[008.23] Exploring Care for Children with Complex Needs in Children’s Homes

In an Ofsted upcoming research project focused on children with complex needs residing in children’s homes, the initial stage involved a survey conducted among local authorities and children’s home providers. The responses from 807 children’s homes and 78 local authorities shed light on the associations and difficulties faced in finding suitable homes and accepting referrals for children with complex needs. This project builds upon a previous report that highlighted the increasing demand for specialized provisions to support children with complex needs and the challenges faced by local authorities in finding appropriate placements.

The research aims to gain a clearer understanding of the term “complex needs,” examine the efforts made by local authorities and children’s homes in providing positive experiences for these children, explore collaborative approaches between authorities and homes, and identify potential areas for improvement.

The survey revealed that “complex needs” encompass various types of needs and risks, often requiring support from multiple partner agencies. Mental health needs, behavioral needs linked to safeguarding concerns, behavioral needs associated with learning difficulties, and physical health needs were identified as the primary categories contributing to complex needs. These areas, when combined, form the basis of the definition.

Local authorities reported significant challenges in finding homes for children with complex needs, with an average time of four months to secure stable placements and some cases taking up to three years. Placement breakdowns, unplanned moves, out-of-area placements, and homes declining referrals were common issues experienced by children with complex needs.

The research also highlighted systemic barriers impacting the care and placement of children with complex needs. These barriers include the effectiveness of multi-agency working, access to health services, staff consistency and skills, availability of suitable homes, and the thoroughness of referral processes. Communication gaps and lack of transparency between local authorities and children’s homes were identified as obstacles to making informed referral decisions.

The next phase of the research will involve engaging with children living in children’s homes and professionals involved in their care, with the intention of sharing examples of good practices.

The comprehensive report will be published in the autumn, offering insights and recommendations based on the survey findings and subsequent research stages.

[007.23] The Hidden Risks Faced by Young Mental Health Patients in Children’s Wards

A safety investigation conducted by the Healthcare Safety Investigation Branch (HSIB) has highlighted the significant risk faced by young people with complex mental health needs who are placed in general children’s wards in England. The investigation found that pediatric wards, designed for patients with physical health needs, are not safe or suitable for those with mental health needs. The report described the situation in 18 hospitals as challenging, with 13 of them being deemed unsafe for children at risk of self-harm or suicide. The investigation was prompted by a case where a young patient in a pediatric ward attempted self-harm while awaiting a mental health assessment.

The BBC highlighted the case of a 16-year-old autistic girl who spent several months in a children’s ward, and other families have since come forward with similar stories. Many families faced difficulties in accessing appropriate support for their children with mental health needs. Hospitals have reported an increasing number of children with a combination of autism, learning disabilities, and complex mental health needs.

NHS England acknowledges the need for improvement in mental health services for children and young people. They have ongoing programs to transform these services, including adapting hospital environments to meet the sensory needs of patients. However, the HSIB report raises concerns about the lack of therapeutic help available in pediatric wards and the deterioration of children’s conditions as a result.

The report also highlights the risks of self-harm, including ligature points, in pediatric wards. It mentions the busy and noisy nature of these wards, which can be traumatic for children experiencing mental health crises or those with sensory needs. Security incidents involving high-risk behaviors were frequent, often leading to physical restraint or sedation. Staff expressed concerns about the negative impact on other patients and families, and some hospitals described their workforce as “collapsing.”

NHS England has stated that it will review the concerns raised by the HSIB and incorporate them into ongoing efforts to improve care for children and young people with mental health needs. While it acknowledges that mental health care in acute settings can be appropriate in certain cases, efforts are being made to develop integrated mental and physical health care services through pilot programs and online training platforms for staff.

[006.23] Supported Accommodation Providers Forum

I had the privilege of organizing (through FEVACA’s initiative) a forum and spending the day with numerous providers of Supported Accommodation. It was truly inspiring to witness the collective interest and dedication we all share in learning and committing ourselves to the development of high-quality services and provisions.

The forum comprised a series of engaging presentations, including my own (fingers crossed!!!), where we discussed the current state of affairs and the impact of the new regulatory framework on the sector. We also had the invaluable opportunity to have our questions answered by representatives from Ofsted and the DfE, as well as to learn from other agencies with whom we collaborate.

While there is still progress to be made, it is incredibly motivating to see the genuine interest and commitment to maintaining, creating, and improving services that meet the needs of the young people we work with. These services demonstrate the true impact that quality caring support can have on the lives of these individuals.

