1 Recommendations

This guideline was refreshed in May 2015. The refresh consisted of changes in recommendations 3, 5, 12, 36 and 38 to reflect changes to government policy since this guideline was published in October 2010. The evidence for the recommendations was not reviewed as part of this refresh, and the recommendations have not been changed.

This is NICE and SCIE's formal guidance on improving the physical and emotional health and wellbeing of looked-after children and young people. When writing the recommendations, the Programme Development Group (PDG) (see appendix A) considered the evidence of effectiveness (including cost effectiveness), commissioned reports, expert testimony, fieldwork data, a consultation with children and young people, and comments from stakeholders. Full details are available from the NICE website.

The evidence statements underpinning the recommendations are listed in appendix C.

The evidence reviews, commissioned reports, supporting evidence statements and economic analysis are available.

Influences on the quality of life of looked-after children and young people

Note that health and social care services include dedicated services to promote the mental health and emotional wellbeing of looked-after children and young people, and to support young people in the transition to independence. Services should be designed to address the needs of children and young people with particular needs, including those from black and minority ethnic backgrounds, unaccompanied asylum seekers and those with disabilities.

Strategic leadership, planning and commissioning

Evidence indicates that high-performing local authorities are those with strong leaders who have an aspirational vision of effective corporate parenting for all looked-after children and young people. These authorities embed partnership and multi-agency working at the heart of the planning process and ensure that children and young people are fully engaged in the design and delivery of services.

Recommendation 1 Prioritise the needs of looked-after children and young people

Who should take action?
  • Directors of children's services.

  • Directors of public health.

  • Senior staff with responsibility for commissioning and providing health services.

What action should they take?
  • Create strong leadership and strategic partnerships to develop a vision and a corporate parenting strategy that:

    • focuses on effective partnership and multi-agency working

    • addresses health and educational inequalities for looked-after children and young people.

  • Ensure that local strategic plans adhere to national guidance, primarily Statutory guidance on promoting the health and well-being of looked after children (Department for Children, Schools and Families).

  • Ensure the joint strategic needs assessment process is a central component in assessing the needs of looked-after children and young people (Statutory guidance on joint strategic needs assessments and joint health and wellbeing strategies Department of Health).

  • Ensure local plans and strategies for children and young people's health and wellbeing fully reflect the needs of looked-after children and young people, and care leavers, and set out how these needs will be met. They should describe how to:

    • meet the changing needs of looked-after populations and provide high-quality care

    • provide services that meet the emotional health and wellbeing needs of children and their carers, including child and adolescent mental health services (CAMHS), core health services (for example, immunisation) and enhanced services (for example, paediatrics)

    • promote healthy lifestyles

    • provide access to extra-curricular activities

    • improve the stability of placements and education.

  • Ensure senior managers in partner agencies provide strong, visible leadership to raise aspirations and attainment, and promote joint working to meet the needs of looked-after children and young people.

  • Ensure effective corporate parenting by complying with guidance on the role of lead members for children's services and directors of children's services in helping looked-after children and young people improve their aspirations and outcomes. (Statutory guidance on the roles and responsibilities of the Director of Children's Services and the Lead Member for Children's Services Department for Education.)

  • Ensure services are developed taking account of the views of looked-after children and young people (see recommendation 24). These views should be channelled through the corporate parenting board or children-in-care council.

  • Provide an annual report to the children-in-care council, the local authority overview and scrutiny committee, the director of public health, the NHS commissioner and the leader of the council. This report should cover the effectiveness of services for looked-after children and young people when evaluated against local plans for health and wellbeing, the local pledge to children in care, national indicators and local targets.

  • Build communication networks with key partner organisations and publish, publicise and update regularly a local map that identifies all agencies that are involved with looked-after children and young people.

  • Publish and update regularly a directory of resources for looked-after children and young people to aid social workers, and a resource guide for looked-after children and young people and care leavers.

  • Ensure local authorities reflect in their yearly 'pledge' to looked-after children and young people the needs and challenges raised by children-in-care councils about improving services to achieve better outcomes.

Recommendation 2 Commission services for looked-after children and young people

Who should take action?

Commissioners of health services and local authority children's services.

What action should they take?
  • Commission services that enhance the quality of life of the child or young person by promoting and supporting their relationships with others (Outcomes and efficiency: commissioning for looked after children Commissioning Support Programme).

  • Ensure that service commissioning for looked-after children and young people is informed by:

    • the views of children and young people (see recommendation 24)

    • national evidence, guidance and performance data

    • the local corporate parenting strategy

    • local knowledge and experts (for example, the director of public health)

    • local audits

    • the joint strategic needs assessment

    • local plans and strategies for children and young people's health and wellbeing.

  • Commission services dedicated to looked-after children and young people that are integrated, preferably on the same site, and have expert resources to address physical and emotional health needs. These services should have links with universal services, be friendly, accessible and non-stigmatising (see You're welcome: quality criteria for young people friendly health services Department of Health) and should include:

    • health promotion (see recommendations 37 and 46)

    • early identification and prevention of physical and emotional health problems (see recommendations 8–11 and 20–23)

    • access to specialist services, including child and adolescent mental health services (see recommendations 8–11)

    • access to professional advice for the looked-after children and young people's care team (see recommendation 6).

  • Encourage authorities to work together in local partnerships when commissioning services to offer greater choice and quality of services.

Audit and inspection

Evidence suggests that a robust audit and inspection framework ensures that looked-after children and young people continue to be strategic priorities for local authorities, the NHS and their key partners.

Recommendation 3 Regulate services

Who should take action?

Regulators and inspectors (including the Care Quality Commission and Ofsted).

What action should they take?
  • Use the processes for auditing, monitoring and inspecting local authorities, providers of health services and key partners to ensure that local strategic partnerships (including children's services and their partners) provide services for looked-after children and young people (including those placed out of area) that:

    • take account of their views (see recommendation 24)

    • meet the full range of their needs (including needs relating to physical, social, educational and emotional health and wellbeing)

    • promote and support healthy lifestyles

    • deliver quality care, and placement and educational stability

    • comply with relevant standards and statutory guidance.

  • Assess local strategic partnerships (including children's services and their partners) to:

    • ensure the needs of looked-after children and young people are given the priority that statutory guidance dictates

    • ensure mainstream budgets are pooled or aligned to meet those needs

    • ensure effective joint commissioning of services is in place and show how costs are shared between agencies.

Recommendation 4 Inspect services for care leavers

Whose health and wellbeing will benefit?

Looked-after young people preparing to leave or leaving care.

Who should take action?
  • Ofsted.

  • Care Quality Commission.

What action should they take?
  • Adopt the standards developed by the National Leaving Care Advisory Service (National standards in leaving care National Leaving Care Advisory Service).

  • Monitor the provision of health services and how well different services communicate with one another.

Care planning, placements and case review

Evidence indicates that effective care planning, led by social workers, promotes permanence and reduces the need for emergency placements and placement changes. Good care planning supports the quality of the relationship between the child or young person and carer by minimising disruption, increasing attachment and providing greater placement stability, which also helps promote a stable education.

Recommendation 5 Implement care planning, placement and case review regulations and guidance

Who should take action?

Directors of children's services.

