Stability & positive long term outcomes for Looked after Children

1. Stability & positive long term outcomes for Looked after Children Efun Johnson Designated Doctor for Looked after Children, Lambeth Dr Efun Johnson November 2013

2. Introduction “The need for good quality health assessments to enhance services that give stability and positive long term outcomes for Looked After Children.” - Dr. Efun Johnson Dr Efun Johnson November 2013

3. Overview of workshop • Children’s Rights -UNRC articles • Looked after children – the background and context • Placement stability -importance • Guidance for health of Looked after Children • Action points for practitioners Dr Efun Johnson November 2013

4. UNCRC Ratified in UK in 1991 42 articles What the convention says about keeping looked after children safe Dr Efun Johnson November 2013

5. UNCRC Article 19 – Governments should ensure that children are properly cared for, and protected from violence, abuse and neglect by their parents, or anyone else who looks after them. Article 25 – Children who are looked after by their local authority, rather than their parents, should have their situation reviewed regularly. Dr Efun Johnson November 2013

6. Definition of “stability” The state or quality of being stable, or firm. The strength to stand or endure. Merriam Webster Dictionary Definition of “resilience” Process of, capacity for, or outcome of successful adaptation despite challenging or threatening circumstances. Masten, Best Garmezy (1990) Dr Efun Johnson November 2013

7. Placement Stability • The short term stability indicator measures the number of placements a young person has in a year. • The long term stability measure identifies those young people who have lived in the same placement for two years, if they have been looked after for two and a half years. National Indicator 63. Dr Efun Johnson November 2013

8. National and Local Themes • It is generally agreed that it is damaging for children to be moved often and is known to have an adverse affect on their emotional stability and security. It also has a considerable impact on their education and learning. • NICE/SCIE guidelines for LAC (2011) Encourage warm and caring relationships between child and carer that nurtures attachment and creates a sense of belonging so that the child or young person feels safe, valued and protected. Emphasis on multi-agency working. • Every Child Matters - "Stability can make a positive difference to their [children's] lives, giving them the opportunity to form strong attachments with carers and friends, maximising their resilience, and improving their chances of achieving positive outcomes". Dr Efun Johnson November 2013

9. Why is placement stability important? • Attachment • Importance of Relationships • Child Development (social, emotional, cognitive, physical) • Educational achievement • Interests and enjoyment • Community • Developing identity Dr Efun Johnson November 2013

10. Why is it important that children form secure attachments? • Attain his/her full potential • Have a blue print for relationships • Think logically - executive functioning • Develop social emotions and conscience –Theory of mind • Trust others • Become self-reliant • Cope better with stress and frustration • Reduce feelings of jealousy • Overcome common fears and worries • Increase feelings of self-worth Dr Efun Johnson November 2013

11. What is known to contribute to instability – Child factors • Child aggression • Mental health problems • History of maltreatment/abuse • Child’s perception that the placement is temporary • If been in residential care previously. Dr Efun Johnson November 2013

12. Local factors - child • Gang involvement/affiliation • Offending • Absconding / missing from care • Substance misuse • Risk of sexual exploitation • Not in education • Non-engagement with services Dr Efun Johnson November 2013

13. Birth family risk factors • Parental substance misuse or alcohol abuse • Parental criminality • Death of a parent Dr Efun Johnson November 2013

14. Birth family – local factors • Internet/ social networking • Loyalty to birth family • Unconscious manipulation/ sabotaging of placement • 14+ years safeguarding plans may need to be reassessed • Parental mental health • Siblings at home • Parental relationships with new partners Dr Efun Johnson November 2013

15. Placement risk factors • Siblings placed separately • Younger foster children in placement or recently moved in • Foster carer’s own children within similar age range Dr Efun Johnson November 2013

16. Placement – local factors • Good matching • Timing – e.g. moving placement as transition to secondary Dr Efun Johnson November 2013

17. Carer risk factors • Carer having unrealistic expectations (e.g. expecting gratitude/respect; challenging behaviour) • Carer stress – difficult life events Dr Efun Johnson November 2013

18. Carer - local factors • Lack of flexible/adaptive parenting skills • Single/pair of FCS • Lack of family network • Carer life experience – unresolved trauma/abuse/life experience • Own extended family history of mental health problems • Language barriers Dr Efun Johnson November 2013

19. Relationship risk factors - attachment • Child - SW • Carer - SW – clear communication • Child – Carer, e.g. eating, boundaries, seeking help • Child - birth parent Dr Efun Johnson November 2013

20. Relationships – local factors • The match • Splitting of the roles: FC needing more support and SW hearing they can’t cope • System is feeling stuck, feeling hopeless • IRO consistency Dr Efun Johnson November 2013

21. What promotes stability? Child factors: • Placements that support intellectual/educational development • Meaningful friendships • Activities - consistent Dr Efun Johnson November 2013

22. Local factors - children • Resilience and adaptive • Able to seek support when hurt • Ongoing Life story work to promote a coherent narrative • Emotional regulation/intelligence • Pro-social skills Dr Efun Johnson November 2013

23. Protective carer factors • Carer with good family support – long-term partnership • Social support – friends, neighbours, colleagues, respite • Carer parenting ability - strong parenting skills Dr Efun Johnson November 2013

24. Local factors- carer • Genuine interest in children • Warmth • Humour • Patience • Energy • Open to novelty • Emotionally resilient/emotional intelligence • Good cook…. Dr Efun Johnson November 2013

25. Protective relationship factors • Role models • SW continuity • Positive child - SW relationship • Positive child - carer relationship • Managed contact with birth family • Education • Positive peer relationships • Sense of community Dr Efun Johnson November 2013

