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Planning, commissioning and monitoring placements and case reviews for looked-after babies, children and young people

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Looked-after babies, children and young people

About

What is covered

The pathway sets out how agencies and services can work together to improve the quality of life (that is, the physical, social, educational and emotional wellbeing) of looked-after babies, children and young people from birth to age 25.
It contains recommendations for local and national strategy and for training. In addition, there are recommendations grouped by specific topics or themes, such as promoting mental health and emotional wellbeing, and promoting and supporting diversity, each of which covers particular groups of babies, children and young people. This means that anyone commissioning services, planning training or providing a service that considers the 'whole' child or young person will also probably need to read the topic-specific recommendations.
The term 'looked-after children and young people' is used in the pathway to mean those looked after by the State where the Children Act 1989 applies. This includes those who are subject to a care order, or who are temporarily classed as looked after on a planned basis, for short breaks or respite care.
The focus is on putting the child or young person at the centre of every activity that affects their life.
The recommendations are for all those responsible for looked-after babies, children and young people. This includes local authorities (children's services, social care and public health services), the NHS (including mental health) services, carers (including foster carers), schools, voluntary and independent agencies and organisations responsible for training and development, regulatory bodies and inspectorates.
The recommendations may also be of interest to looked-after children and young people themselves, their families, prospective adopters and other members of the public.
The original guidance on which this pathway is based was developed jointly with the Social Care Institute for Excellence (SCIE).

Updates

Updates to this pathway

29 May 2015 Link to NICE pathway on challenging behaviour and learning disabilities added.

Principles and values

The recommendations in this pathway are supported by the following principlesThese were based on the principles in the Promoting the health and well-being of looked after children: revised guidance (Department for Children, Schools and Families and DH 2009), the 6 entitlements of the National Children's Bureau 'National healthy care standard' (see its website) and discussion of a quality of care index developed by David Berridge and colleagues. For details of the index, see Stein M, editor (2009) Quality matters in children's services: messages from research. London: Jessica Kingsley Publishers. .
  • Put the voices of children, young people and their families at the heart of service design and delivery.
  • Deliver services that are tailored to the individual and diverse needs of children and young people by ensuring effective joint commissioning and integrated professional working.
  • Develop services that address health and wellbeing and promote high-quality care.
  • Encourage warm and caring relationships between child and carer that nurture attachment and create a sense of belonging so that the child or young person feels safe, valued and protected.
  • Help children and young people to develop a strong sense of personal identity and maintain the cultural and religious beliefs they choose.
  • Ensure young people are prepared for, and supported in their transition to, adulthood.
  • Support the child or young person to participate in the wider network of peer, school and community activities to help build resilience and a sense of belonging.
  • Ensure children and young people have a stable experience of education that encourages high aspiration and supports them in achieving their potential.

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 services and care for looked-after babies, children and young people up to 25 in an interactive flowchart

What is covered

The pathway sets out how agencies and services can work together to improve the quality of life (that is, the physical, social, educational and emotional wellbeing) of looked-after babies, children and young people from birth to age 25.
It contains recommendations for local and national strategy and for training. In addition, there are recommendations grouped by specific topics or themes, such as promoting mental health and emotional wellbeing, and promoting and supporting diversity, each of which covers particular groups of babies, children and young people. This means that anyone commissioning services, planning training or providing a service that considers the 'whole' child or young person will also probably need to read the topic-specific recommendations.
The term 'looked-after children and young people' is used in the pathway to mean those looked after by the State where the Children Act 1989 applies. This includes those who are subject to a care order, or who are temporarily classed as looked after on a planned basis, for short breaks or respite care.
The focus is on putting the child or young person at the centre of every activity that affects their life.
The recommendations are for all those responsible for looked-after babies, children and young people. This includes local authorities (children's services, social care and public health services), the NHS (including mental health) services, carers (including foster carers), schools, voluntary and independent agencies and organisations responsible for training and development, regulatory bodies and inspectorates.
The recommendations may also be of interest to looked-after children and young people themselves, their families, prospective adopters and other members of the public.
The original guidance on which this pathway is based was developed jointly with the Social Care Institute for Excellence (SCIE).

