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Achieving Emotional Well-being for Looked After Children and Care Leavers
Louise Bazalgette, NSPCC
24th June 2015
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Introduction: The project
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Achieving emotional wellbeing for looked after children project
One-year service design project in partnership with four UK councils and their health/ education partners. Aims are to:
• Develop a detailed understanding of the emotional and mental health needs of children in care
• Gather evidence on ‘what works’ in meeting the emotional needs of looked after children
• Identify how these messages from research can be translated into practice
• Identify how local services can improve emotional and mental health support for children in care
The project will culminate in a published report, aimed at an audience of policymakers and practitioners (early July 2015)
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Two central questions
How can we achieve good emotional wellbeing for all children in care? What would a care system that prioritises children’s emotional wellbeing look like?
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Project approach
Phase 1: How well are we currently meeting the emotional and mental health needs of children in care in the UK?
• Literature review• Expert interviews and steering group • Field work• Mapping workshop (3 local authorities in England, 1 in Wales)
Phase 2: Designing the solution in partnership
• Horizons scanning• Service redesign workshops• Feasibility and prototyping• Individual action plan for each local authority• Sharing learning
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Findings
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Rates of mental health problems among looked after children
Category of disorder Non-disadvantaged children (n = 1253)
Disadvantaged children (n = 761)
Looked After Children(n = 9677)
Any disorder
8.5% 14.6% 46.4%
Anxiety disorders
3.6% 5.5% 11.1%
Post-traumatic stress disorder
0.1% 0.5% 1.9%
Depression
0.9% 1.2% 3.4%
Behavioural disorders
4.3% 9.7% 38.9%
ADHD
1.1% 1.3% 8.7%
Autistic spectrum disorder
0.3% 0.1% 2.6%
Neurodevelopmental disorder
3.3% 4.5% 12.8%
Learning disability
1.3% 1.5% 10.7%
Comparison of rates of mental disorder among British children aged 5-17 (Ford et al, 2007)
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Causes of poor mental health among looked after children (Woolgar, 2013)
• Genes: ‘inherited contribution to behaviour’
• Exposure to maltreatment (interaction with genes through ‘epigenetic processes’)
o 5.9 per cent of children in UK (under 11) have experienced severe maltreatment
o 18.6 per cent of CYP aged 11-17 (Radford et al, 2011)
o 62 per cent of looked after children in England first entered care due to abuse or neglect (DfE)
• Physiology: stress levels for children who have experienced maltreatment may be ‘chronically elevated or chronically suppressed’
• Brain development is shaped by early experience. In a context of maltreatment, the brain is adapting to an adverse environment. Behaviour appears ‘maladaptive’ when the child’s environment changes
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What support is currently offered?
Assessment
• Health assessments at entry to care: often more focused on physical health than mental health (new statutory guidance says there should be ‘parity’)
• Completion rate of SDQs for young people aged 5-16 (DfE, 2014):
o Nationally: 68% (range = 0% - 100%)
o Kent: 76%
• SDQ scores (nationally/ Kent, 2014)
Normal Borderline Cause for concern
England 50% 13% 37%
Kent 47% 12% 41%
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What support is currently offered?
Across 4 local authorities: support for carers is highly variable
Foster carer: The CAMHS consultation has been quite easy to arrange – they have been willing to support emotional and behavioural difficulties over there.
Foster carer: I tried to get the children an emergency CAMHS appointment but it took a year.
Foster carer: I wasn’t offered respite and I didn’t ask for it. In hindsight I think that if I had taken some respite the placement might not have broken down. I needed some time apart to re-connect with my son.
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What support is currently offered?
Across 4 local authorities
Support for young people can make a big difference….
