Quality statement 1: Warm, nurturing care

Quality statement

Looked-after children and young people experience warm, nurturing care.

Rationale

Fulfilling a child's need to be loved and nurtured is essential to achieving long-term physical, mental and emotional wellbeing.

This quality statement builds on the principle of encouraging warm and caring relationships between the child and carer that nurture attachment and create a sense of permanence. An important part of this is ensuring that carers are trained and supported to develop their skills and adopt a consistent parenting style that combines clear guidance and boundary setting with emotional warmth, nurturing and good physical care.

Quality measure

Structure:

a) Evidence of local arrangements for all carers of looked-after children and young people to receive ongoing high-quality core training and support packages that equip them to provide warm, nurturing care.

b) Evidence of local arrangements to ensure that all carers of babies and young children receive specialist training and support that helps them to develop positive attachments with children in their care.

Outcome:

a) Feedback from looked-after children and young people that they feel they receive warm, nurturing care.

b) Looked-after children and young people's self-reported wellbeing and self-esteem.

c) Carer satisfaction with provision of training and support.

What the quality statement means for each audience

Looked-after children and young people experience warm, nurturing care.

Carers of looked-after children and young people receive ongoing high-quality core and specialist training and support to help them provide warm, nurturing care.

Local authorities and other commissioning services ensure they commission services that provide carers of looked-after children and young people with ongoing high-quality core and specialist training and support to help them provide warm, nurturing care.

Organisations providing care ensure systems are in place to provide all carers of looked-after children and young people with ongoing high-quality core and specialist training and support to help them provide warm, nurturing care.

Source guidance

NICE public health guidance 28/SCIE guide 40 recommendations 17, 18, 36 and 37.

Data source

Structure: a) and b) Local data collection.

Outcome: a) Local data collection and Children's Commissioner for England State of the Nation: children in care and care leavers survey.

b) and c) Local data collection.

Data will also be collected against Public health outcomes framework for England, 2013–2016 indicator 2.8: emotional wellbeing of looked-after children (currently a placeholder indicator and subject to further development).

Definitions

Carers

Carers include foster carers (including family and friends carers), residential carers and supported lodging providers.

High-quality core training

NICE public health guidance 28/SCIE guide 40 recommendation 36 recommends that high-quality, core training should be provided from trainers with specialist knowledge and expertise, adapted to local needs, and to ensure that 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

  • develops understanding of how transitions and stability affect 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.

Sense of permanence

A sense of permanence relates to emotional permanence. Emotional permanence (attachment) is one of the aspects of the framework of permanence described in the Children Act 1989 guidance and regulations volume 2: care planning, placement and case review. The objective of planning for permanence is described as ensuring that children have a secure, stable and loving family to support them through childhood and beyond.

Specialist training and support

NICE public health guidance 28/SCIE guide 40 recommendation 17 recommends that specialist services for babies and young children provide support such as consultation and training to carers and can work directly with the child and carer on interventions that focus on supporting secure attachments.

NICE public health guidance 28/SCIE guide 40 recommendation 18 recommends that specialist training should be additional to the core training described above and 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.

Support packages

NICE public health guidance 28/SCIE guide 40 recommendation 37 recommends that ongoing support packages 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

  • 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.

Equality and diversity considerations

The individual needs of carers should be considered when training and support is being delivered to ensure it is appropriate and meets their needs, for example it should be culturally sensitive.

NICE public health guidance 28/SCIE guide 40 recommendation 33 recommends that providers of health services should provide support and training to carers to ensure they have a good understanding of the particular issues affecting unaccompanied asylum-seeking children and young people who are looked after.

NICE public health guidance 28/SCIE guide 40 recommendation 38 recommends that social workers and managers provide support for cross-cultural placements.

Additional support may also be needed for carers of looked-after children and young people with particular needs, such as learning and physical disabilities, special educational needs or speech, language and communication difficulties.

Context for this quality statement

This section signposts practitioners to regulations, statutory guidance and national minimum standards for looked-after children and young people that are of particular relevance to the NICE quality statement and its associated measures. As the legislative framework in relation to looked-after children and care leavers is complex and cross-cutting, this should not be viewed as an exhaustive list.