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Attachment difficulties in children and young people

About

What is covered

This pathway covers the identification, assessment and treatment of attachment difficulties in children and young people up to age 18 who are adopted from care, in special guardianship, looked after by local authorities in foster homes (including kinship foster care), residential settings and other accommodation, or on the edge of care. It aims to address the many emotional and psychological needs of children and young people in these situations, including those resulting from maltreatment.

Who is it for?

  • commissioners and providers of health and social care services
  • schools and other education providers
  • all health and social care professionals working in a range of community (including fostering, residential and kinship care settings), primary care, secondary care and secure settings who have contact with children and young people who are adopted from care, in special guardianship, looked after by local authorities or on the edge of care
  • all educational staff working in schools and other education settings (including early years) who have contact with children and young people who are adopted from care, in special guardianship, looked after by local authorities or on the edge of care
  • children and young people with attachment difficulties and their families and carers

Updates

Updates to this pathway

11 October 2016 Children's attachment (NICE quality standard 133) added.

Your responsibility

Guidelines

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this interactive flowchart is not mandatory and does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the interactive flowchart to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Short Text

Everything NICE has said on identifying, assessing and treating attachment disorders in under 18s in an interactive flowchart

What is covered

This pathway covers the identification, assessment and treatment of attachment difficulties in children and young people up to age 18 who are adopted from care, in special guardianship, looked after by local authorities in foster homes (including kinship foster care), residential settings and other accommodation, or on the edge of care. It aims to address the many emotional and psychological needs of children and young people in these situations, including those resulting from maltreatment.

Who is it for?

  • commissioners and providers of health and social care services
  • schools and other education providers
  • all health and social care professionals working in a range of community (including fostering, residential and kinship care settings), primary care, secondary care and secure settings who have contact with children and young people who are adopted from care, in special guardianship, looked after by local authorities or on the edge of care
  • all educational staff working in schools and other education settings (including early years) who have contact with children and young people who are adopted from care, in special guardianship, looked after by local authorities or on the edge of care
  • children and young people with attachment difficulties and their families and carers

Updates

Updates to this pathway

11 October 2016 Children's attachment (NICE quality standard 133) added.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Children's attachment quality standard (2016) NICE quality standard 133

Quality standards

Children's attachment

These quality statements are taken from the children's attachment quality standard. The quality standard defines clinical best practice for children's attachment and should be read in full.

Quality statements

Training and support for carers

This quality statement is taken from the children's attachment quality standard. The quality standard defines clinical best practice in children's attachment and should be read in full.

Quality statement

Health and social care provider organisations provide training, education and support programmes for carers of school aged children and young people with attachment difficulties.

Rationale

Carers can benefit from training and support to improve the stability of placements and reduce the likelihood of placement breakdown. Unstable placements are associated with poorer mental health and behavioural problems in children and young people.

Quality measures

Structure
a) Evidence of local arrangements to provide training, education and support programmes for carers of children and young people with attachment difficulties.
Data source: Local data collection.
b) Evidence that training, education and support programmes for carers of children and young people with attachment difficulties are appropriate to the age of the child.
Data source: Local data collection.
Outcome
a) Breakdown of placements for children and young people with attachment difficulties.
Data source: Local data collection. Department for education (2016/2017) Looked after children return, collects return to care after or during previous permanent arrangement. National Audit Office (2014) Children in care.
b) School attendance rates for children and young people with attachment difficulties in care.
Data source: Local data collection. Department for Education (2016) Outcomes for children looked after by local authorities in England, 31 March 2015.
c) School exclusions for children and young people with attachment difficulties in care.
Data source: Local data collection. Department for Education (2016) Outcomes for children looked after by local authorities in England, 31 March 2015.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers (health and social care providers) ensure that carers of school aged children and young people with attachment difficulties can have training, education and support before and during a placement. Service providers should offer a range of training and support programmes appropriate for different age groups of children.
Health and social care practitioners (Child and Adolescent Mental Health Services [CAMHS], specialist paediatricians, and social care practitioners) ensure that they consider training, education and support programmes for carers of school aged children and young people with attachment difficulties before and during a placement.
Commissioners (local authorities) ensure they commission training and support programmes for carers of school aged children and young people with attachment difficulties before and during placements. Programmes should be appropriate to different age groups.

