How we made the decision
We check our guidelines regularly to ensure they remain up to date. We based the decision on surveillance 7 years after the publication of looked-after children and young people (2010) NICE guideline PH28.
For details of the process and update decisions that are available, see ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual.
At the last surveillance review in 2013 no literature search was undertaken, as topic experts were consulted and they identified that no new evidence was available that would substantially alter the current recommendations in the guideline or the related quality standard. However, given the extent of recent changes in the organisational control and responsibility for local authorities and children's services, it was suggested that we complete a factual amendment of the guideline to align with these changes. In May 2015, changes were made to recommendations to reflect changes to government policy.
A literature search was undertaken for studies and systematic reviews published between August 2008 and August 2017 that report the effectiveness of interventions for looked-after children and young people.
All relevant abstracts were assessed for their impact on the recommendations within NICE guideline PH28. We also reviewed relevant studies highlighted by topic experts for any potential impact on the guideline scope and remit.
We checked for ongoing and newly published research from NIHR and Cochrane as well as new policy developments. Two published studies were included as evidence, and 3 pieces of ongoing research were identified.
See appendix A: evidence summary for references and assessment of the abstracts for all new evidence considered.
We found 58 new studies and 3 pieces of ongoing research within the scope of the guideline. The identified studies related to the following sections of the guideline:
Sibling placement and contact: Evidence from 3 studies indicates that placing siblings together can be beneficial (in line with the recommendations). Of those studies 2 trials indicate that interventions can improve the relationship quality of siblings in care. Sibling and family interventions are not covered in the current guideline.
Supporting foster and residential care: The literature search yielded 39 studies which assessed the effectiveness of a range of interventions that support or train residential and foster carers (including kinship carers). The evaluated interventions included multi-dimensional treatment foster care (MTFC), Keeping Foster and Kinship Parents Trained and Supported (KEEP), Incredible Years programme and other parenting interventions.
Improving education for looked-after children and young people: New evidence was identified across 11 studies of education (pedagogical) interventions aimed at improving outcomes for looked-after children and young people. Overall, the studies reported some tentative impact of the interventions. The guideline does not include recommendations for pedagogical interventions.
Preparing for independence: New evidence from 4 studies indicates that interventions for improving the transition outcomes can be effective. The interventions included life-skills training, transitional housing support and transition support for pregnant and parenting young foster care woman. The current recommendations do not provide specific details on the type or duration of interventions to support young people preparing for independence from foster care.
Training for professionals: The review identified 1 study of a training intervention aimed at case workers to improve outcomes for children and young people in foster care.
In addition, the current guideline does not provide detailed information on health promotion, although this area is within scope. The surveillance review identified 2 studies which evaluated interventions providing advice and information on contraception and sexual health for young people in care and 1 study which evaluated interventions providing advice and information on substance misuse for young people in care.
Other considerations based on initial intelligence gathering:
The guideline includes 52 recommendations and makes extensive use of cross-references to statutory guidance, including Promoting the health and wellbeing of looked-after children (Department for Education and Department of Health 2015), Promoting the education of looked-after children: statutory guidance for local authorities (Department for Education 2014) and Children Act 1989: care planning, placement and case review (Department for Education 2015).
There is overlap between the current guideline recommendations and existing statutory guidance.
Within the current guideline there are recommendations which cover 'Supporting foster and residential care'. This covers similar areas to recommendations within children's attachment: attachment in children and young people who are adopted from care, in care or at high risk of going into care (2015) NICE guidance NG26. Both guidelines make recommendations about treatment, care and support for foster carers and their families (including kinship care) and draw on the same evidence base, although NG26 is more focused on interventions to improve foster care which may have superseded guidance in PH28. New evidence in this area will be considered by the next surveillance review of NG26.
Feedback from experts identified that there are a number of important topics which are not currently addressed in the current guideline, including:
parenting support for birth parents to enable reunification or 'twin tracking' and a pathway to permanence
looked-after children and young people who are victims of trafficking
child sexual exploitation of children and young people in care.
See appendix A for details of the evidence reviewed.
We did not find any new evidence related to the following sections of the guideline: 'Strategic leadership, planning and commissioning', 'Audit and inspection', 'Care planning, placements and case review', 'Professional collaboration', 'Dedicated services to promote the mental health and emotional wellbeing of children and young people in care', 'Placements for children and young people – residential care, foster care and care by family and friends', 'Supporting babies and young children', 'Personal quality of life' and 'Diversity'.
No evidence has been found to indicate that the guideline does not comply with anti-discrimination and equalities legislation.
We considered the views of topic experts, including those who helped to develop the guideline. We received responses from 1 topic expert, Public Health England and the Social Care Institute for Excellence (SCIE). One responder identified that the guideline did not need updating and 2 indicated that it did need updating. As discussed above, experts identified gaps in the guideline and local service priorities, including improvements in support for foster and residential care and mental health and wellbeing support for looked-after children and young people.
The guideline provides various recommendations about how organisations, professionals and carers can work together to deliver high quality care. As part of the current surveillance review we compared the guideline with existing statutory guidance in the area, including Promoting the health and wellbeing of looked-after children (Department for Education and Department of Health 2015), Promoting the education of looked-after children: statutory guidance for local authorities (Department for Education 2014) and Children Act 1989: care planning, placement and case review (Department for Education 2015). Given the extent of overlap, it was decided that Looked-after children and young people (NICE guidance PH28) should undergo a full update with a modified scope.
The revised guideline should provide greater focus and detail of effective interventions for looked-after children and young people, and their parents and foster carers. Topic areas within the current guideline as well as those identified by topic experts would be considered for inclusion. Existing national statutory guidance and existing NICE guidance should also be taken into consideration during the scoping process.
This page was last updated: 14 December 2017