What action should they take?
  • Ensure all social workers and independent reviewing officers (IROs) refer to and implement the 'Care planning, placement and case review (England) regulations and associated amendments (The Children Act 1989 guidance and regulations volume 2: care planning, placement and case review Department for Children Schools and Families; Annex B: The care planning, placement and case review and fostering services (England) (miscellaneous amendments) regulations 2013 Department for Education). These documents set out the statutory duties of children's services, which include ensuring that social workers carry out their pivotal role of 'local corporate parent' with overall responsibility for the coordination and implementation of the care plan and healthcare plan (also see recommendations 26–34).

  • Ensure the social worker's role is supported by:

    • regular high-quality supervision with a particular focus on the management of the care plan and corrective action to ensure that interventions are acted on as agreed – preventing 'drift' in the care system

    • continuing professional development for social workers to better understand and manage the role of a local corporate parent.

  • Implement in full the strengthened function of the independent reviewing officer as outlined in: Care planning, placement and case review (The Children Act 1989 guidance and regulations volume 2: care planning, placement and case review Department for Children Schools and Families; Annex B: the care planning, placement and case review and fostering services (England) (miscellaneous amendments) regulations 2013 Department for Education; the Independent Reviewing Officers' handbook Department for Children Schools and Families).

  • Ensure the expanded and strengthened role of independent reviewing officers (see recommendation 52 on IRO training) is supported by high-quality supervision.

  • Ensure that prompt and decisive action is taken when planning permanence for very young children and babies who come into care (see also recommendations 16–19), to safeguard and promote the wellbeing of the child. For example, where there is any uncertainty concerning reunification with birth parents, 'twin tracking' should be in place to ensure other permanence arrangements are available.

  • When deciding whether rehabilitation with birth parents is a possibility especially for young children or babies, give particular attention to the reasons why any siblings have been placed in care or been adopted. This is to gather evidence on the willingness and ability of parents to change and sustain their behaviour after concerns were raised about this particular child.

  • Ensure the voice of the child or young person is heard at every stage in the care planning process, with particular concern for the choice, quality and continuity of the placement (also see recommendations about diversity 26–34 and personal quality of life recommendations 24 and 25).

Professional collaboration

Evidence suggests that for the 'team around the child' to provide effective care, professionals need to collaborate closely and share relevant and sensitive information. It is also reported that when multi-agency teams are supported and encouraged to address their way of working, they are better able to collaborate when handling difficult and complex situations, and more readily adopt a non-defensive approach that focuses on the best outcomes.

Recommendation 6 Support professional collaboration on complex casework

Who should take action?
  • Directors of children's services.

  • Directors of public health.

  • Senior staff with responsibility for commissioning and providing health services.

What action should they take?
  • Ensure the multi-agency 'team around the child' (including frontline staff and carers) has access to a consultancy service to support collaboration on complex casework. The approach taken by this service should be based on the concept of reflective practice (see also recommendations 33, 34, 36, 38 and 50–52), and how to manage:

    • conflicting views in the team about the best interests and needs of a looked-after child or young person

    • risks to or disruptions of long-term placements

    • patterns of repeated placement breakdown or exclusion from education

    • uncertainty or delays in care planning

    • communication with colleagues, decision making, information sharing and lead responsibilities, ensuring that the needs of the child continue to be prioritised.

  • Such a service could be designed and delivered by in-house experts, external advisers or child and adolescent mental health services (CAMHS), and should participate in regional support networks. This can contribute to children's needs being met and placements being more effectively supported.

Recommendation 7 Ensure everyone involved understands their role

Who should take action?
  • Directors of children's services.

  • Directors of public health.

  • Senior staff with responsibility for commissioning and providing health services.

What action should they take
  • Ensure that social workers undertake the key worker and coordinating role and fulfil their responsibility for managing the multidisciplinary care plan, including managing the transition between child and adult health services (see recommendation 49).

  • Ensure that any professional who considers that the needs of the child or young person are not being addressed, or that interventions are being avoidably delayed, can request through their line manager that a review of the care plan is reconvened before the date of the next statutory review.

  • Ensure that a child or young person is able to request a review of their needs and that they are consistently reminded of this right by their social worker and independent reviewing officer.

  • Ensure that independent reviewing officers have routine access to managers at all levels to deal with any problems in implementing agreed actions.

Dedicated services to promote the mental health and emotional wellbeing of children and young people in care

Evidence suggests that early intervention to promote mental health and wellbeing can prevent the escalation of challenging behaviours and reduce the risk of placement breakdown. Flexible and accessible mental health services are needed that offer skilled interventions to looked-after children and young people and their carers. These services should have the capacity and expertise to work with black and minority ethnic children and unaccompanied asylum-seeking children and young people who may have particular needs.

Recommendation 8 Commission mental health services

Who should take action?
  • Directors of children's services.

  • Commissioners of mental health services.

What action should they take?
  • Jointly commission services dedicated to promoting the mental health and emotional wellbeing of children and young people who are looked after or are moving to independent living. These services should be structured as integrated teams (virtually or, ideally, co-located), and have a mix of professionals who will vary according to local circumstances (see also recommendations 9–11, 14, 16–19 and 49).

  • As a minimum, ensure these services have local authority children's specialists, dedicated health and mental health (including CAMHS) professionals, and education specialists working with looked-after children and young people (see also recommendations 9–11, 14,16–19, 42–43 and 49).

  • Ensure that the team includes experienced practitioners who are trained and supported to work with multi-agency networks on complex casework.

  • Ensure that looked-after children and young people have access to these services in situations where their emotional wellbeing is at risk.

  • Ensure that child and adolescent mental health services (CAMHS) are sensitive to the needs of the groups of children and young people identified in recommendations 26–34. Ensure that the commissioned team has the capacity and expertise to work sensitively with looked-after children and young people on the impact of discrimination, racism, bullying and isolation on self-esteem and personal identity (see recommendations 26–34).

  • Ensure that equal priority is given to identifying the needs of those children or young people who may not attract attention because they express emotional distress through passive, withdrawn or compliant behaviour.

  • Ensure that the services include:

    • training, support and access to specialist advisers for frontline practitioners, carers and other professionals in the multidisciplinary 'team around the child' (see recommendation 6)

    • specific training to prevent placement breakdown, covering early identification of those at risk of mental health problems (see 16–19, 35–38, 50–52)

    • therapeutic services for children and young people, including those in unstable, short-term and transitional placements

    • continuing with and completing a therapeutic intervention after the young person reaches the age of 18, when this is necessary.

      Provide a responsive outreach service to carers, schools, residential homes, secure accommodation establishments and leaving-care services.

  • Include a specialist practitioner role in a dedicated multi-agency mental health service to support young people moving to independent living at age 18, or 21 where applicable, who may not meet the threshold for onward referral to adult mental health services (see recommendation 49 and NICE's guideline on service user experience in adult mental health). The specialist role should:

    • support leaving care teams in local authorities on the mental health and emotional wellbeing needs of the young person leaving care (see recommendations 46–49)

    • provide information and advice to adult mental health services about the particular issues affecting young people's mental health while they are in care and the emotional and mental health needs of young people leaving care (see recommendations 20–23 and 46–49 and NICE's guideline on service user experience in adult mental health)

    • provide specialist support services to young people aged 18 and older when this is the best option to meet their mental health needs in the short to medium term.

Recommendation 9 Ensure access to mental health services for black and minority ethnic children and young people

Whose health and wellbeing will benefit?
  • Black and minority ethnic looked-after children and young people.

  • Looked-after children and young people of multiple heritage.

Who should take action?
  • Commissioners and providers of mental health services.