Updates

Updates to this pathway

29 May 2015 Link to NICE pathway on challenging behaviour and learning disabilities added.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Looked-after children and young people (2010 updated 2015) NICE guideline PH28
Looked-after children and young people (2013) NICE quality standard 31

Quality standards

Quality statements

Warm, nurturing care

These quality statements are taken from the looked-after children and young people quality standard. The quality standard defines best practice for the health and wellbeing of looked-after children and young people and should be read in full.

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.

Description of 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.

Collaborative working between services and professionals

These quality statements are taken from the looked-after children and young people quality standard. The quality standard defines best practice for the health and wellbeing of looked-after children and young people and should be read in full.

Quality statement

Looked-after children and young people receive care from services and professionals that work collaboratively.

Rationale

Collaborative working between professionals and services, including carers, promotes high-quality and consistent care and a stable experience of placements for looked-after children and young people.

Quality measure

Structure
a) Evidence of local arrangements for the team working with the child or young person to work collaboratively to manage the multidisciplinary care plan, with the named lead social worker taking a lead professional role.
b) Evidence of effective local information-sharing protocols between health, social care and educational services.
c) Evidence of local arrangements to include the carer as part of the team working with the child or young person.
d) Evidence of local arrangements to ensure the team working with the child or young person has access to a consultancy service to support collaboration on complex casework.
Outcome
a) Feedback from looked-after children and young people that they do not have to re-tell their life and medical history when using services.
b) Feedback from looked-after children and young people that they feel information about them is shared appropriately between people working with them, and caring for them.
c) Feedback from carers that they feel involved as part of the team working with the child or young person.
d) Feedback from the team working with the child or young person that they have all of the information they need to work effectively.

Description of what the quality statement means for each audience

Looked-after children and young people are supported by a team, including their carer, who work together to meet their needs, sharing relevant information effectively and appropriately.
Carers of looked-after children and young people are part of the team working with the child or young person that works collaboratively, sharing information effectively and appropriately.
Local authorities and other commissioning services ensure they commission services that work collaboratively to meet the needs of the child, sharing information effectively and appropriately.
Organisations providing care ensure systems are in place for the team working with the child or young person to work collaboratively to meet the needs of the child or young person, and that information is shared effectively and appropriately.
Social care, education and healthcare staff work collaboratively as part of the team working with the child or young person, sharing information effectively and appropriately.

Source guidance

NICE public health guidance 28/SCIE guide 40 recommendations 6, 7 and 21.

Data source

Structure
a), b), c) and d) Local data collection.
Outcome
a) and b) Local data collection. The Children's Rights Director for England collects and reports information from looked-after children and young people in England about their experience of care in the Children's care monitor.
c) and d) Local data collection

Definitions

Carers
Carers include foster carers (including family and friends carers), residential carers and supported lodging providers.
Consultancy service
NICE public health guidance 28/SCIE guide 40 recommendation 6 recommends that a consultancy service could be designed and delivered by in-house experts, external advisers or child and adolescent mental health services and should participate in regional support networks. This can contribute to children's needs being met and placements being more effectively supported. The approach taken by such a service should be based on the concept of reflective practice 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.
Information sharing protocols
NICE public health guidance 28/SCIE guide 40 recommendation 21 recommends that protocols should address legal and confidentiality issues, to assist information flows between health and social care.
Team working with the child or young person
The team working with the child or young person is a collaborative team of key professionals and frontline staff (staff working directly with or caring for looked-after children and young people, including but not limited to, carers, social workers, designated healthcare professionals and special educational needs coordinators) working to support a child or young person.

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.

Stability and quality of placements

These quality statements are taken from the looked-after children and young people quality standard. The quality standard defines best practice for the health and wellbeing of looked-after children and young people and should be read in full.

Quality statement

Looked-after children and young people live in stable placements that take account of their needs and preferences.