What the quality statement means for children, young people and their carers

Carers of school aged children and young people with attachment difficulties have training and support before and after they provide a place within their care.

Source guidance

Definitions of terms used in this quality statement

Carers
A foster carer (including kinship carers), special guardian or adoptive parent.
[Adapted from NICE’s guideline on children’s attachment]
Training, education and support programmes
The content and type of training, education and support programmes can vary according to the age of the child or young person and their individual circumstances. Examples of training and support programmes that could be provided can be found in section 1.5 of NICE’s guideline on children’s attachment.

Video feedback programmes

This quality statement is taken from the children's attachment quality standard. The quality standard defines clinical best practice in children's attachment and should be read in full.

Quality statement

Parents and carers of preschool-age children with or at risk of attachment difficulties are offered a video feedback programme.

Rationale

A video feedback programme can help parents and carers nurture their child, understand their child’s behaviour, respond positively and behave in ways that are not frightening. It can also improve how parents and carers respond to their own feelings when nurturing the child. Improving a carer’s relationship with a child may ensure placement stability.

Quality measures

Structure
Evidence of local arrangements to ensure that parents and carers of preschool-age children identified to have or be at risk of attachment difficulties are offered a video feedback programme.
Data source: Local data collection.
Process
Proportion of preschool-age children with or at risk of attachment difficulties whose parents or carers receive a video feedback programme.
Numerator – the number in the denominator whose parents or carers receive a video feedback programme.
Denominator – the number of preschool-age children with or at risk of attachment difficulties.
Data source: Local data collection.
Outcome
a) Sensitivity and responsiveness in parents of children with attachment difficulties on the edge of care.
Data source: Local data collection.
b) Breakdown in care placements for preschool aged children with or at risk of attachment difficulties.
Data source: Local data collection. Department for education (2016/2017) Looked after children return, collects return to care after or during previous permanent arrangement. National Audit Office (2014) Children in care.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers (health and social care providers) ensure that they have a video feedback programme available to offer the parents and carers of preschool aged children with or at risk of attachment difficulties.
Health and social care practitioners (such as mental health professionals in multi-agency services, health visitors and social workers) ensure that they offer a video feedback programme to parents and carers of preschool aged children with or at risk of attachment difficulties.
Commissioners (clinical commissioning groups and local authorities) ensure that they commission services that can offer parents and carers of preschool aged children with or at risk of attachment difficulties a video feedback programme.

What the quality statement means for children and their parents and carers

Parents and carers of preschool aged children identified to have or be at risk of attachment difficulties are recorded interacting together on video. This helps the parent or carer see how they react and behave with the child or young person, and the social care professional give help on how to change any behaviour that could cause problems.

Source guidance

Definitions of terms used in this quality statement

Carers
Foster carers (including kinship carers), special guardians and adoptive parents.
[Adapted from NICE’s guideline on children’s attachment]
Video feedback programmes
Video feedback programmes are delivered in the parental or carers home by a trained health or social care worker who has experience of working with children and young people. The programme should:
  • consist of 10 sessions (each lasting at least 60 minutes) over 3–4 months
  • include filming the parents or carers interacting with the child for 10–20 minutes every session
  • include the health or social care worker watching the video with the parents or carers to:
    • highlight parental or carer sensitivity, responsiveness and communication
    • highlight parental or carer strengths
    • acknowledge positive changes in the behaviour of the parents or carer and child.
[Adapted from recommendation 1.4.2 in NICE’s guideline on children’s attachment]

Education plan

This quality statement is taken from the children's attachment quality standard. The quality standard defines clinical best practice in children's attachment and should be read in full.

Quality statement

Children and young people with attachment difficulties have an education plan setting out how they will be supported in school.