What action should they take?
  • Ensure that child and adolescent mental health services (CAMHS) are sensitive to the needs of black and minority ethnic children and young people (including those with multiple heritage) and can provide appropriate interventions for emotional and mental health problems associated with racism and cultural identify.

  • Ensure service providers are alert to the possibility that children and young people may not overtly express the impact of their experience of racism on their self-esteem and cultural identity, and practitioners should ensure there are opportunities for these concerns to be discussed.

Recommendation 10 Ensure access to mental health services for unaccompanied asylum-seeking children who are looked after

Whose health and wellbeing will benefit?

Unaccompanied asylum-seeking children and young people who are looked after.

Who should take action?
  • Commissioners and providers of mental health services.

What action should they take?

Ensure that unaccompanied asylum-seeking children and young people have access to specialist psychological services (including CAMHS) with the necessary capacity, skills and expertise to address their particular and exceptional health and wellbeing needs, including:

  • post-traumatic stress

  • dislocation from country, family, culture, language and religion

  • risk of sexual exploitation

  • lack of parental support and advocacy in a foreign country

  • stress related to the immigration process

  • physical and emotional trauma from war and disruption at home such as torture, beatings, rape and death of family members

  • increased risk for suicide and mental illness.

Recommendation 11 Ensure access to specialist assessment services for young people entering secure accommodation or custody

Who should take action?
  • Commissioners and providers of health services.

  • Social work managers.

What action should they take?

Ensure that looked-after children and young people entering secure accommodation or custody have their physical, developmental and mental health needs assessed by a paediatrician, or suitably qualified professional with input from the dedicated multi-agency mental health service (see Children and young people in secure settings Royal College of Paediatrics and Child Health). Ensure that any recommendations from these assessments are included in the care plan or pathway plan. (See recommendations 9, 10 and 14.)

Placements for children and young people – residential care, foster care and care by family and friends

To meet the diverse needs of all looked-after children and young people, it is necessary to have an adequate range of suitable placements, including secure and custodial care and ensure that children are involved in decisions about placement changes. Children and young people report that they value honesty from those responsible for their care about where they can and cannot influence decisions that concern their care.

Recommendation 12 Plan and commission placements

Who should take action?
  • Directors of children's services.

  • Senior staff with responsibility for commissioning health services.

What action should they take?

Develop a strategy to identify suitable placements and interventions for looked-after children and young people (see also recommendations 26–34). Such a strategy should:

  • Clearly set out how to meet the 'sufficiency' duty under the Children and Young Persons Act 2008 (Sufficiency: statutory guidance on securing sufficient accommodation for looked after children Department for Education) to provide suitable placements to meet the needs of looked-after children and young people with a statement of the role of various forms of care, to include:

    • foster care, residential care and care provided by family and friends (see recommendations 24, 25, 26–34, 35–38, 40)

    • use of secure accommodation (see also recommendations 11 and 20)

    • how placements will be made if unavailable within the local authority area (see also recommendation 20)

    • consideration of sibling co-placement and contact (including those placed out of area) (see recommendations 15, 20 and 24).

  • Use current statutory guidance on complex care funding (The Children Act 1989 guidance and regulations volume 2: care planning, placement and case review Department for Children Schools and Families; Resources on local partnerships Commissioning Support Programme)to ensure there are pooled and aligned budgets for looked-after children and young people who are likely to require highly specialised care placements for a significant period.

  • Ensure there is a multi-agency process for placement decisions that is informed by a comprehensive assessment of the social care, health and educational needs of the child or young person.

  • Include a robust protocol for sharing payment for placements that have a healthcare component. This is especially applicable to a 'best placement' decision where an integrated package of care and therapeutic, psychological or psychiatric input is purchased.

  • Monitor the services for children and young people who have been placed out of the area, including how to support care leavers (see recommendations 46–49) if they choose to remain out of the area and how these services are sourced from local providers (including CAMHS and adult mental health services, see NICE's guideline on service user experience in adult mental health).

Recommendation 13 Use current information to make decisions about placement changes

Who should take action?
  • Social workers and social work managers.

  • Placement teams.

  • Independent reviewing officers.

What action should they take?
  • Ensure decisions on changing placements are taken on a current assessment of the needs of the child or young person, or when their care plan clearly indicates that it is in their best interests to move, and not on the basis of poor planning and resource shortfalls (Data pack: improving permanence for looked after children Department for Education).

  • Ensure that the number of emergency placements are monitored with the aims of understanding why they happen and reducing their frequency as they can lead to placement instability.

  • Ensure placement plans and contracts state whether the placement is intended to meet the child or young person's long-term needs and further ensure that the provider has a specific and robust policy to minimise exclusions and terminations.

  • When making decisions about moving children or young people from existing placements:

    • fully take into account the wishes and feelings of a child or young person

    • record the reasons for decisions taken that are not in accord with the wishes and feelings of the child or young person

    • explain to the child or young person why these decisions were made

    • ensure children and young people are made fully aware of their right to access advocacy services when a review decision is likely to overrule their wishes and feelings

    • ensure sibling co-placement and contact are considered (including those placed out of area) (see also recommendations 15, 20 and 24).

  • Ensure the child or young person has enough notice of any planned change to arrange for an advocate to support them in their review meeting.

  • Monitor and audit the number of decisions where placement moves are made against the wishes of a child or young person, including the reasons for such moves.

  • After any placement move ensure appropriate measures are put in place for continued contact with any adults and younger people, including siblings, identified by the child or young person as important, if this is desirable and safe (see also recommendations 15 and 24).

  • Ensure that for transitional arrangements the child or young person gets to know their new carers and placement through prior visits and, wherever possible, overnight stays. Ensure also that 'good endings' are made with previous carers.

  • Ensure that placement decisions, including decisions about making and breaking placements, and planning for transition to leaving care:

    • take account of the health needs and developmental stage of the child or young person as well as their age

    • take into account fully all professional views about the progress and needs of the child or young person for any review, assessment and decision about changing placements

    • allow young people in residential care to remain in placement up to age 18 and beyond where it is in their best interests and appropriate to their continuing needs.

  • Ensure placement changes among family and friends are recorded, including the reasons for the moves.

Recommendation 14 Ensure looked-after children and young people in secure and custodial settings have their care plan or pathway plan reviewed

Who should take action?
  • Independent reviewing officers.

  • Placement teams.

  • Social workers and social work managers.

  • Leaving care teams.

What action should they take?
  • Ensure that looked-after children or young people living in secure accommodation have a care plan or a pathway plan that is based on a comprehensive assessment of all their needs (see recommendations 5, 11, 20, 26–34). (National standards in leaving care National Leaving Care Advisory Service.)

  • Carry out an immediate review of the care or pathway plan when any looked-after child or young person enters or leaves secure accommodation or a custodial setting. The review should ensure that all the health needs of the child or young person, including their emotional and psychological health and wellbeing, are provided for during their time in secure accommodation or custody (see Children and young people in secure settings Royal College of Paediatrics and Child Health).

  • The pathway plans of young people who are leaving or have left care must also be reviewed when they enter or leave secure accommodation or a custodial setting.

  • Ensure that the care or pathway plan is communicated to the receiving team, including health partners, when the young person leaves the secure setting.

  • Ensure that a child or young person is not moved from a secure or custodial placement into independence or semi-independence any sooner than if they had not been in secure or custodial accommodation.