Undoubtedly, there are challenges ahead, which emphasize the importance of providers coming together, continuing on the path of improvement, and ensuring we have a united voice.

Regarding my presentation, I had the opportunity to share my thoughts about the impact that the new regulations will have on our practice, as well as some thoughts regarding what is allowed and not allowed within the regulations including, and opposite to what I keep reading, the fact that we “can” care for the young people we work with.

[005.23] Changing the narrative around Supported Accommodation

The Supported Accommodation Regulations have been recently published (late last month), marking a significant milestone in residential children’s care, and it has created a buzz in the “world” of residential care for children and young people. These regulations are specifically designed to address the care and support provided to individuals aged 16 and above residing in supported accommodation settings. This groundbreaking publication signifies a commitment to safeguarding vulnerable young individuals and promoting their journey towards independence within a safe and nurturing environment.

One prevailing misconception that is important to clarify is the belief that supported accommodation settings do not provide adequate care. Until April 2023, and included in Ofsted guidance, there was a document that intended to explain where, depending on their needs and level of support, a child could be in Supported Accommodation or when the child should be in a Residential Children’s Home. Unfortunately, the informal title given to this document was “Care v. Support”. However, With the introduction of the Supported Accommodation Regulations, this notion is now firmly challenged. The regulations prioritize the provision of comprehensive care and support tailored to the unique needs of each young individual in residential settings.

Parallel to the regulations governing Children’s Homes, the Supported Accommodation Regulations emphasize the importance of thorough risk assessments. Just as Children’s Homes assess and mitigate potential risks to children, supported accommodation providers are now required to implement rigorous risk assessment procedures. This ensures that appropriate measures are in place to address any identified risks and safeguard the well-being of young residents, further reinforcing the commitment to providing quality care in residential settings.

Furthermore, both regulatory frameworks recognize the significance of well-trained and qualified staff members. In Children’s Homes, a competent and compassionate team is essential for catering to the specific needs of children. Similarly, supported accommodation providers are mandated under the new regulations to employ skilled staff who possess the necessary knowledge and expertise to deliver exceptional care and support to young individuals in residential settings. This affirmation dispels any doubts regarding the provision of care available in supported accommodation, underscoring the commitment to promoting the well-being of children and young people. It is now “accepted” that care can be provided in Supported Accommodation and that (finally!!!) it is impossible to legally define what care is.

In reality, even before these new regulations, not being able to provide care, did not mean that Supported Accommodation settings could not provide a caring approach, or support, being the “forbidden” care mostly associated with control of the child residing in those homes (i.e. not allowing a child to leave the home). It is now time to stop with the false correlation between Supported Accommodation and no provision of care.

To ensure accountability and maintain quality standards, the Supported Accommodation Regulations also establish robust monitoring and evaluation mechanisms. Just as Children’s Homes undergo regular inspections to assess compliance with established standards, supported accommodation settings will be subject to stringent monitoring processes. This fosters a culture of continuous improvement and guarantees that young residents in residential care receive the care and support they deserve on their path toward independence. Yes, there are aspects that might need to change and monitoring and inspection to be more robust (I have presented some ideas for changes on the regulatory framework before), but this is a huge step in the right direction.

It is time to stay informed, debunk misconceptions, and foster a culture of care, protection, and support for children and young people in residential settings, and embrace the opportunities presented by these regulations to create a brighter future for vulnerable children and young people.

[004.23] Care Leavers’ Emotional Wellbeing

A study conducted by researchers at the University of East Anglia and the University of Bristol (published this week by What Works for Children’s Social Care) surveyed 1,000 care leavers in England and conducted interviews with a smaller group of care leavers and professionals working with them.

The survey revealed that care leavers experience lower well-being and life satisfaction compared to the general population. For instance, 30% of care leavers reported feelings of loneliness or isolation, while only 10% of the general population reported the same. Additionally, 26% of care leavers reported feelings of anxiety or depression, compared to 13% of the general population.

The study also found that care leavers are more likely to face homelessness and involvement with the criminal justice system. Among care leavers aged 19-21, 38% are not in education, employment, or training (NEET), while only 12% of the general population falls in that category. Furthermore, 15% of care leavers have been in prison, while the same is true for only 4% of the general population.

