Earlier this month, Anthony Douglas, chief executive of Cafcass (the Children and Family Advisory Support Service), said that record numbers of children are likely to be taken into care this year, due to the effects of benefits changes and public sector cuts. He warned there could be an increase of 8 per cent, putting more strain on an already-stretched system. Michael Gove tacitly acknowledged this would be the case in a speech last year. In response, he was keen to focus on one aspect of care
The most important thing is to find adults equipped to care, in circumstances that provide stability. Sometimes that will mean fostering – and if there are one group of people who rival social workers in their unselfish commitment to helping our most vulnerable young people then they are foster carers…But more and more often it should – must – mean adoption.
And this has become the overriding priority. Last week he announced that authorities which are failing to find adoptive parents could be stripped of their powers, which would be handed to the voluntary or private sector – the latest in a raft of measures designed to increase adoption rates.
Behind this policy, an assumption appears to have been made about mental health: the idea that all that is needed is stable, loving family, and that, in the long term, this is the best treatment for all children from a traumatic background. (“My experience of adoption has shown me how – whatever your start in life – being brought up by adults who love you, who are now your parents, is transformative”). Gove’s not afraid to admit that his own personal history – he was adopted at four months – has informed this belief.
And there have been a number of recent stories about residential care which suggest it is no place to send a child who may well have suffered severe trauma. One of the details about the recent Rochdale abuse cases which slipped under the radar concerned a victim who had been moved from Essex and placed in a one-to-one home, where she was the only resident. It wasn’t a foster placement: she never woke up with the same staff member in the home who had been there when she went to sleep. It wasn’t unusual for members of staff to be charged with her care who had never met her.
Providing stable, loving care is clearly critical to supporting children in care; all the evidence says so. But is the situation as simple as all that? Is residential care failing so badly, is adoption so infallible an option? Before we even consider that question, we need to think about what’s happening beforehand, Tom Rahilly, the Head of Strategy for Looked After Children at the NSPCC, tells me. “We’ve seen a sustained rise in the numbers, with over 28,000 children entering care in England last year. The evidence shows that care provides a safe environment for most of these children – indeed the majority say they think their care is good. But for many the support comes too late. Most children are known to social services before they enter, but far too many children and families on the edge of care don’t receive the support that they need. They’re left bumping along the bottom without the support needed. We need to get better at both identifying which children need to enter care, and at providing effective early help for families at risk.”
He points out that the latest policies are being implemented at the expense of preventative work: “Parents don’t receive enough help to stop problems such as drug or alcohol abuse or mental health difficulties. This puts children at risk of harm and we’re worried that this will get worse. The government has just announced a cut in funding for early intervention, to fund increased support for adoption. We welcome support for adoption, but it simply doesn’t make sense to take money from early intervention. It’s a false economy: this support helps stop family breakdown and address problems which can lead to children needing to enter care in the first place. Improving early help was a key recommendation of the Munro Review, which ministers supported just 18 months ago.” Clearly we need to improve our preventative work, and it seems a cruel irony that it’s instead being jeopardised by a focus on adoption.
However, there will always be children for whom there is simply no safe option other than to take them away from their families, a view clearly supported by the NSPCC. Many of these children will have suffered horrific abuse, and have mental health, and emotional and behavioural difficulties as a result of their experiences before care – four to five times the level for all children, and even higher for those in residential care. Even with reform, adoption will remain the option for a minority of children. We have to ask whether we – and the government’s reforms – are doing enough to support all children in care.
Three quarters of children in residential care will have a diagnosable mental health difficulty (a figure that rises to 95 per cent for young offenders). But believe it or not, the mental health of children and young people upon entry into state care is not systematically assessed. There is an obligatory health assessment, but in practice it often only focuses on physical health.
The patchiness of provision extends on from the moment the child first enters care. I spoke to a number of professionals who work in children’s services for a deprived London borough. One of them, Sarah (name changed), said: “If you’re in a local authority and place the child in another one, then actually accessing the services can be difficult depending on what the health trust’s care arrangements are. Working with young adults, if you want to make a referral to a community mental health team they have to be registered with a GP. Just having the money to get from A to B or to get a foster parent to take time out can be a barrier. And there are less practical barriers. I was trained in America – where there’s much more openness in our culture about accessing therapy. Here there’s much more of a stigma – if you break your arm there’s no shame in going to the doctor. It can be hard for social workers to talk comfortably with young people about their mental health.”
What she says is borne out by a 2009 study which showed that 49 per cent of children with an “apparent mental health problem” were not receiving or accessing a service from district Child and Adolescent Mental Health Services (CAMHS). These services are often characterised by limited provision, strict referral criteria, significant local variation in health care planning, and long waiting lists. Research has found only those children or young people with a diagnosed illness or easily identifiable mental health problem tend to be prioritised, meaning that the majority of children and young people who have been affected by neglect or abuse are often overlooked. This isn’t just a problem with residential care. Around three-quarters of looked after children in England and Wales are in foster placements and foster carers frequently report that the most common difficulty for the children or young people in their care is their mental health.