Sibling placements and contact

Evidence suggests that membership of a sibling group is a unique part of the identity of a child or young person and can promote a sense of belonging and promote positive self-esteem and emotional wellbeing. Good management of sibling placement and contact is important to encourage and nurture healthy relationships, and can also help children and young people manage relationships they may find difficult. Siblings can include those who are not looked after and 'sibling-like' relationships that develop in a care setting.

Recommendation 15 Support sibling placements

Who should take action?
  • Placement teams.

  • Social workers and social work managers.

What action should they take?
  • Ensure that all decisions taken about sibling care, placement and contact (including recommendations below) includes siblings who may be adopted, those who share 1 birth parent, and stepbrothers and stepsisters.

  • Ensure contact orders made by a court are followed, and place siblings together unless assessments and the wishes of the child or young person suggest otherwise.

  • Ensure a placement strategy is in place that addresses any shortage of foster carers or suitable residential placements to meet the needs of sibling groups, for example through:

    • recruiting foster families specifically for sibling groups

    • commissioning homes for small family groups

    • meeting the additional financial and housing needs of foster carers to enable siblings to be placed together.

  • Where a looked-after child or young person has a brother or sister in care, identify a placement that allows siblings to live together unless there is clear evidence that this would not be in their best interests, or the child or young person is unhappy with the arrangement. Ensure this approach applies equally to siblings of multiple heritage.

  • Ensure siblings have the same social worker, wherever possible and practical.

  • Establish a clear communication and liaison plan where siblings have different social workers.

  • Where decisions are made to separate sibling family groups:

  • Provide additional support and resources that help the co-placement of siblings to prevent disruption and possible end of a placement for any child or young person in a sibling family group.

  • Where siblings live or are placed in different local authority areas ensure that arrangements are in place for their independent reviewing officers or social workers to liaise on their needs, ensuring ongoing contact and any possibility of future co-placement are regularly considered from the perspective and wishes of each sibling (see recommendation 24).

Supporting babies and young children

Evidence suggests that frequent moves and parents' physical and mental health problems can adversely affect the ability of babies and very young children to form healthy attachments that lead to healthy emotional and physical development. To combat this disadvantage, there is a need to plan decisively for permanent placements, based on high-quality assessments carried out by skilled professionals. Comprehensive, flexible service provision can help meet this aim.

Recommendation 16 Assess the needs of babies and young children and ensure access to services

Who should take action?
  • Social work managers.

  • Providers of health services (including CAMHS).

What action should they take?
  • Ensure that comprehensive and sensitive assessment processes are in place to identify the needs of babies and young children as early as possible.

  • Ensure frontline practitioners support the baby or young child and carers and, if necessary, a referral is made to specialist services, following the needs assessment.

  • Ensure that equal priority is given to identifying the needs of children who may not attract attention because they express emotional distress through passive, withdrawn or very compliant behaviour.

  • Ensure assessments:

    • are conducted by appropriately trained health professionals and frontline practitioners who work with looked-after children, such as health visitors, community and specialist paediatricians, psychologists and nurses for looked-after children and young people

    • include the views of carers, social workers and early years practitioners who have day-to-day contact with the baby or young child.

  • Ensure that interventions recommended by assessments are included in the healthcare plan. This is the responsibility of the social worker managing the case (see also recommendation 5).

  • Ensure that interventions recommended in the healthcare plan continue to be made through transitional periods if babies or young children move from a placement and when they move to permanence.

Recommendation 17 Ensure there are specialist services for babies and young children

Who should take action?
  • Directors of children's services.

  • Senior staff with responsibility for commissioning and providing health services (including CAMHS).

What action should they take?
  • Ensure that all frontline practitioners have access to specialist services and evidence based interventions (including dedicated CAMHS teams) to help them meet the emotional and physical wellbeing needs of looked-after babies and young children. These services should have practitioners who:

    • have a good understanding of the emotional, physical and developmental needs of babies and young children, including those with complex emotional needs

    • have a high level of understanding of attachment theory, and the impact of trauma and loss on child development and the forming of attachments

    • are skilled in observing and understanding the behaviour of babies and young children, and parent–child interactions.

  • Ensure that specialist services can provide support such as consultation and training to carers and frontline practitioners, and can work directly with the child and carer on interventions that focus on supporting secure attachments.

Recommendation 18 Ensure carers and frontline practitioners working with babies and young children receive specialist training

Whose health and wellbeing will benefit?

Looked-after babies and young children.

Who should take action?
  • Directors of children's services.

  • Senior staff with responsibility for commissioning and providing health services (including CAMHS).

  • Senior staff in fostering services and residential care.

What action should they take?

Ensure that all carers and practitioners who care for and work with babies and young children (including foster carers and prospective adopters) receive training from specialist training providers (including CAMHS). This should be additional to core training (see also recommendations 18, 31–38 and 50) and should include information on the:

  • development of attachment in infancy and early childhood

  • impact of broken attachments

  • early identification of attachment difficulties

  • particular needs of babies and young children who have experienced prenatal substance exposure or who have inherited or acquired learning or developmental problems.

Recommendation 19 Reduce moves and achieve permanence for babies and young children

Whose health and wellbeing will benefit?

Looked-after babies and young children.

Who should take action?
  • Social workers and social work managers.

  • Independent reviewing officers.

  • Placement teams.

What action should they take?
  • Ensure care planning takes account of the need to minimise the experience of separation and loss for babies and young children (see also recommendations 5, 12, 13 and 30) (see The Children and Families Act 2014).

  • Ensure assessments of emotional welfare and the impact of loss of attachment are primary considerations in a decision to make a placement change, including a move to permanent carers.

  • Consider returning the child to a previous stable placement if an adoption placement breaks down.

  • Ensure that the history and extent of previous placement instability is taken into account before a change from the current placement is agreed.

  • Give serious consideration to a foster carer's desire to adopt a child and ensure that an adoption assessment fully considers the capacity of foster carers to provide long-term stability and secure attachment.

  • Ensure alternative placements are available ('twin tracking') if assessments of birth parents or carers who are family or friends are unsatisfactory. This might include approving carers who wish to adopt as both foster carers and prospective adopters.

Health assessments, records and information

Evidence indicates that accurate and up-to-date personal health information has significant implications for the immediate and future wellbeing of children and young people during their time in care and afterwards. Understanding their own 'health history' is an essential part of growing up securely. Inconsistent record keeping can lead to wrong decisions by professionals and adversely affect the child or young person.

Recommendation 20 Assess the health needs of looked-after children and young people

Who should take action?
  • Commissioners and providers of health services.

  • Social work managers.

What action should they take?

Recommendation 21 Share health information and ensure consent is obtained

Who should take action?
  • Social work managers.

  • All service providers including independent and voluntary sector providers.

  • All primary and secondary healthcare providers (including CAMHS and adult mental health services).

What action should they take?
  • Consider introducing a protocol into information-sharing processes that addresses legal and confidentiality issues, to assist information flows between health and social care.

  • Ensure that healthcare professionals share health information with social workers and other professionals.

  • Ensure that there is a process for social workers to obtain consent for statutory health assessments, routine screenings and immunisations.

  • Ensure social workers obtain permission to access the child or young person's neonatal and early health information.

  • Ensure social workers obtain permission to access information on parental health, including obstetric health.

  • Ensure that parental or delegated consent is given to healthcare professionals when they are scheduled to carry out a medical or surgical procedure on any looked-after child or young person.

  • Ensure that a system is in place to monitor, and address failure to obtain, permission or consent for health matters.