26. What are the outcomes of instability on child and psychological development? • Impact on an already disrupted attachment pattern • Emotional development- delay or dysregulation • Social development –theory of mind • Cognitive development – executive functioning • Behavioural problems – tantrums, challenging behaviour, aggression, oppositionality • Low resilience Dr Efun Johnson November 2013

27. Social Care Perspective • Thorough assessment by SW • Informed intervention plan • Identification and matching of appropriate F/C • Need for multi-agency working and clear communication • Impacted on by varying standard of assessment • Lack of FC recruitment? Dr Efun Johnson November 2013

28. Dr Efun Johnson November 2013

29. Looked After Children Background, Outcomes , Pathways and Guidance Dr Efun Johnson November 2013

30. How Many Children? • Nationally – children in England • CLA in UK England Lambeth Southwark Lewisham Dr Efun Johnson November 2013

31. Context Child altogether in England - 11 million Lambeth, Southwark, Lewisham - 600,000 Over 91,000 looked after children in the UK England - 67,050 children looked after (31 March 2012) Northern Ireland - 2,644 children looked after(31 March 2012) Wales - 5,725 children looked after (31 March 2012) Scotland - 16,248 children looked after ( 31 July 2012) 3,400 adopted Dr Efun Johnson November 2013

32. Trends Significant • Fall in the No. of CIC over past 30 years, then • ↑ between 2008 - 2009 (overall increase almost 3%) • Increase in the No. of care proceedings in England following Baby P Inquiry (CAFCASS, 2009). • Children remaining in care for longer periods, • 13% staying in the care system for more than 5 years (House of Commons, 2009). Dr Efun Johnson November 2013

33. Who are the looked after children? What are the reasons for being LAC? Dr Efun Johnson November 2013

34. Reasons for being LAC Dr Efun Johnson November 2013

35. Reasons for being LAC • Abuse or neglect • Child’s Disability • Parent’s illness or disability • Family in acute stress • Family Dysfunction • Socially unacceptable behaviour • Poverty • Assent parenting/Child abandonment Dr Efun Johnson November 2013

36. What is fostering? • Fostering is a temporary arrangement • Allows a child to live with a family until circumstances enable the child to: • Return to their own family • Live independently or • Be placed for adoption. • Can be for a few weeks, months, or even years Dr Efun Johnson November 2013

37. Foster carers are: • Always given an allowance towards the cost of keeping the child • Share the responsibility for the child with the agency Dr Efun Johnson November 2013

38. Private Fostering • Looked after by an adult who is not a relative for more than 28 days • Child under age of 16 (18 if disabled) • Private arrangement between parent and carer • Not Looked after by LA • Carer does not hold PR • Carer has legal obligation to inform their Local council of intention & when child leaves care • Most children are black and most carers white Dr Efun Johnson November 2013

39. Private Fostering • Often lack of information on child e.g. name • Lack of medical histories • Frequent moves • Abuse can occur • There can be cultural problems • Often it is with carers that have been turned down for fostering! Children need to be safeguarded Dr Efun Johnson November 2013

40. What is adoption? • Legal procedure • All parental responsibility is transferred to the adopters • Once an order has been granted, • It cannot be reversed • An adopted child • Loses all legal ties with the birth family • Becomes a full member of the new family Dr Efun Johnson November 2013

41. Adoption- pattern changed Changes in social support has encouraged new thinking about: • which children are eligible for adoption • who is eligible to adopt. • Children • Adopters • Contact Dr Efun Johnson November 2013

42. Who can adopt? • Must be over 18 • Show that they can give a child the care needed • Be able to afford to take in the child • The requirements vary from agency to agency • Focus is on needs of the child Dr Efun Johnson November 2013

43. Adoption- who can adopt now • Married couple • Unmarried couple living in an enduring family relationship, same or different gender • Single person over 18 • Married person where • spouse cannot be found, • separated, likely to be permanent • spouse incapable of applying due to physical or mental illness • Partner of parent of child Dr Efun Johnson November 2013

44. Why adoption fails • Information not clear or realistic • 36% positive • 33% negative • 13% mixed • problems not fully recognised by agencies • anticipating the wrong problems • being deliberately misled increased disruption Dr Efun Johnson November 2013

45. Outcomes Dr Efun Johnson November 2013

46. Attainment snapshot • On average 58% of those LAC in the appropriate age group achieved level 2 at Key Stage 1 & 51% achieved level 4 at Key Stage 2. • The comparable %ages for all children were 85% & 82% respectively. • 68% of LAC obtained at least 1 GCSE or GNVQ compared with 99% of all school children who achieved any qualification. • 29% of LAC did not sit an examination of this type Dr Efun Johnson November 2013

47. Continuing education, employment & convictions At the end of school year 11, • 73% of children remained in full-time education • 14 were unemployed the September after leaving school. • 9% of LAC aged 10 or over, were cautioned or convicted for an offence - 2½ times the rate for all children of this age. Dr Efun Johnson November 2013

48. Health outcomes • 84% of LAC had immunisations that were up-to- date • 86% had a dental check, • 85% had an annual health assessment • 5% of LAC were identified as having a substance misuse problem (60% received an intervention) Dr Efun Johnson November 2013

49. Cautions and Convictions • 9.6% of looked after children aged 10 or over, were cautioned or convicted for an offence during the year, almost 3 times the rate for all children of this age. • This rate has been similar over the past 3 years. Dr Efun Johnson November 2013

50. In summary LAC have poor outcomes for: • Health • Education • Employment opportunities Therefore • We need to provide a coordinated and comprehensive package of care to improve the outcomes for these children & YP Dr Efun Johnson November 2013