Rationale

Children and young people with attachment difficulties can have stress, fears and insecurities that impact on their experience of school, peer relationships and learning. An education plan for these children and young people can help educational staff understand and respond effectively to the child or young person. This can minimise disruption to their learning, ensure they are supported when at school and make it less likely the child or young person will be absent or excluded from school.

Quality measures

Structure
Evidence of local arrangements to develop education plans for all children and young people with attachment difficulties that set out how they will be supported in school.
Data source: Local data collection.
Process
Proportion of children and young people with attachment difficulties who have an education plan setting out how they will be supported in school.
Numerator – the number in the denominator who have an education plan setting out how they will be supported in school.
Denominator – the number of children and young people with attachment difficulties.
Data source: Local data collection.
Outcome
a) School attendance rates for children and young people with attachment difficulties.
Data source: Local data collection. National Audit Office (2014) Children in care.
b) School exclusions for children and young people with attachment difficulties.
Data source: Local data collection. Department for Education (2016) Outcomes for children looked after by local authorities in England, 31 March 2015.

What the quality statement means for education providers and local authorities

Education providers (schools and other settings such as early years providers) ensure that systems are in place for children and young people with attachment difficulties to have education plans setting out how they will be supported in school. Providers ensure staff involved in the design and development of education plans have had training in supporting children with attachment difficulties.
Education staff (such as designated teachers, virtual school heads and other identified teachers) work with health and social care practitioners to develop and maintain education plans for children and young people with attachment difficulties. Teachers, through the framework of core content for initial teacher training (ITT) should have an awareness of the importance of emotional development such as attachment issues and mental health on pupils’ performance.
Local authorities ensure that education providers have and maintain an education plan for children and young people with attachment difficulties that set out how they will be supported in school.

What the quality statement means for children, young people and their parents and carers

Children and young people with attachment difficulties have a plan that says how they will be supported in school.

Source guidance

Definitions of terms used in this quality statement

Education plan
An up-to-date plan for children and young people with attachment difficulties may contain:
  • details of how support in school will be provided
  • contact details for the parents, carers and health and social care professionals for the child or young person
  • details of a key person who can advocate for the child or young person and to whom the child or young person can go for support
  • details of a safe place in school, for example a room where a child or young person can go if they are distressed.
It should take into account the child or young person’s preferences, needs and abilities when it is developed.
For children and young people in care this plan is known as a personal education plan (PEP).
[Adapted from recommendations 1.2.4 and 1.2.5 in NICE’s guideline on children’s attachment, and expert opinion]

Comprehensive assessment

This quality statement is taken from the children's attachment quality standard. The quality standard defines clinical best practice in children's attachment and should be read in full.

Quality statement

Children and young people who may have attachment difficulties, and their parents or carers, have a comprehensive assessment before any intervention programme.

Rationale

A comprehensive assessment can identify environmental, personal and parental factors linked to the development of attachment difficulties. This can help confirm risk or presence of attachment difficulties, guide decisions on appropriate programmes and minimise harm from unnecessary intervention.

Quality measures

Structure
Evidence of local arrangements to undertake comprehensive assessment before any intervention programme for attachment difficulties.
Data source: Local data collection.
Process
Proportion of intervention programmes commencing for attachment difficulties in children and young people that included a comprehensive assessment before the interventions began.
Numerator – the number in the denominator that included a comprehensive assessment before the interventions began.
Denominator – the number of intervention programmes commencing for attachment difficulties in children and young people.
Data source: Local data collection.
Outcome
a) Social and emotional development and behavioural functioning of children at risk of or with confirmed attachment difficulties.
Data source: Local data collection.
b) Sensitivity and responsiveness in parents of children with attachment difficulties on the edge of care.
Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers (providers of attachment interventions) ensure that systems are in place so that children and young people who may have attachment difficulties, and their parents or carers have a comprehensive assessment before any intervention programme.
Health and social care practitioners (groups delivering attachment interventions) ensure they undertake comprehensive assessments for children and young people who may have attachment difficulties before any intervention programmes commence.
Commissioners (clinical commissioning groups and local authorities) ensure that services providing intervention programmes for attachment difficulties undertake comprehensive assessments on children and young people who may have attachment difficulties before initiation of a programme.