  • Ensure that any health information is collected and shared in a sensitive and professional manner.

  • Ensure health information is incorporated into relevant assessments and shared with healthcare professionals, as appropriate.

  • Ensure that physical and emotional health information, and consent for medical procedures, including mental health interventions, follows the child or young person. This may include deciding with partner agencies how hand-held (paper) records can stay with the child or young person.

  • Ensure that early health information is available to enhance life-story work with the child or young person when they are ready (see also recommendations 24, 25 and 48) or to help them make informed decisions when they are ready to start their own family.

Recommendation 22 Update the personal health record (red book) and ensure this follows the child or young person

Who should take action?
  • Social work managers.

  • Commissioners and providers of health services.

What action should they take?
  • Ask social workers to ensure that the personal health record (red book) follows the child or young person up to the age of 18.

  • Ensure that if the original personal health record is lost or unavailable a new one is provided, and when it is reissued it should include as much information as possible; the issuer will need to look back and incorporate historic information.

  • Share all information obtained from parents and other sources to help complete the reissued record, and if birth parents are unwilling to give up the original personal health record, ensure social workers work with them to relinquish it temporarily to enable information to be copied.

  • Ensure that early health information is obtained, including obstetric and neonatal health information, on all children or young people entering care.

  • Ensure there is a clear process to reissue the personal health record to all new carers for children or young people in their care.

  • Ensure that a contact person is identified to manage the administration of the personal health record.

Recommendation 23 Share information from assessments for court processes

Who should take action?

Social work managers.

What action should they take?

Ensure that when assessments are commissioned for court processes, permission from the court is obtained to share this information with health professionals who carry out statutory assessments or advise on health needs.

Personal quality of life

Evidence indicates that developing a positive personal identity and a sense of personal history is associated with high self-esteem and emotional wellbeing. Life-story work, as an ongoing activity, can help children and young people understand their family history and life outside of care. Children and young people also have needs and preferences for contact with valued people and participation in the wider community as ways to build their self-esteem and assertiveness.

Recommendation 24 Meet the individual needs and preferences of looked-after children and young people

Who should take action?
  • Social workers and social work managers.

  • Independent reviewing officers.

What action should they take?
  • Promote continued contact with former carers, siblings or family members personally valued by the child or young person where this is felt to be in their best interests. Where this is not possible, acknowledge the significance of losing former attachment figures and relationships.

  • Promote ongoing contact with valued friends, professionals or advocates where this enhances and promotes emotional wellbeing and self-esteem.

  • Ensure access to creative arts, physical activities, and other hobbies and interests to support and encourage overall wellbeing and self-esteem.

  • Offer assertiveness training (appropriate to age) to all children and young people to promote self-esteem and safety, combat bullying and enhance wellbeing (see also recommendations 26–34).

  • Ensure looked-after children and young people participate in policy decisions that affect their life (see also recommendations 1 and 2).

  • Allow contact with close family members to diminish when it is clearly not in the best interests of the child or young person and contrary to their wishes (see also recommendation 15).

Recommendation 25 Explore personal identity and support ongoing life-story activities

Who should take action?
  • Social workers and social work managers.

  • Independent reviewing officers.

What action should they take?
  • Ensure that policies and activities are in place to allow each child or young person to explore their personal identity, including their life story.

  • For information gathering when a child or young person first becomes looked after, consider using forms such as those provided by the British Association of Fostering and Adoption, which collect data on early infant health and parents' general health.

  • Ensure life-story activities are planned and supported using a sensitive approach that focuses on the needs of a child or young person and that information is delivered by a trusted individual known to them in a respectful, sensitive and supportive manner. To carry out life-story activities:

    • give careful consideration to the timing and person who delivers life-story information and the extent of information given at any one time, according to the developmental stage and emotional needs of the child or young person

    • approach life-story work as an ongoing process rather than a 'one-off', ensuring it is reviewed and revisited as appropriate for each child or young person

    • inform, authorise and support carers to answer questions about the personal history of the child or young person, including helping with sensitive or distressing information

    • ensure the inclusion of written information, including:

      • 'later in life' letters (usually written by a social worker who knows the child or young person well, setting out his or her early history and sensitive explanations about becoming looked after)

      • photographs, letters and personal information from birth parents where contact has ceased

      • letters from former carers

      • life-story books

      • visual records of celebrations, achievements and foster or residential family events (such as birthdays, religious and cultural events, and family and residential holidays).

  • Ensure that in life-story work looked-after children and young people have access to as much personal information (including family history) as possible by promoting ongoing conversations between children, young people and their carers and social workers that include discussion about their:

    • personal journey before and through care

    • immediate and extended family and friends

    • step-family members, if identified by the child or young person as significant

    • personal health history

    • family health history

    • culture and faith

    • sexual identity and orientation.

  • Extend existing good practice and policy on life-story work with children and young people during and after the adoption process to all children and young people who are looked after, including those leaving care.

Diversity

Looked-after children and young people from black and minority ethnic backgrounds have particular needs. Other groups of looked-after children and young people also have particular needs, such as those seeking asylum and those who are gay or lesbian. Ensuring their needs are adequately met requires special attention and expertise to champion their rights. Strategic plans need to identify how appropriate services will be commissioned to ensure these looked-after children and young people are not marginalised.

Whose health and wellbeing will benefit?

The recommendations in this section aim to help looked-after children and young people who:

  • are from black and minority ethnic communities

  • have physical or learning disabilities

  • are lesbian, gay, bisexual or transgender

  • are an unaccompanied asylum seeker with looked-after status

  • are from travelling communities

  • belong to a faith group.

Recommendation 33 is about unaccompanied asylum seekers with looked-after status, and recommendation 34 is about black and minority ethnic children and young people.

Recommendation 26 Ensure everyone understands diversity issues

Who should take action?
  • Directors of children's services.

  • Senior staff with responsibility for commissioning and providing health services.

What action should they take?

Provide all professionals and managers with specialist training, resources and access to expertise to:

  • promote an organisational approach where diversity is considered in all day-to-day decision making, and is freely discussed by professionals with open debate encouraged

  • understand the complex issues affecting the looked-after children and young people identified at the beginning of this section, including discrimination and its impact, and, in particular, health, culture, identity, education and placement needs

  • identify and contact relevant support groups in the local community to reduce isolation for looked-after children and young people and provide positive avenues of support.

Recommendation 27 Share learning about diversity

Who should take action?
  • Directors of children's services.

  • Senior staff with responsibility for commissioning and providing health services.

What action should they take?
  • Consider setting up a multi-agency panel tailored to local needs to discuss particular requirements and placement choices for the looked-after children and young people identified at the beginning of this section. This could be a priority in areas with low numbers of these looked-after children and young people as there may be a need to increase local knowledge.

  • Ensure that children and young people with particular needs are consulted about their experiences of services (see also recommendations 24 and 25).

  • Network and share good practice with other local authorities with a similar profile of looked-after children and young people.

  • Consider secondments of key staff to local authorities where good practice is recognised, and ensure that there are mentoring and co-working opportunities.

  • Ensure children-in-care councils include discussion of looked-after children with particular needs as a standing item on their agenda.

Recommendation 28 Appoint a diversity champion

Who should take action?

Director of children's services.

What action should they take?
  • Appoint a local diversity champion with strategic and leadership responsibilities to increase awareness of the needs of looked-after children and young people identified at the beginning of this section and act as an advocate on their behalf.