But as Rahilly says: “Problems often have to get worse before the threshold for accessing services is passed. In some cases children aren’t able to access support until they’re in stable placements, but this can prevent support being provided to some children with significant needs. It creates a vicious circle where children can’t access support because they’re not in a stable placement, but the difficulties they face contribute to the instability of their placements. This can’t be right.”
And as he adds, this a problem across all facets of the care system: “Even where mental health difficulties are identified, we hear too many stories of foster carers having to fight to receive the support that children in their care need; the assessment and identification of need doesn’t necessarily result in support. The help that we give children in care should be based on their need, not on the ability of their carer to fight for it, often in the face of repeated failure to access necessary support.”
Few understand how exactly difficult the task of caring for a traumatised child can be, and how much specialist knowledge is required. Kim Golding, a clinical psychologist based in Worcestershire, is a member of a mental health team that offers support to foster carers, adoptive children’s homes, parents on special guardian orders, and others. She tells me about the state these children will be in: “Developmental trauma – domestic violence, drugs, sexual abuse – causes neurological damage. It affects the way the way the brain is wired. On top of that, you have the trauma of removal from their families – and sometimes of multiple placements after that.”
These problems end up being transferred onto the carer: “A child who has suffered sexual abuse can end up acting sexually towards the carer, because that’s the only way they know how to get comfort. It can put the carer in a very difficult situation – we have to teach them how to provide comfort but remain appropriate. It’s a similar job with children who only know how to get attention through aggression. Parents get drawn into patterns of relating – we try to spot them so they offer a different way of being.”
Golding’s service may sound invaluable, but it’s not required by statute. In fact, research shows foster parents who receive similar support are in a minority around the country. You’d be amazed at exactly how little help they get. They often get a limited amount of background information. As Kate (name changed), another local government worker says: “We don’t necessarily give them the whole story with all its nasty details. I think sometimes we can hide some of the realities. That’s an issue. It’s not to say we’re being dishonest – it’s just that sometimes we can make it sound better than it is. If the child’s behaviour is causing issues in a placement which can mean it’ll break down, we take the child out for therapy when we should actually be teaching the carers how to deal with that behaviour. Actually they end up being the sponge for a lot of negativity. It’s about preparing them for what that reality looks like.”
Without Golding’s service the local foster parents would still receive help from social workers, but this specialist knowledge would be missing. Whilst Golding’s own service is not at risk, others around the country are facing the axe. Sarah says: “Local government has been squeezed with little bits of money continually taken away from services – salami slicing – and there’s a limit before the service is viable. You end up having to take whole services away – that’s better than having a bunch of services which can’t do their jobs because they’re poorly staffed and resourced. A lot of the supportive services aren’t statutory, and because the voluntary sector’s had a role for years, that makes them more vulnerable to cuts. We’re trying not to cut out anything that’s preventative or supportive because we know that in the long run it’ll increase demand for statutory services. At the same time you have to provide the statutory services.”
Kate also questioned whether the sacking of Tim Loughton – the former children’s minister – was down to the fact he was prioritising the wrong things: “I went to the All Party Parliamentary Group meetings for looked-after children and children leaving care, and he was fantastic, regularly meeting young people, clear about his direction. I was disappointed the Prime Minister took him off that position. It can’t be a coincidence that he was identifying a lot of things we need, all of which cost money. At the moment the pressure on us is coming from Ofsted – it’s not unhelpful but it’s not right that’s the only pressure. We should reduce the number of children that are looked after, but it should be so that it’s the right children that are looked after.” Might Loughton’s undoing have been the fact that he took a less one-eyed view of the care process than his boss?
And as Rahilly says: “Too many people still talk of children “languishing in care”, thinking that what we need to do to support children is to remove them from care. We need to ensure that all children in care have loving, stable, long terms homes. But we also need to dramatically improve the support to address the mental health and emotional difficulties faced by many children in care. Until we do this we cannot ever say that we’re doing enough for our most vulnerable children.”
Does a single-minded focus on adoption really meet the needs of all children in care? It seems the Government is looking for a quick fix. The issues described above are serious, and dealing with them does not run counter to Gove’s aim to provide more children with a stable upbringing through adoption. Indeed, they’re complementary: if they’re not dealt with adoption is unlikely to be the magical happy ending Gove envisages. This is not an either/or choice: the care of our most vulnerable children must be seen a continuous process. Yet his statements and policies thus far suggest one element is being prioritised at the expense of the others.