What the quality statement means for children, young people and their parents and carers

Children and young people who may have attachment difficulties, and their parents and carers, have an assessment of their personal, parental and environmental circumstances before any intervention programme. This will help ensure any future support related to attachment difficulties is appropriate.

Source guidance

Definitions of terms used in this quality statement

Comprehensive assessment
A comprehensive assessment can include assessment of:
  • personal factors, including the child or young person's attachment pattern and relationships
  • factors associated with the child or young person's placement, such as history of placement changes, access to respite and trusted relationships within the care system or school
  • the child or young person's educational experience and attainment
  • parental sensitivity
  • parental factors, including conflict between parents (such as domestic violence and abuse), parental drug and alcohol misuse or mental health problems, and parents' and carers' experiences of maltreatment and trauma in their own childhood
  • the child or young person's experience of maltreatment or trauma
  • the child or young person's physical health
  • coexisting mental health problems and neurodevelopmental conditions commonly associated with attachment difficulties, including antisocial behaviour and conduct disorders, attention deficit hyperactivity disorder, autism, anxiety disorders (especially post-traumatic stress disorder), depression, alcohol misuse and emotional dysregulation.
[Recommendation 1.3.2 in NICE’s guideline on children’s attachment]

Equality and diversity considerations

All children, young people with attachment difficulties and their parents or carers should have equal access to assessment regardless of whether they:
  • are on the edge of care, accommodated under Section 20 of the Children Act 1989, subject to a care order, under special guardianship or adopted from care
  • are placed with birth parents, foster carers (including kinship carers), special guardians or in residential care
  • are from a minority ethnic group
  • have a disability or a mental health problem
  • are from the UK or overseas.
All children and young people with attachment difficulties who enter the UK as unaccompanied asylum-seeking children should be assessed once a stable placement has been found.
[NICE’s guideline on children’s attachment]

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.

Pathway information

Your responsibility

Guidelines

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this interactive flowchart is not mandatory and does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the interactive flowchart to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Supporting information

Ensure video feedback programmes are delivered in the parental home by a trained health or social care worker who has experience of working with children and young people and:
  • consist of 10 sessions (each lasting at least 60 minutes) over 3–4 months
  • include filming the parents interacting with their child for 10–20 minutes every session
  • include the health or social care worker watching the video with the parents to:
    • highlight parental sensitivity, responsiveness and communication
    • highlight parental strengths
    • acknowledge positive changes in the behaviour of the parents and child.
If there is little improvement to parental sensitivity or the child's attachment after 10 sessions of a video feedback programme, arrange a multi-agency review before going ahead with more sessions or other interventions.
Ensure parental sensitivity and behaviour training:
  • first consists of a single session with the parents followed by at least 5 (and up to 15) weekly or fortnightly parent–child sessions (lasting 60 minutes) over a 6-month period
  • is delivered by a trained health or social care professional
  • includes:
    • coaching the parents in behavioural management (not for children aged 0–18 months) and limit setting
    • reinforcing sensitive responsiveness
    • ways to improve parenting quality
    • homework to practise applying new skills.

Assessment tools to guide decisions on interventions for children and young people who have or may have attachment difficulties

Tool
Setting
Format
Age (years)
Classification
Insecure attachment
Disorganised attachment
Strange Situation Procedure
Clinic
Observation
1–2
Y
Y
Cassidy–Marvin Preschool Attachment Coding System
Clinic
Observation
2–4
Y
Y
Preschool Assessment of Attachment
Clinic
Observation
2–4
Y
Y
Attachment Q-sort
Home
Observation
1–4
Y
N
Manchester Child Attachment Story Task
Any setting
Interviewer-researcher/clinician
4–7
Y
Y
McArthur Story Stem
Any setting
Interviewer-researcher/clinician
4–7
Y
Y
Child Attachment Interview
Any setting
Interviewer-researcher/clinician
7–15
Y
Y
Adult Attachment Interview
Any setting
Interviewer-researcher/clinician
15+ and parents or carers
Y
Y

