care in England and Wales

• A reasonable service for children with ordinary needs

• Not a high quality service for children with aspirations

• Not a specialist service for children with exceptional needs

If care is to compensate for previous deficits then:

– We need to accept the responsibilities of a corporate parent

– All entrants will need a thorough assessment of need followed by routine evaluation of progress

– All long-term entrants will need stable, supportive placements that endure until adulthood

– At least 70% will require a package of specialist services

– Specialist support will need to be continuing and accessible

– Support for parents will need to be coordinated with that for children

What happens in England and Wales?

– Processes for assessing need and evaluating progress developed but not well implemented

– About one in eight children have three or more placements in a year

– 18% are placed over 20 miles from home

– Workforce with too few skills for children with exceptional needs

– Too many children and carers have low aspirations

What happens in England and Wales?

– Packages of specialist services not well coordinated

– Specialist support often fragmented and inaccessible

– Transitions from care to independence still condensed and accelerated

– Adult services poorly coordinated with children’s services

Key messages for policy• Acknowledge corporate parenting responsibilities• Strengthen early interventions• Accept that care is necessary• Outcomes focussed • Aim to narrow the gap • Concrete initiatives to raise aspirations and

outcomes• Development of a workforce with appropriate skills • Support for care leavers into adulthood • Continuum of services for children in need• Evaluating progress integral to the service• Integrated service delivery

Focus on outcomes in the UK

• Looking After Children 1995-2005 Integrated Children’s System 2005-

• Quality Protects (1999- 2004)

• Every Child Matters (2003 -

Every Child Matters: Outcomes Framework

• Be healthy• Stay safe• Enjoy and achieve• Make a positive contribution• Achieve economic wellbeing

Children Act 2004

• Integration of services: Children’s Services Departments

• Integration of responsibility: Local Safeguarding Boards, lead professionals

• Transparency of information• All within the outcomes framework

Key messages for policy• Accept corporate parenting responsibilities• Strengthen early interventions • Accept that care is necessary • Outcomes focussed• Aim to narrow the gap• Concrete initiatives to raise aspirations and

outcomes • Development of a workforce with appropriate

skills • Support for care leavers into adulthood• Continuum of services for children in need• Evaluating progress integral to the service • Integrated service delivery

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Key messages for managers

• Make use of information (assessments of need; exceptions reports)

• Evaluate initiatives to raise aspirations• Encourage practitioners to monitor progress• Encourage informed decision making (sibling

placements, same race placements, early assessments)

• Reduce planned changes of placement • Promote continuity of education• Promote continuity of inter-agency support• Ask – if this were my child?

Key messages for practitioners• Listen to the child/parents/carers• Partnership is not easy• The fostering task is increasingly complex• Some children have problems that require

specialist support• Understand the child’s previous history• Understand the importance of attachment in

children’s development • Assess needs and monitor progress• Very small, informal gestures make a huge

difference• Ask – if this were my child?

A final word from the children

‘I think it’s a good thing that I went into care….I don’t think I would be the person I am now, really, if I hadn’t. It’s made us stronger.’

(Lara, age interviewed 18 years) ‘The fact that I have been in care, I wouldn’t change it. I think that the care system brought out a lot in me that I didn’t have…’

(Rob, age interviewed 19 years)