Children in Care (CiC)

If you only read four things:

1. As of 31st March 2018, a total of 861 children were looked after by Suffolk County Council.

2. The numbers of children in care in England continue to increase and this same pattern is reflected in Suffolk.

3. The profile and characteristics of children in care and care leavers has changed considerably over the last few years.

4. The main needs of children entering care are reported to be due to abuse or neglect, family dysfunction, family stress and absent parenting.

1.Key points

This topic paper is based on the Children in Care (CiC) health needs assessment (HNA) completed in July 20181.

The numbers:

  • The numbers of children in care in England continue to increase and this same pattern is reflected in Suffolk. As of 31st March 2018, a total of 861 children were looked after by Suffolk County Council, (comprising of 790 non-Unaccompanied Asylum Seeking Children (UASC) and 71 UASC children), at a rate of 56.3 per 10,000 children under 18 years.

Figure 1: Number of children in care in Suffolk, March 2014-March 2018

Children in care in Suffolk increased from 712 in March 2014 to 790 in March 2018

  • The absolute number of children in care (excluding UASC) has increased by 11% (712-790) between March 2014 and March 2018. This increase is statistically significant.
  • In the last five years, the proportion of children in care (including UASC) aged 15-17 years has increased by 10% (27% to 37%). This increase was 6% when excluding UASC. In contrast, the proportion of those aged 0-4 and 5-9 years have reduced by 6% and 3% respectively.
  • The main needs of children entering care are reported to be due to abuse or neglect, family dysfunction, family stress and absent parenting. In 2016/17 family dysfunction as a primary need was higher among Suffolk children (26%) compared with the national average (15%). Parental issues as reasons why children become ‘at the edge of care’ or come into care have also been highlighted.  However, it must be noted, interpretation of these categories can vary, due to limited consistency in the reporting, therefore direct comparisons may not be valid.
  • The number of children in care who were adopted has decreased by almost 50% over the last five years (from 81 to 44).
  • As of 31st March 2018, the most prevalent placement type is in foster placements at approximately 56%, followed by those fostered with friends or family at 14%, indicating the bulk of placements (~80%) are in family settings.
  • The numbers of children placed in secure units/children’s homes/ hostels has decreased by 18.6% in Suffolk between March 2016 and 2017.
  • In 2016/17, 18% of Suffolk’s children in care were placed out of the county, reducing to 11% as of 31st March 2018. This is significantly better than national average (38%) and statistical neighbours average (17.6%) for 2016/17, highlighting Suffolk’s improved local provision. More episodes of out of county placements were accounted for in the adolescent age groups.
  • As of 31st March 2018, one in five children (20.4%) placed in the county were more than 20 miles from home which is significantly higher than the England average (4%) and statistical neighbours (15%) for 2016/17. Suffolk is a large county; however, it would be useful to review the local provision in areas where children in care live, to see if they meet their needs.
  • Suffolk has had high levels of placement stability over the last five years. Long term stability was 70.0% in 2017/18 similar to 67.7% in 2013/14. The proportion of children in care who had three or more placements in the previous year has also remained relatively stable, currently at 9.5%.
  • In 2016/17, 57.1% of children in care had a special educational need or disability (SEND) of any level and 29.3% of CiC had an EHC plan or statement.2 Analysis has further shown that the numbers of children with SEN may increase up to 18% in the next three years. In addition, nationally, 1 in 5 school children reported having a long-term condition or disability which affected their day to day activities.3 It can be assumed this prevalence would be higher among the CiC cohort as well as the wider children in need (CIN) cohort, therefore this is an area which may warrant prioritisation in the coming years. 

The impact:

  • There is strong evidence that children in care are at a higher risk of poor health, education and social outcomes than their peers who are not in care and these disadvantages persist into adulthood.2
  • The backgrounds and experiences of children in care are likely to make them particularly vulnerable to poor health outcomes. Coming into care often means that frequent placements and school moves lead to common health issues and routine health checks and health promotion initiatives, are overlooked. Children and young people who have experienced disrupted childhoods and inconsistent or broken attachments with their parents and families are also more likely to have mental health problems than their peers. 
  • The number of children in care in Suffolk are expected to increase slightly in the next twenty years, as the number of adolescents rises over time, particularly in Forest Heath, Ipswich and Waveney.
  • In Suffolk, between March 2017 and March 2018, nearly half of all children (47%) screened using the Strength and Difficulty Questionnaire (SDQ) were identified as having ‘a concern for their mental health needs.4 NICE estimates that around 45% of all CiC in the UK have a diagnosable mental health disorder and that 70-80% have mental health problems that are recognisable5, applying this prevalence estimate to Suffolk, 388 children (356 children in care and 32 UASC) may have mental ill health.
  • UASC health needs are different from the indigenous children in care population. The main health issues reported are:
    • Communicable diseases (Tuberculosis, Hepatitis B, scabies, sexual health issues) and a need for catch-up preventive immunisations and screening.
    • Emotional and mental health issues (most commonly post-traumatic stress disorder(PTSD), anxiety and depression).

2.What are the key inequalities in Suffolk?

  • There is a strong correlation between the numbers of children in care and deprivation. Higher rates of children in care and children on protection plans (CPP) (excluding UASC) are seen in the 10% most deprived areas of the county.
  • The Social Mobility Index combines factors associated with the chances of someone from a disadvantaged background experiencing upward social mobility. Analysis shows Ipswich, Forest Heath, Babergh and Waveney fall into the lowest social mobility category nationally. A gradual increase in the numbers of their adolescent populations are also expected in these areas, therefore this should be taken into consideration when focusing on improving outcomes for children and young people (CYP).
  • The Leaving Care Service in Suffolk noted that care leavers are more likely to suffer with mental ill health; notably anxiety, depression and self-harm are more prevalent. Although CAMHS offers a ‘youth pathway’ for those aged 16+ (recognising that turning 18 and becoming an adult is a difficult cut off point for young people), there are ongoing challenges with the admission into the CAMHS pathway due to their differing needs.

3.Costs

Estimated national expenditure on services for Children in Care was £2.5 billion (gross) in 2013-14. The highest proportion of spend (55%) was on foster care, and children’s homes (36%)5. A more recent report highlighted that nearly half of the entire £8.6bn budget for children's services across England is spent on 73,000 children in the care system7.

In Suffolk, the total spend on children’s placements has increased recently, particularly due to an increase in purchased care placements. Total placement spend for Suffolk children in care rose from £18,800,531 in 2013-14 to £21,783,167 in 2015-166. The cost of care varies between local authorities. In 2012-13, average spend per place in residential care was between £131,000-£135,000 per child. Average spend on foster care was between £29,000-£33,00013.

There is an inverse relationship between the cost and outcomes of poor care:

  • In a report for Barnardos, researchers modelled the cost of contrasting care experiences for children in long-term care and found that effective ‘good’ care was less costly both on an annual basis and overall, well into adulthood.  Assuming that roughly 5-10% of the care population each experiences both ‘good’ and ‘poor’ care, they found a saving of £32,755 per year for the ‘good’ journey, adding up to a total saving of £133,330 to the state by the age of 30.  ‘Good’ care was characterised as having stable placements, supported transition, leading to university level study employment; ‘poor’ care as experiencing unstable and disrupted placements, having ongoing mental ill health and being unemployed at age 303.
  • Failed reunifications for Children in Care are costly in terms of outcomes for the individual and cost to the state.  Research for the NSPCC in 2014 estimated the total estimated current cost for all failed reunifications at £300 million a year (£61,614 per child returning to care). This is more than five times the estimated annual cost (£56 million) of providing  support and services to meet the needs of ALL children and families returning home from care (average annual cost per child £5,627)11

One of the six transformational programmes for Children and Young People’s Services, is ‘CYP High Cost Demand-Children in Care’ which aims to reduce the need for children coming into care and ensure value for money of services for children in care.

4.What are we doing?

Suffolk has made substantial progress on a number of indicators regarding the health and wellbeing of children in care. There have been marked improvements on the overall completion of initial health assessments (IHAs) for children in care as well as timely completion within 28 days (15.9% at the end of March 2018 compared to 2.3% end of March 2017). The recording of immunisation status and undertaking of dental checks are also statistically similar compared to national and regional averages.

Challenges that children and young people’s services face in looking after young people can range from substance misuse, missing episodes, child exploitation, disengagement with education, poor social skills, self-harming, gang related activity, and attachment disorders. To address these common issues, agencies in Suffolk are working jointly to support children and prevent further exposure or deterioration.