Glossary

a foster carer, residential carer, special guardian or kinship carer
foster carers, residential carers, special guardians or kinship carers
this covers all children and young people looked after by a local authority, including those subject to care orders under section 31 of the Children Act 1989 and those provided with accommodation under section 20
a teacher who must be appointed by the governing body of all maintained schools, as set out in the Children and Young Persons Act 2008, to promote the educational achievement of looked-after children. Academies, with their funding agreement with the Secretary of State, are also required to appoint a designated teacher for looked-after children
teachers who must be appointed by the governing body of all maintained schools, as set out in the Children and Young Persons Act 2008, to promote the educational achievement of looked-after children. Academies, with their funding agreement with the Secretary of State, are also required to appoint a designated teacher for looked-after children
Diagnostic and Statistical Manual of Mental Disorders, 5th edition
this covers children and young people who are considered by social care workers to be at high risk of going into care (for example, because of maltreatment, parental mental health problems or parental substance misuse). This includes those currently living with their birth parents or original family (such as step-parents), and those adopted from care but who are at high risk of returning to care
foster care is the placement of a child or young person with a foster carer, who may or may not be related to the child or young person. This might be an emergency, short-term or long-term placement in a private family home
International Statistical Classification of Diseases and Related Health Problems, 10th revision
kinship care is care provided by adults who have a relationship with or connection to the child or young person, including grandparents, siblings, aunts, uncles, godparents or step-grandparents. Kinship care includes children and young people living in an informal arrangement, looked after by the local authority and placed with kinship foster carers, or in an arrangement planned to lead to adoption by a relative or friend
a child is looked after by a local authority if they have been provided with accommodation for a continuous period of more than 24 hours (in the circumstances set out in sections 20 and 21 of the Children Act 1989), or placed in the care of a local authority by virtue of an order made under part 4 of the Act
physical, sexual or emotional abuse or neglect
a birth parent, adoptive parent or step-parent who has parental responsibility for a child or young person
birth parents, adoptive parents or step-parents who have parental responsibility for a child or young person
person who is responsible, as set out in Children (Leaving Care) (England) Regulations 2001, for making sure that children and young people receive care and support from appropriate services when they leave the care system. They provide advice and support to the child or young person, are involved in preparing a 'pathway plan' (covering health and development, education training and employment, contact with parents, wider family and friends and managing finances), and are responsible for keeping it up to date
people who are responsible, as set out in Children (Leaving Care) (England) Regulations 2001, for making sure that children and young people receive care and support from appropriate services when they leave the care system. They provide advice and support to the child or young person, are involved in preparing a 'pathway plan' (covering health and development, education training and employment, contact with parents, wider family and friends and managing finances), and are responsible for keeping it up to date
a home environment, whether in a family or residential setting, which may be temporary or permanent for a child or young person who is either voluntarily, or by order of a court, looked after or placed with a view to adoption by a local authority
home environments, whether in a family or residential setting, which may be temporary or permanent for a child or young person who is either voluntarily, or by order of a court, looked after or placed with a view to adoption by a local authority
care provided under the Children Act 1989 in a children's home run by a local authority, voluntary or private provider, where 1 or more children or young people are cared for by a team of employed staff
a multi-agency action to protect children from maltreatment, prevent the impairment of their health and development, ensure that they grow up in circumstances consistent with the provision of safe and effective care, and actively enable all children to have the best outcomes
under the Children Act 1989, amended by the Adoption and Children Act 2002, a legally secure placement for children and young people who cannot live with their birth parents that confers parental responsibility on the special guardian
officers who must be appointed by local authorities, as set out in the Children and Families Act 2014, who ensure that the authority properly carries out its duty to promote the educational achievement of its looked-after children

Paths in this pathway

Pathway created: November 2015 Last updated: November 2016

© NICE 2017

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