Rationale

Well-planned care that takes account of the needs and preferences of looked-after children and young people promotes stability and can reduce the need for placement changes and emergency placements.

Quality measure

Structure
a) Evidence of a strategy to commission a diverse range of placements for looked-after children and young people, which includes arrangements for considering sibling co-placement.
b) Evidence of local arrangements to involve looked-after children and young people in choices and discussions about placement changes.
c) Evidence of local arrangements for identifying potential carers among extended family and friends and assessing them for suitability at the start of the care planning process.
d) Evidence of local arrangements to ensure that the child or young person gets to know their new carers and placement through visits and, where possible, overnight stays before they move to the placement.
Outcome
a) Looked-after children and young people's satisfaction with their placement.
b) Carer satisfaction with decisions made to place children or young people in their care.
c) Feedback from looked-after children and young people that they were involved in decisions about placement changes.
d) Placement stability.
e) Proportion of all placements that are emergency placements.

Description of what the quality statement means for each audience

Looked-after children and young people live in placements that take account of their needs and preferences, and understand how and why decisions about placement changes are made.
Carers of looked-after children and young people have children and young people placed with them who have been matched to the placement to take account of their needs and preferences.
Local authorities and other commissioning services ensure they commission services that provide a diverse range of quality placements and that ensure placement decisions take account of children and young people's needs and preferences.
Organisations providing care provide a diverse range of placements to enable matching that takes account of children and young people's needs and preferences.
Social care, education and healthcare staff discuss placement changes with the child or young person, taking account of their preferences along with their best interests, and explaining and documenting any reasons why their wishes cannot be followed.

Source guidance

NICE public health guidance 28/SCIE guide 40 recommendations 12, 13, 30 and 40.

Data source

Structure
a), b), c) and d) Local data collection.
Outcome
a) and c) Local data collection and Children’s Commissioner for England State of the Nation: children in care and care leavers survey.
b) Local data collection.
d) Contained within the Children looked after return (SSDA903) and reported in the Department for Education Statistical first release: outcomes for children looked after by local authorities in England. Contained within the Children’s Commissioner for England State of the Nation: children in care and care leavers survey.
e) Local data collection

Definitions

Care plan
The preparation of the care plan and its content should be in accordance with The Children Act 1989 guidance and regulations volume 2: care planning, placement and case review.
The health and education dimensions of the care plan are populated by the health plan and the personal education plan.
Involvement in choices and discussions
NICE public health guidance PH28/SCIE guide 40 recommendation 13 recommends that when planning placement changes, the child or young person's wishes need to be fully taken into account, along with consideration of their best interests. Any reasons why wishes cannot be followed should be explained to the child or young person and these reasons recorded. Children and young people should be made fully aware of their right to access advocacy services when a review decision is likely to overrule their wishes and feelings. The child or young person should also have enough notice of any planned change to arrange for an advocate to support them in their review meeting. An advocate is an independent person who helps make sure that the child or young person's views are heard and their rights are respected.
Range of placements
The Children Act 1989 guidance and regulations volume 2: care planning, placement and case review states that local authorities should have a range of residential placements available to allow placements to be matched to each child's individual needs. Needs and placement options should be considered in advance of a placement being made to allow full consideration of the suitability of each option including the opportunity for a visit as part of the decision-making process. A strategy for placement decisions should also clearly set out how to meet the local authority's 'sufficiency duty' under the Children and Young Person's Act 2008, described in Sufficiency: statutory guidance on securing sufficient accommodation for looked after children.
Stability
Stability 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.

Equality and diversity considerations

Services need to be aware of different communication needs among looked-after children and young people and should consider a variety of means of involvement and communication. Consider creative techniques to gather and understand views. Specific groups identified through consultation as having potential additional needs include:
  • very young children
  • children and young people with special educational needs
  • children and young people with learning or physical disabilities
  • children and young people with speech, language and communication difficulties
  • children and young people with a hearing or visual impairment.
Unaccompanied asylum-seeking children and young people, and black and minority ethnic looked-after children and young people should have access to interpreters if their knowledge of English is limited, so they can explain their situation and make their needs known. This applies to all children and young people who do not have English as a first language, and to those with specific communication needs.