I’ve had a lot of help and support, but foster carers need to be listened to more. I really had to fight to get therapy for [foster daughter], and her social workers didn’t listen. She eventually got it because the referral to CAMHS was made by a doctor. At the moment only schools or a GP can refer. (Foster carer)
…. If it can be accessed
I didn’t get any [support with my anger]. I was trying to get counselling and I’ve only just got it now. So I’ve been wanting it for the past 4-5 years. (Young person in care)
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Impact of unmet emotional and mental health needs
Placement breakdown
• Biehal et al 2010: Children with higher SDQ scores went on to have a more unstable experience of care
• Instability itself exacerbates poor mental health (Rubin, 2007)
• Rates of placement instability:
o In 2014 30,430 children left care (DfE)
o Approximately 5% (1,480 children) had 10 or more placements in care history
A young person who had 15 placements:
Maybe if there was more support for you to express yourself in a different way [I wouldn’t have had so many placement breakdowns]. Maybe… people just didn’t understand. […] I just think maybe they could have tried to find out what those behaviours were and how you can overcome it, instead of saying ‘No, we’re not dealing with this.
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Impact on young people: a story
Joe, aged 16, living in foster care
• Entered care aged 5
• Short-term foster care placement (3 months)
• Foster care placement where carer was abusive (3 years)
• New foster care placement ‘they were like a mum and dad to me’
o After four years ‘my anger got really bad’
o After five years, placement broke down
• Four foster care placements: ‘I was doing drugs, running away, getting kicked out of different schools’
• Residential care: finally got 1-1 support (18 months)
• Moved back to foster care (6 months, now aged 16), going to college
• Accessing counselling for the first time (had been waiting 4-5 years)
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Impact of unmet emotional and mental health needs
Care leavers’ outcomes
Dixon et al (2006): Research with 106 care leavers in first 12-15 months living independently:
• 41% of care leavers experienced increased symptoms of poor mental health, indicating deterioration in well-being
• Care leavers with poor mental health were at greater risk of experiencing homelessness and were twice as likely to have poor employment outcomes
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What makes a difference?
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Key findings from research (Luke et al, 2014)
1. Looked after children’s emotional wellbeing is not ‘fixed’
o High quality caregiving relationships can drive positive change
o Targeted interventions can successfully reduce problems
2. Early interventions are more likely to promote good mental health
3. Relationships are crucial to children’s progress (especially caregiver relationships)
4. Caregiver training is a promising method for improving children’s outcomes
5. Caregivers’ attitudes can affect the take-up of services
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Key findings from research (Luke et al, 2014)
6. Continuity and stability are important to children's outcomes
7. Efforts to improve mental health should be systemic and sustained (e.g. importance of strong team work)
8. Children and young people should be treated as individuals (what is important to them?)
9. Professionals need to listen to children and young people
10. Interventions need a clear theoretical base but should be open to more than one interpretation of children’s behaviour
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Priorities for practice
1. Embed an emphasis on emotional wellbeing throughout the system
2. Take a proactive and preventative approach to supporting good emotional wellbeing
3. Give children and young people voice and influence
4. Support and sustain children’s relationships
5. Support care leavers’ emotional needs
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References
• Biehal, N., Ellison, S., Baker, C., Sinclair, I., (2009) Characteristics, outcomes and meanings of three types of permanent placement – adoption by strangers, adoption by carers and long-term foster care. Research brief DCSF-RBX-09-11, London: Department for Children, Schools and Families.
• CQC (2014) ‘Review of Health Services for Looked After Children and Safeguarding in Cumbria’.
• Dixon, J., Wade, J., Byford, S., Weatherly, H. and Lee, J. (2006) Young people leaving care: A study of costs and outcomes. York: University of York.
• Ford, T., Vostanis, P., Meltzer, H., and Goodman, R. (2007). Psychiatric disorder among British children looked after by local authorities: comparison with children living in private households. The British Journal of Psychiatry, 190(4), 319-325
• Radford, L., Corral S., Bradley, C., Fisher, H., Bassett, C., Howat, N. & Collishaw, S., (2011) Child abuse and neglect in the UK today. London: NSPCC
• Rubin, D., O’Reilly, A., Luan, X., and Localio, A. (2006) The Impact of Placement Stability on Behavioural Well-being of Children in Foster Care. Pediatrics, 119 (2), pp. 336-344. [USA]
• Sempik, J., Ward, H., & Darker, I. (2008). Emotional and behavioural difficulties of children and young people at entry into care. Clinical child psychology and psychiatry, 13(2), 221-233
• Woolgar, M. (2013) The practical implications of the emerging findings in the neurobiology of maltreatment for looked after and adopted children: recognising the diversity of outcomes. Adoption & Fostering 37 (3) 237-252.