  • Ensure that the diversity champion reports to and is accountable to the director of children's services.

  • Ensure the diversity champion also reports to and engages with the children-in-care council to help define the particular needs of these children and young people.

Recommendation 29 Produce and use a diversity profile

Who should take action?
  • Senior staff with responsibility for commissioning health and children's services.

  • Directors of public health.

What action should they take?
  • Produce a local diversity profile covering the looked-after children and young people identified at the beginning of this section.

  • Use the diversity profile when commissioning services to ensure services are relevant and meet specific needs (see also recommendation 5).

  • Use the diversity profile to develop and train the workforce to meet existing and anticipated needs (see also recommendations 35–38, 40 and 50–52).

Recommendation 30 Ensure there is a diverse range of placements

Who should take action?

Directors of children's services.

What action should they take?
  • Ensure the placement strategy in the area includes a sufficiently diverse range of placements (see also recommendations 5, 15, 46 and 47 and 'Sufficiency: statutory guidance on securing sufficient accommodation for looked after children').

  • If the diversity profile (see recommendation 26) indicates a more diverse range of placements is required (now or in the future) increase the number of foster carers accordingly.

Recommendation 31 Carry out core assessments

Who should take action?
  • Social workers and social work managers.

  • Independent reviewing officers and their managers.

What action should they take?
  • Ensure that core assessments contain an accurate and comprehensive picture of the child or young person's needs relating to their cultural, religious and ethnic identity, and pay particular attention to race, sexual orientation, language, faith and diet (see also recommendations 8–11, 16, 20, 23, 24–25, 33, 34).

  • Ensure that the review of the care plan reflects the developing nature of the child or young person's cultural, religious and ethnic identity and sexual orientation and how these might change as a child or young person grows and matures.

Recommendation 32 Embed diversity in local plans

Who should take action?

Directors of children's services.

What action should they take?

Ensure that the particular needs of looked-after children and young people are clearly identified in local plans for health and wellbeing and that a delivery plan is in place to meet these needs that includes clear targets and outcomes.

Recommendation 33 Provide expertise relating to unaccompanied asylum-seeking children and young people who are looked after

Whose health and wellbeing will benefit?

Unaccompanied asylum-seeking children and young people who are looked after.

Who should take action?
  • Social work managers.

  • Providers of health services.

What action should they take?
  • Provide support and training to foster parents and residential staff to ensure they have a good understanding of the particular issues affecting unaccompanied asylum-seeking children and young people who are looked after.

  • Ensure that unaccompanied asylum-seeking children and young people who are looked after have access to:

    • peer group support and religious and community groups to reduce their sense of isolation and disorientation in a foreign country

    • interpreters if their knowledge of English is limited, so they can explain their situation and make their needs known.

  • Ensure all professionals in services that work with unaccompanied asylum-seeking children and young people who are looked after have a good understanding of cultural differences in attitudes to and beliefs about physical and mental health or wellbeing (see also recommendations 8–11, 46–49, 50–52).

Recommendation 34 Provide expertise relating to black and minority ethnic children and young people

Whose health and wellbeing will benefit?
  • Black and minority ethnic looked-after children and young people.

  • Looked-after children and young people of multiple heritage.

Who should take action?
  • Directors of children's services.

  • Senior staff with responsibility for commissioning and providing health services.

What action should they take?

Provide all practitioners and managers with specialist training, resources, and access to expertise to:

  • understand the complexity of racism for looked-after black and minority ethnic children and young people, including those of multiple heritage, and its impact on their ability to enhance their life chances and lead settled lives (see also recommendations 8–11, 46–49, 50–52)

  • create links with community support groups to reduce isolation and provide continuity of cultural experience to reinforce a stronger sense of identity

  • ensure that black and minority ethnic looked-after children and young people have access to interpreters if their knowledge of English is limited so they can explain their situation and make their needs known.

Supporting foster and residential care

Evidence indicates that foster and residential care are complex activities that require rehabilitative and therapeutic approaches and skills. Carers who feel supported by their social worker and have ready access to support services are better able to use these skills to encourage healthy relationships and provide a more secure base, and so reduce the risk of placement breakdown. These skills should also be reflected in the recruitment of foster carers and residential staff, and in the training and support they receive.

Recommendation 35 Assure the quality of foster and residential care

Who should take action?

Directors of children's services.

What action should they take?

Ensure all fostering services and residential care homes meet and maintain statutory standards (Fostering services: national minimum standards and Children's homes: national minimum standards Department for Education) as set out in Revising the national minimum standards (NMS) for adoption, children's homes and fostering (Department for Children, Families and Schools) and mechanisms are in place to identify and remove those foster or residential carers who repeatedly underperform or are unwilling to undertake additional training to meet these standards.

Recommendation 36 Train foster and residential carers

Who should take action?
What action should they take?
  • Ensure foster and residential carers receive high-quality, core training from trainers with specialist knowledge and expertise that:

    • covers the key components of parenting set out in the 'principles and values' section of this guideline

    • meets the standards set out by the Department for Education (Training, support and development standards for foster care), core training recommendation 50 of the training section in this guideline.

  • Adapt training to local needs and ensure it:

    • includes psychological theories of infant, child and adolescent development

    • develops understanding of how to develop secure attachment (according to attachment theory) for babies and young children (see also recommendations 16–19 and Statutory guidance on promoting the health and well-being of looked after children Department for Children, Families and Schools.)

    • develops understanding of the impact of transitions and stability on a child or young person, and how best to manage change and plan age-appropriate transitions, including preparation to leave care

    • develops knowledge and awareness of how to safely meet the child or young person's needs for physical affection and intimacy within the context of the care relationship

    • develops knowledge and understanding of the education system, educational stability and encouraging achievement

    • develops knowledge and awareness of how to promote, improve or maintain good health and healthy relationships

    • promotes joint working practices with people from all agencies involved in the care of looked-after children and young people

    • develops understanding and awareness of the role of extra-curricular activities for looked-after children and young people

    • provides a good understanding of how the absence of appropriate physical and emotional affection, or different forms of emotional and physical abuse, affect a child or young person's psychological development and behaviour.

Recommendation 37 Support foster carers and their families

Who should take action?
  • Social workers and social work managers.

  • CAMHS professionals.

  • Private and independent fostering agencies.

What action should they take?

Ensure foster carers and their families (including carers who are family or friends) receive high quality ongoing support packages that are based on the approach set out in the core training recommendation (see recommendation 50 and Family and friends care: statutory guidance for local authorities Department for Education). A support package should include:

  • helping social workers to have reflective conversations with foster carers that include emotional support and parenting guidance

  • ensuring foster carers are included in the 'team around the child' that is receiving advice to support collaborative, multi-agency working on complex casework (see recommendation 6 on multi-agency working)

  • ensuring that childcare arrangements are in place to enable foster carers to attend training

  • ensuring that foster carers receive additional supervision, support and monitoring until foster care training is completed

  • ensuring children of foster carers are included when support is offered to foster care families

  • enabling foster carers to recognise and manage stress within their family (in its broadest sense, for example, everyday pressures on family life) to avoid placement breakdown

  • providing out-of-hours emergency advice and help in calming and understanding emotions and handling challenging behaviours to support stability

  • giving ongoing health promotion advice and help such as how to provide a healthy diet

  • providing information about the role and availability of creative and leisure activities for looked-after children and young people (Delegation of authority: amendments to the Children Act 1989 Guidance and Regulations Department for Education).