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.

Support to explore and make sense of identity and relationships

These quality statements are taken from the looked-after children and young people quality standard. The quality standard defines best practice for the health and wellbeing of looked-after children and young people and should be read in full.

Quality statement

Looked-after children and young people have ongoing opportunities to explore and make sense of their identity and relationships.

Rationale

Developing a positive identity is associated with high self-esteem and emotional wellbeing. Life-history work can contribute to this by helping children and young people to explore and make sense of their family history and life outside the care system. Having accurate and up-to-date personal health information is an important part of this and may also be important for the immediate and future wellbeing of children and young people during their time in care and afterwards.
Children and young people have needs and preferences for contact with people they value, for example siblings, who may be an important part of their identity. Good contact management is important for promoting a sense of belonging, positive self-esteem and emotional wellbeing.

Quality measure

Structure
a) Evidence of local arrangements to offer ongoing activities to looked-after children and young people to explore and make sense of their identity, including their life history and appropriate health history.
b) Evidence of local arrangements to coordinate ongoing contact with people that looked-after children and young people value, including former carers, siblings, other family members, friends or professionals, if this is desired and in their best interests.
Outcome
a) Feedback from looked-after children and young people that they feel supported to explore and make sense of their identity and life history, including their health history.
b) Feedback from looked-after children and young people that they feel supported to have continued contact with people they value.
c) Feedback from looked-after children and young people that they have a supportive peer network.

Description of what the quality statement means for each audience

Looked-after children and young people are offered ongoing opportunities to explore and make sense of their identity, and are supported to maintain contact with people they value, if this is desired and in their best interests.
Local authorities and other commissioning services ensure they commission services that offer looked-after children and young people ongoing opportunities to explore and make sense of their identity, and to maintain contact with people they value, if this is desired and in their best interests.
Organisations providing care ensure systems are in place to offer looked-after children and young people ongoing opportunities to explore and make sense of their identity, and to maintain contact with people they value, if this is desired and in their best interests.
Social care, education and healthcare staff offer looked-after children and young people ongoing opportunities to explore and make sense of their identity, and coordinate ongoing contact with people they value, if this is desired and in their best interests.

Source guidance

NICE public health guidance 28/SCIE guide 40 recommendations 15, 24, 25 and 46.

Data source

Structure
a) and b) Local data collection.
Outcome
a), b) and c) Local data collection.

Definitions

Carers
Carers include foster carers (including family and friends carers), residential carers and supported lodging providers.
Health history
NICE public health guidance 28/SCIE guide 40 recommendation 21 recommends that early health information is available to enhance life-history work with the child or young person when they are ready, or to help them make informed decisions when they are ready to start their own family.
Social workers should obtain permission to access the child or young person's neonatal and early health information and information on parental health, including obstetric health.
NICE public health guidance 28/SCIE guide 40 recommendation 25 recommends that in life-history work looked-after children and young people have access to as much personal information as possible by promoting ongoing conversations between children, young people and their carers and social workers. This should include discussion about their personal health history and family health history.
Life history
Life-history (or life-story) work includes activities that help a child or young person to create a personal or family history. It can be an organised activity with a person trained to support this type of work, or an informal process reflected in the everyday conversations between carers and looked-after children or young people. NICE public health guidance 28/SCIE guide 40 recommendation 25 recommends that 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. The guidance recommends that the individual carrying out the activity with the child or young person should:
  • 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 (further detail about written information to include is set out in NICE public health guidance 28/SCIE guide 40).
Ongoing contact
NICE public health guidance 28/SCIE guide 40 recommendation 15 recommends that when a decision is made to separate sibling family groups, social workers should coordinate ongoing contact desired by the child or young person, arranging appropriate supervision where necessary and supporting foster or residential carers. NICE public health guidance 28/SCIE guide 40 recommendation 24 recommends that the significance of losing former attachment figures and relationships where ongoing contact is not possible should be acknowledged.