The study revealed that professionals assisting care leavers tend to focus more on practical aspects like securing housing rather than addressing emotional well-being, despite research indicating that emotional support is equally important. The study recommends:

  1. Train professionals working with care leavers to understand and provide emotional support.
  2. Offer more support to care leavers for the development and maintenance of a support network.
  3. Conduct further research on the emotional well-being of care leavers and the effectiveness of interventions to support them.

The study also emphasizes the importance of providing emotional support to care leavers, as it helps them cope with the challenges of leaving care and build a positive future. Additional information on the emotional well-being of care leavers includes the following statistics:

  • 45% of care leavers have a mental health disorder, compared to 10% in the general population.
  • Care leavers attempt suicide at a rate four times higher than the general population.
  • One in three care leavers will experience homelessness at some point in their lives.
  • One in four care leavers will be involved in the criminal justice system.

Factors contributing to these problems among care leavers include the lasting impact of trauma experienced in care, multiple changes and transitions at a young age, lack of support from family and friends, and limited financial resources.

To support the emotional well-being of care leavers, the following measures can be taken:

  • Provide emotional support during the transition to adulthood.
  • Assist care leavers in developing and maintaining a support network.
  • Offer financial support to care leavers.
  • Ensure access to mental health services for care leavers.

[003.23] It is time to change the narrative about children’s homes

In recent times, we frequently come across news highlighting opposition to the establishment of children’s homes in certain neighborhoods. However, it is crucial to emphasize the importance of considering the best interests of children and recognizing their right to a safe and nurturing living environment.

Children’s homes play a vital role in providing a supportive and stable living environment for children who, for various reasons, are unable to live with their biological families. These homes strive to offer a safe haven where children can grow, develop, and thrive.

It is understandable that concerns may arise when a children’s home is proposed in a community. People may worry about the impact on the neighborhood or have misconceptions about the children who will reside there. However, it is essential to move beyond fear and prejudice and instead focus on the well-being and future of these vulnerable children.

Every child deserves a safe place to call home, where they can feel loved, valued, and protected. By opposing the establishment of children’s homes, we risk denying these children the chance to have a stable upbringing and access to essential support services. We should recognize that these homes are (and must be) carefully regulated by Ofsted and other entities and supervised to ensure the safety and well-being of the children they serve.

It is also important to acknowledge that children’s homes are not isolated entities but rather part of a larger community. By embracing these homes and offering support, communities have an opportunity to contribute positively to the lives of these children. It allows us to foster a sense of compassion, understanding, and inclusivity, which are invaluable qualities for any society.

Instead of focusing on the potential negative aspects, let us strive to create an environment where these children are welcomed, embraced, and given a fair chance at a brighter future. By working together, we can break down barriers, dispel misconceptions, and ensure that children’s homes become a positive and integral part of our communities.

It is time to change the narrative. When considering the establishment of children’s homes, we must prioritize the best interests of the children involved. Every child deserves a safe and nurturing place to live, and by supporting the creation of children’s homes in our neighborhoods, we can collectively contribute to their well-being and development. Let us remember that our actions today have the power to shape a better tomorrow for these deserving children.

[002.23] Alarming Rise in Restrictions on Vulnerable Children’s Liberties

Research into applications made to the Deprivation of Liberty court, located at the Royal Courts of Justice, reveals concerning findings regarding the restriction of vulnerable children’s movements and freedoms. The court, operating as a 12-month pilot since July last year, aims to handle cases involving the deprivation of a child’s liberty.

These court orders can involve confining a child to their room or restricting their access to technology, such as phones or social media. On average, there are 116 applications per month, with the highest number occurring in March of this year. However, the figure dropped to 88 in April.

Since the court’s launch until April this year, a total of 1,139 applications have been issued, including 76 repeat orders related to changes in application details. The research conducted by the Nuffield Family Justice Observatory indicates that 1,069 children have been affected by these applications.

The applications have been made by 151 councils and 21 other entities, often hospital or mental health trusts, seeking to limit the liberty of children in hospitals who are not already under the care of a local authority.

Regional analysis shows that over a fifth of applications come from councils in the North West of England, while London local authorities account for 17.2%. The fewest applications originate from councils in the North East. This regional distribution has remained consistent throughout the pilot’s first 10 months.

Nearly 60% of the applications pertain to children aged 15 to 17, with 15-year-olds being the most affected group, representing over a quarter of the orders since July. Additionally, Nuffield’s research indicates that 1.3% of applications are for children aged 10 or younger.

Slightly more girls than boys are subject to these applications, according to the findings.