Recommendation 38 Train supervisors

Who should take action?
  • Social work managers.

  • Independent fostering agencies.

What action should they take?
  • Ensure all social workers and managers who undertake direct supervision of carers receive training that enables them to provide support to carers and recognise the emotional impact of the role. Such training should include:

    • identifying support needs

    • how to support carers and develop their self-awareness and self-care skills

    • recognising signs of stress or secondary trauma

    • an understanding of when a child or young person needs to be referred for professional assessment or intervention (see recommendation on promoting mental health and wellbeing)

    • awareness of any additional support and information needed for carers of children and young people with particular vulnerabilities such as unaccompanied asylum seekers and those with special needs.

  • Ensure that social workers and managers provide support for cross-cultural placements (see recommendations 26–34).

  • Ensure that social workers and managers support sibling placements and contact between siblings and family members (see recommendation 15).

Care provided by family and friends

Evidence suggests the high value of care provided by family and friends may lead to good long-term outcomes for many children and young people. However, care by family and friends can be placed under strain without adequate financial support, clear signposting to services and timely access to mental health services for children and young people (Family and friends care: statutory guidance for local authorities Department for Education).

Recommendation 39 Consider developing a national strategy to implement statutory guidance for care provided by family and friends

Who should take action?

Department for Education.

What action should they take?

Since this guideline was originally produced (October 2010) the Department for Education has issued statutory guidance for local authorities on the implementation of the duties in the Children Act 1989 with respect to children and young people who are brought up by members of their extended family, friends or other people who are connected with them ('Family and friends care: statutory guidance for local authorities').

Recommendation 40 Promote care provided by family and friends

Who should take action?
  • Directors of children's services.

  • Social work training bodies.

  • Senior staff with responsibility for commissioning and providing health services.

What action should they take?

Support placements with family and friends as a choice of equal status to adoption, foster care and residential care for looked-after children and young people, by ensuring that:

  • social work education and in-service training provides the knowledge and skills to support care with family and friends as a sustainable placement option (see recommendations on training 50–52)

  • extended family and friends who could be carers are identified as part of the care planning process, and arrangements are made to assess their suitability

  • local placement strategies provide effective support to approve relatives and friends as foster carers who can offer stability and continuity of care

  • agencies provide the necessary financial and emotional resources to support care efforts, given the high levels of emotional and behavioural difficulty children and young people can present (see recommendations 8–11 and 16–19). This support should include:

    • information about what financial support is available

    • access to health services provided for all looked-after children and young people, including child and adolescent mental health services (CAMHS) and opportunities for short breaks.

Improving education for looked-after children and young people

Education that encourages high aspirations, individual achievement and minimum disruption is central to improving immediate and long-term outcomes for looked-after children and young people. Evidence indicates that looked-after children do not generally do as well at school as their peers, which reduces their opportunity to move to further education, and affects their employment or training opportunities. It is important that education professionals are equipped with the necessary skills, knowledge and understanding to help looked-after children and young people get the most out of their time in education and to successfully negotiate their educational careers.

Recommendation 41 Develop teacher training

Who should take action?

Department for Education

What action should they take?

Ensure all teacher training programmes have a core training module that looks at the needs of looked-after children and young people (see recommendations 50–52) and includes an understanding of:

  • the impact of stable care and education on children and young people and how to help them have a stable education

  • the impact of loss, separation and trauma on child development, attachment and cognitive functioning

  • the value of engaging in activities outside the school curriculum and in the community.

Recommendation 42 Involve designated teachers for looked-after children and young people

Who should take action?
  • Local authorities.

  • School governors

  • Head teachers.

What action should they take?

Ensure designated teachers:

Recommendation 43 Monitor the quality of education for looked-after children and young people

Who should take action?
  • Local authorities.

What action should they take?
  • Ensure that educational provision for looked-after children and young people (including those placed out of area) is appropriate and of high quality, in line with statutory regulations (Promoting the education of looked after children: statutory guidance for local authorities Department for Children, Schools and Families).

  • Appoint a virtual school head ('Promoting the education of looked after children: statutory guidance for local authorities'; Children and Families Act 2014) and ensure that he or she:

    • works with headteachers and governors responsible for educating looked-after children and young people (including those placed out of area) to maximise educational potential

    • shares good practice nationally to shape national and local policy

    • maintains a record of all looked-after children and young people educated out of the area and is aware of their educational needs and the adequacy of their educational provision

    • maintains a register of all pupils on part-time timetables and monitor their appropriateness.

  • Ensure that independent schools are included in the above actions.

Recommendation 44 Support access to further and higher education

Whose health and wellbeing will benefit?

Looked-after young people and care leavers who are continuing their education after school-leaving age.

Who should take action?
  • Leaving care teams.

  • Social workers and social work managers.

What action should they take?
  • Identify and provide personal support before and during the application process, and continue to support students throughout their time at university or college.

  • Ensure that looked-after young people and care leavers have access to bursaries and other forms of financial and practical support.

  • Publicise the bursaries currently available for looked-after young people who continue in full time education (16–19 Bursary) and for those who go to university and ensure all eligible care leavers receive this legal entitlement ('Promoting the education of looked after children: statutory guidance for local authorities'; 16-19 Bursary Fund: examples of good practice Education Funding Agency).

  • Ensure that good quality accommodation, including return to carers, is guaranteed for the duration of the course, including holidays, for students who have been in care.

  • Continue to support care leavers after they have left higher education. This should include support with housing and other forms of practical and emotional support, such as careers advice and coping with living alone, until they gain employment and are ready to be independent.

Recommendation 45 Support looked-after young people in further and higher education

Whose health and wellbeing will benefit?

Looked-after young people and care leavers.

Who should take action?

Universities and colleges.

What action should they take?
  • Ensure admissions procedures are transparent and accessible and that care leavers are given appropriate and easily accessible support and advice on accommodation, services, scholarships and any other support available to care leavers.

  • Endeavour to provide good quality accommodation to students who have been looked after for the duration of the course, regardless of where they live.

  • Work to attain the Frank Buttle Trust quality mark, which recognises higher education institutions that provide additional and targeted support to students who have been looked after (For additional information, see the website of Action on Access.)

Preparing for independence

The transition to adulthood for young people in care can be difficult. Evidence indicates that services designed with young people in mind and delivered by friendly, approachable professionals can help young people find the right support and advice at the right time, to help them become independent (see Children to stay with foster families until 21 Department for Education).

Recommendation 46 Support preparation for the transition to adulthood and moving to independent living

Whose health and wellbeing will benefit?

Looked-after young people (including care leavers).

Who should take action?

Directors of children's services.

What action should they take?
  • Refer to and implement the statutory guidance, Planning transitions to adulthood for care leavers (Department for Education) and the cross departmental strategy for young people leaving care (Care leaver strategy: a cross departmental strategy for young people leaving care Department for Education and others).

  • Ensure that preparation for adulthood is part of care planning for children and young people of all ages and abilities who are looked after, in a way that is appropriate to age and supports them to move at their own pace and feel integrated and secure within their local communities (Care leavers' charter Department for Education).

  • Establish protocols with housing, health and adult social care partners that help identify young people moving to independent living as a priority group for accessing adult services.

  • Ensure that supported housing commissioned for care leavers enables them to remain until they are ready to take the next step towards independence and a secure tenancy, or other suitable arrangement. Supported housing should not be unduly constrained by set periods of time or a predetermined age at which the young person must move on; it should be provided on the best interests and needs of the individual.