Equality and diversity considerations

It is important for looked-after children and young people to be given the opportunity to develop their own identity, rather than assumptions being made by those working with and caring for them based on particular characteristics, such as ethnicity, faith or gender. NICE public health guidance 28/SCIE guide 40 recommendation 25 recommends that ongoing discussions to inform life-history work should include culture and faith and sexual identity and orientation.
Certain groups of looked-after children and young people may face additional issues affecting their sense of identity. For example, NICE public health guidance 28/SCIE guide 40 recognises that children and young people from black, minority ethnic and multiple heritage backgrounds, and unaccompanied asylum-seekers, may face racism and isolation that can affect their ability to develop resilience and self-esteem.

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.

Support from specialist and dedicated services

These quality statements are taken from the looked-after children and young people quality standard. The quality standard defines best practice for the health and wellbeing of looked-after children and young people and should be read in full.

Quality statement

Looked-after children and young people receive specialist and dedicated services within agreed timescales.

Rationale

Looked-after children and young people have particular emotional needs, and often behavioural needs relating to their experiences before entering care and during the care process. They share many of the same health risks and problems of their peers, but often to a greater degree. Access to an appropriate level of services when needed is essential to meet their emotional, physical, behavioural and educational needs (including specialist educational needs).

Quality measure

Structure
a) Evidence of local arrangements to ensure that looked-after children and young people receive specialist and dedicated services to meet their needs. These services should be delivered on a continuing basis within agreed timescales.
b) Evidence of local arrangements for health plans to be monitored and updated by independent reviewing officers, social workers and the lead health professional to ensure that the child or young person's continuing needs are being met.
c) Evidence of local arrangements for case management and treatment to continue for looked-after young people moving from child to adult mental health services, until a handover with an assessment and completed care plan has been developed with the adult service.
Process
Proportion of looked-after young people who are moving from child to adult mental health services, whose case management and treatment continues until a handover is completed with the adult service.
Numerator – the number of people in the denominator who have their case management and treatment continued until handover with the adult service.
Denominator – the number of looked-after young people who are moving from child to adult mental health services.
Outcome
a) Feedback from looked-after children and young people that they have access to the services they need.
b) Feedback from recognised assessment tools that the child, young person or care leaver's needs are being met through access to specialist and dedicated services when needed.
c) Feedback from carers that they feel the needs of children and young people that they look after are being met through access to specialist and dedicated services when needed.

Description of what the quality statement means for each audience

Looked-after children and young people have access to specialist and dedicated services within agreed timescales.
Local authorities and other commissioning services ensure they commission services that provide looked-after children and young people with access to specialist and dedicated services within agreed timescales, and that health plans are monitored and updated.
Organisations providing care ensure local arrangements are in place to refer looked-after children and young people to specialist and dedicated services within agreed timescales, and to monitor and update health plans to ensure their needs are continuously met.
Social care, education and healthcare staff refer looked-after children and young people to specialist and dedicated services within agreed timescales, and monitor and update health plans to ensure their needs are continuously met.

Source guidance

NICE public health guidance 28/SCIE guide 40 recommendations 2, 5, 8, 9, 10, 11, 16 and 17.

Data source

Structure
a), b) and c) Local data collection.
Process
Local data collection. Data are collected through the Children and young people's health service secondary uses data set on the type of service, specialty or sub-specialty providing the care contact (global number 17101630) and consultation medium used (global number 17104470).
Data are collected through the Child and adolescent mental health services (CAMHS) secondary uses data set on whether a child is a looked-after child (global number 17300540), their accommodation status (global number 17300070), the relationship to the person that the child or young person lives with (global number 17300380), discharge reason (global number 17300880), status of service request (global number 17300780), activity location (global number 17300910), intervention type (global number 17302820), care professional team start and end dates (global numbers 17309180 and 17309190) and other assessment tool types completed (global number 17307060).
Outcome
a) and c) Local data collection.
b) Local data collection. Providers may consider using the Strengths and difficulties questionnaire as part of an evaluation of whether needs are being met.