Children’s homes have developed close working links with main partners and services through:

  • Child and Adolescent Mental Health Services (CAMHS): which cover all services working with CYP who have difficulties with their emotional or behavioural wellbeing.
  • Connect Service: the countywide service for children in care, which specialises in working with trauma, complex care or parenting issues, and offers specialist assessments, consultation, and a wide range of therapeutic interventions.
  • Turning Point: the dedicated drug and alcohol service for young people with a substance misuse problem.
  • The Police: working to prevent children’s involvement in crime.
  • Make a Change team: the countywide service for CYP who are at risk or are victims of child exploitation.

Data shows that Family Solutions, the edge of care service, have had high success rates of CIN and CPP avoiding the need for care at over 80%. Given such success rates it would be useful to explore further opportunities to expand their capacity working with CIN and their families. Similarly, Home Start Suffolk is a good example of provision working with vulnerable families through well trained and experienced befriending volunteers.

Suffolk also places a higher number of UASC compared to its statistical neighbours and has responded to this high demand efficiently by providing a range of services for their challenging needs.  Provision to support this cohort is continuously being expanded and recent developments include:

  • A Drama Therapist pilot service (commenced in June 2018) to support their emotional wellbeing and a translator service to meet language needs.
  • The Grandmentors Scheme (whereby someone aged 50+ mentors a care leaver) is in the process of being tailored to meet the needs of UASC, as many lack adult/parenting figures in the UK. It is important to monitor the risk levels of these young people and their exposure to substance misuse, gang and sexual exploitation due to their living circumstances.

Mental health, accommodation and educational outcomes are some of the main challenges care leavers experience. The Leaving Care Service has made considerable steps to develop care leavers independence skills for transitioning into adulthood through a range of new initiatives such as the development of the Transition Panel and health passports for care leavers.  

5. What else could we do / Recommendations

  1. Young people, professionals and service providers have raised concern about the difficulties of accessing mental health services, mainly referring to CAMHS. A principal challenge for CAMHS is the management and treatment of children in care who are not quite meeting the criteria for diagnosis of a ‘mental health condition’. Emotional and conduct issues may defy a psychiatric diagnosis yet are perceived by other stakeholders to be an issue where mental health services could be productively involved. Review of CAMHS activity data would be beneficial to determine any unmet needs. 
  2. There are some reported challenges in timely completion of IHAs, such as delays in social worker completion of paperwork due to limited capacity (delays in getting parent/carer consent and variable quality of completion of the forms). These areas require immediate actions from social workers.
  3. Given the large number of adolescents displaying emotional and behavioural difficulties and mental health issues, developing a therapeutic service provision for adolescents to provide ongoing support for vulnerable groups of children is recommended.
  4. Continued support for care leavers in the following key areas is recommended:
    1. Access to services for emotional and behavioural difficulties still presents challenges- a review of the current provision for those requiring immediate support is recommended.
    2. Further work is required to ensure adults services, foster carers, supported housing providers and other partners are supporting care leavers to develop independent skills to successfully transition to adulthood.
  5. Suffolk should aim to collaborate with partners across the children in care system to collectively assess the extent to which the Suffolk system is adhering to the NICE ‘Looked-after children and young people [PH28]’ guidelines, to identify gaps in service provision and thus action to address this.

6.Useful links 

7.References

1.        Public Health Suffolk County Council. Health Needs Assessment of Children in Care. https://www.healthysuffolk.org.uk/jsna/health-needs-assessments. Published 2018. Accessed July 20, 2018.

2.        Department for Education. Outcomes for looked after children by local authorities, 31st March 2017.

3.        World Health Organization Collaborative Cross National Study. Health Behaviour in School-aged Children (HBSC): England National Report. 2014.

4.        Suffolk County Council. CYP Intelligence Hub- Data for Sufficiency Strategy, 2018.

5.        Centre for Child and Family Research Loughborough University. Mental health of Looked After Children in the UK - Summary.

6.        Office NA. Children in Care.; 2014.

7.        Children and Young People Now. Spiralling care costs “causing millions of children to miss out on help.” https://www.cypnow.co.uk/cyp/news/2005406/spiralling-care-costs-causing-millions-of-children-to-miss-out-on-help. Published 2018. Accessed July 20, 2018.