Statement 5: Looked-after children and young people receive specialist and dedicated services within agreed timescales
Looked-after children and young people have particular physical, emotional and behavioural needs related to their earlier experiences before they were looked after. These earlier experiences have an influence on brain development and attachment behaviour. The rates of emotional, behavioural and mental health difficulties are 4 to 5 times higher amongst looked-after children and young people than the wider population.
Holistic and accurate assessment is needed to address the specific needs of each child, with multidisciplinary support provided where it is needed. It is important that services are provided in a timely manner to prevent the escalation of challenging behaviour and reduce the risk of placement breakdown; these should be based on the child or young person's needs and not on service availability.
Local authorities need to have access to a range of services to meet the individual needs of looked-after children and young people. Local data about needs and effective interventions can be used to help local authorities and their partners deal with demand and improve outcomes for looked-after children. Local authorities should have a range of procurement and commissioning mechanisms to secure services. Independent reviewing officers also have an important role to play in monitoring care plans to ensure that children and young people's needs are met.
Conduct disorder is the most prevalent difficulty amongst looked-after children and young people. Aggressive and challenging behaviour associated with conduct disorder can impose a significant burden to carers, and children and young people with this disorder are also at risk of school exclusion. Looked-after children and young people are also more likely than their peers to experience depression and anxiety. These children may carry the burden internally, and it may go unnoticed or ignored by professionals.
Foster carers, social workers and other carers can provide children and young people with 'therapeutic' care in the way they parent and support the child. In some cases, however, specialist therapeutic support is required, which is the responsibility of Child and Adolescent Mental Health Services (CAMHS). There are often long waiting lists to receive specialist support from CAMHS. Looked-after children and young people are also likely to need other specialist services, particularly in relation to education; over a quarter of looked-after children and young people have a formal statement of Special Educational Need compared to 3% of all pupils. Those leaving care are particularly vulnerable and need continued support from specialist services. 
At present, it is not always clear to parents, and to local services, who is responsible for delivering on the statement of special needs. From 2014 (expected autumn) parents will have a legal right to buy in specialist special educational needs and disabled care for their children. They will have the power to control personal budgets for their children with severe, profound or multiple health and learning difficulties. There will be a single birth-to-25-years assessment process and parents will be able to choose the expert support that is right for their child. Education, health and social care services will also have to plan services together by law to ensure that children's needs are addressed.
 Schofield, G. and Simmonds, J. (Eds) (2009) The Child Placement Handbook. Research, policy and practice. BAAF.
Links to Ofsted Judgements
This statement links to the following Ofsted judgements:
'Children and young people are in good health or are being helped to improve their health and their health needs are identified. Child and adolescent mental health provision, therapeutic help and services for learning or physically disabled children and young people are available when needed and for as long as they are required.'
'Children and young people attend school or other educational provision and they learn. Accurate and timely assessments of their needs, as well as specialist support where it is needed, help them to make good progress in their learning and development wherever they live. '
'Any risks associated with children and young people offending, misusing drugs or alcohol, going missing or being sexually exploited are known by the local authority and by adults who care for them. There are plans and help in place that are reducing the risk of harm or actual harm and these are kept under regular review by senior managers.'
'The health needs of care leavers are clearly assessed, prioritised and met. Child and adolescent mental health services, adult mental health provision, therapeutic help and services for learning or physically disabled young people and adults are available when they are needed.'
Tips, tools and practice examples
Suggestions for evidence that could be collected to assess performance against this quality statement include:
- how needs are assessed at a strategic level and how issues are addressed
- waiting times for CAMHS
- flexibility of services
- availability and satisfaction with therapeutic placements
- improvement in SDQ scores
- how unmet needs are addressed when no local services are available; the mechanisms to identify unmet needs and procedures to address this.
Evidence should always include feedback from children and young people.
The Department for Education's web page on evidence-based interventions provides links to a number of interventions that are effective when working with looked-after children and children on the edge of care or custody.
The Department for Education's web page on promoting the health and wellbeing of looked-after children provides links to statutory guidance on the duties of local authorities and the NHS, as well as guidance on using the strengths and difficulties questionnaire.
Young Minds have a web page dedicated to Children and Adult Mental Health Services policy. It includes the Implementation framework which was developed jointly by the Department of Health, the NHS Confederation’s Mental Health Network, Mind, Rethink Mental Illness, Turning Point and The Centre for Mental Health. The aim of the document is to assist local organisations to improve mental health in all ages, and people from all backgrounds.
There is also a dedicated web page for professionals on looked-after young people, which gives information on 2 projects that are being run to improve the experiences and outcomes for looked-after young people.