  • Give young people the option to remain in a stable foster home or residential home up to the age of 21, as outlined in government guidance on arrangements for care leavers to stay on with former foster carers ('Staying put': arrangements for care leavers aged 18 and above to stay on with their former foster carers HM Government) and the Children and Families Act 2014, and allow those who experience difficulty moving to independent living to return to the care of the local authority for support, including to the previous placement if available. (See '"'Staying put": arrangements for care leavers aged 18 and above to stay on with their former foster carers' and Children to stay with foster families until 21 Department for Education.)

  • Provide the same level of support to young people moving to independent living from the care of family or friends as given to those moving on from any other kind of placement. This should include:

    • health and development

    • education, training and employment

    • supporting wider family relationships

    • financial and practical skills

    • access to a range of housing options

    • advice, assistance and pathway planning from the young person's social worker or personal adviser.

  • Ensure young people moving to independent living are encouraged and helped to maintain contact with past foster or residential carers they value.

  • Ensure that all young people have opportunities to develop the full range of life skills needed to make the transition to independent living and adulthood. In particular, planning for transition should take account of the opportunities for learning skills (such as cooking and shopping) that may not be readily available to young people living in residential care or custodial settings.

  • Ensure pathway planning pays full attention to the emotional needs and developmental capacity of young people preparing to move into independent accommodation.

  • Ensure transition planning takes account of young people with complex needs (including mental health problems), so they can proceed at a pace they can cope with. It is important not to push young people into independence too fast and too far, as some may have crises and breakdowns.

Recommendation 47 Provide leaving-care services

Whose health and wellbeing will benefit?

Looked-after young people (including care leavers).

Who should take action?

Directors of children's services.

What action should they take?
  • Ensure there is an effective and responsive leaving-care service that meets the needs of young people in transition between the ages of 16 and 25.

  • Such a service should be readily accessible to the young person and include:

    • safe and settled accommodation

    • opportunities for continuing education including basic skills such as literacy, numeracy and IT, and further or higher education

    • opportunities for employment, including apprenticeships and employability schemes

    • cultural, leisure and other community activities

    • specialist counselling, advocacy, peer mentoring and mental health services to support emotional needs

    • training in life skills to manage everyday living with confidence, including support with personal relationships and money management

    • sexual health and substance misuse advice

    • support to maintain positive contact with parents, wider family and friends

    • general health advice.

  • Ensure that services available to care leavers are clearly outlined in local plans for children and young people's health and wellbeing and these are readily available to children and young people in suitable formats.

  • Consider a 'one-stop shop' approach to the provision of services to enable care leavers to more easily access a range of services in a familiar environment. Consider making use of current one-stop shops to provide a specialist service for looked-after children and young people.

  • Ensure all young people know their entitlements to services and how to access them, including independent advocacy if needed.

Recommendation 48: Conduct a comprehensive health consultation when young people move on to independent living

Whose health and wellbeing will benefit?

Looked-after young people (including care leavers).

Who should take action?
What action should they take?
  • Ensure that when young people are offered their final statutory health assessment all available details of their medical history can be discussed.

  • Ensure young people are supported to understand their health and medical information.

  • Ensure young people are supported and encouraged to attend their final statutory health assessment.

  • Ensure that if a young person declines to attend their final statutory health assessment they are offered the choice of having a written copy of their basic medical history (such as immunisations and childhood illnesses) and that a health professional, in partnership with the young person's social worker, ensures that the young person knows how to obtain their social care and detailed health history.

  • Ensure that leaving-care services that support young people when they move on to independent living have a process to contact health professionals when necessary to help the young person understand the information in their health history.

Recommendation 49 Support transfer to adult mental health services

Whose health and wellbeing will benefit?

Looked-after young people.

Who should take action?
  • Managers of mental health services (including CAMHS).

  • Social workers and social work managers.

What action should they take?

Also see NICE's guideline on service user experience in adult mental health.

Training for professionals

Evidence suggests that the experiences and needs of looked-after children and young people are not well understood by all the professionals who come into contact with them. Developing national training curriculums, with levels appropriate for a wide range of professionals, will increase understanding of this diverse group of children and young people and can do much to support high-quality care, promote educational stability and achievement, and encourage timely access to services to help maintain or improve emotional health and wellbeing.

Recommendation 50 Develop a national core training module

Who should take action?

Department for Education.

What action should they take?
  • Agree a core training module at national level to inform professionals and carers about the needs of looked-after children and young people. This module should include developing understanding and awareness of:

    • the reasons why children and young people enter care, including babies and young children (with reference to attachment theory)

    • safeguarding issues

    • the impact of entering care on children and young people, including babies and young children

    • relationships with siblings (see also recommendations 15, 20 and 24)

    • care provided by family and friends (see also recommendations 39 and 40)

    • the impact of trauma and distress on the behaviour and development of looked-after children and young people and their ability to form meaningful relationships during childhood and as they move into adulthood

    • bereavement and loss

    • the impact of the carer's own experiences on their parenting style and ability to care for and relate to children and young people

    • the roles of professionals who work with looked-after children and young people

    • how to work effectively in multi-agency settings (see also recommendation 6)

    • differing accountability within and among agencies

    • good practice in recording information on looked-after children and young people to support better care planning (see also recommendations 20–23)

    • how to support educational attainment, including higher education (see also 41–45)

    • how to encourage engagement in activities outside the school curriculum and in the community, including creative and leisure activities.

  • Pay particular attention to developing reflective practice as an integral part of professional training for those working with looked-after children and young people.

  • Monitor the quality and impact of training.

Recommendation 51 Train social workers to support looked-after children and young people in education

Who should take action?

Department for Education.

What action should they take?

Work with education providers to include a module on looked-after children and young people in the educational setting in initial social worker training. This should include:

  • the importance of a stable and settled educational experience

  • a basic understanding of the educational system including the structure and processes of the special needs system (see 'Promoting the education of looked after children: statutory guidance for local authorities')

  • how to encourage educational attainment, including further and higher education and knowledge of entitlements to access and funding

  • how to support carers to get the best from the education system for the children and young people in their care

  • awareness of the importance and impact of extra-curricular and enriching activities for looked-after children and young people.

Recommendation 52 Train independent reviewing officers to support looked-after children and young people in education

Who should take action?

Social work managers.

What action should they take?
  • Ensure all independent reviewing officers undertake a core training module which includes all issues identified in recommendation 50 (core training) and which also covers:

    • the educational system (including the special needs process) and its structure, and the impact of moving schools and part-time timetables on confidence and attainment

    • the importance of a stable education and how to provide it

    • monitoring and evaluating the quality of health assessments, personal education plans (PEPs), personal education allowances (PEAs), individual education plans (IEPs) and pastoral support plans (PSPs)

    • holding professionals accountable for decisions taken at a case review and ensuring all relevant recording is of sufficient quality to describe the interventions required

    • understanding the implications of policy and legislation about looked-after children and young people

    • motivating and influencing others within care agencies and schools to develop effective support for looked-after children and young people

    • understanding the importance and impact of extra-curricular creative and leisure activities for looked-after children and young people.

  • Monitor the quality of training content and its delivery, and evaluate its impact on the quality of education and care of looked-after children and young people. Feed the outcomes into future planning and delivery of courses.

  • Ensure the independent reviewing officers service is monitored for quality.

  • National Institute for Health and Care Excellence (NICE)