Definitions

Agreed timescales
Access needs to be determined locally given the range of services. The aspiration is that looked-after children and young people receive services when needed and should not be subject to delays in access.
Carers
Carers include foster carers (including family and friends carers), residential carers and supported lodging providers.
Health plan
The health plan forms part of the care plan and is developed from the assessment of the child's health needs. The Children Act 1989 guidance and regulations volume 2: care planning, placement and case review sets out what the health plan should include. Care leavers have a pathway plan that will include arrangements to meet their health and development needs (pathway plan is defined in quality statement 8).
Needs
Specialist needs may include physical, emotional, behavioural, health or educational needs (including specialist educational needs).

Equality and diversity considerations

Services should be available to meet the diverse needs of looked-after children and young people, including (but not limited to):
  • babies and young children
  • children and young people with special educational needs
  • children and young people with learning or physical disabilities
  • children and young people with speech, language and communication difficulties
  • children and young people with a hearing or visual impairment.
Unaccompanied asylum-seeking children and young people need access to specialist psychological services (including child and adolescent mental health services), with the capacity, skills and expertise to address their particular and exceptional health and wellbeing needs. Professionals working with unaccompanied children and young people who are looked after should have a good understanding of cultural differences in attitudes to and beliefs about physical and mental health or wellbeing.

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.

Support to fulfil potential

These quality statements are taken from the looked-after children and young people quality standard. The quality standard defines best practice for the health and wellbeing of looked-after children and young people and should be read in full.

Quality statement

Looked-after children and young people are supported to fulfil their potential.

Rationale

Looked-after children and young people should enjoy the same opportunities as their peers. Like other children and young people, they should receive support to recognise, develop and achieve their full potential.
Stable education that is built on high aspirations and encourages individual achievement is central to improving immediate and long-term outcomes among looked-after children and young people. This includes encouragement and support to progress to further and higher education or training.
Taking part in activities that promote wellbeing and participation in the wider community provides an opportunity to meet and interact with others and can help improve social skills and self-esteem.

Quality measure

Structure
a) Evidence of local arrangements for the designated teacher to engage with the child or young person's social worker and carer in developing and monitoring their education plans.
b) Evidence of supportive pathways into further and higher education and training.
c) Evidence of supportive pathways into creative arts, physical activities and other hobbies and interests that support wellbeing and build self-esteem.
Outcome
a) Feedback from looked-after children and young people that they feel supported to access education, training or employment that is right for them.
b) Educational attainment among looked-after children and young people.
c) Education, employment or training status among looked-after children and young people.

Description of what the quality statement means for each audience

Looked-after children and young people are supported to develop and fulfil their potential by those working with and caring for them.
Carers of looked-after children and young people ensure that they encourage looked-after children and young people to develop and fulfil their potential.
Local authorities and other commissioning services ensure they commission services with local arrangements to encourage looked-after children and young people to develop and fulfil their potential.
Organisations providing care ensure systems are in place to encourage looked-after children and young people to develop and fulfil their potential.
Social care, education and healthcare staff support looked-after children and young people to develop and fulfil their potential, including monitoring educational plans and supportive pathways to education and activities to support and encourage overall wellbeing and self-esteem.

Source guidance

NICE public health guidance 28/SCIE guide 40 recommendations 24, 42, 44 and 46.

Data source

Structure
a), b) and c) 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) Data collected through the Children looked after return (SSDA903) and reported in the Department for Education Statistical first release: outcomes for children looked after by local authorities in England include information on the percentage of children in care reaching level 4 in English at key stage 2, children in care reaching level 4 in maths at key stage 2 and children in care achieving 5 GCSEs at grades A* to C (or equivalent) at key stage 4 (including English and maths) and the percentage of young people who were looked after at age 16 and were in higher education at age 19.
Data collected through the Early years foundation stage profile (EYFSP), including the percentage of children achieving each point on the 13 EYFSP assessment scales, the percentage working securely in each assessment scale and the percentage achieving a good level of development.
Data will also be collected against Marmot review indicator 7: 'Children achieving a good level of development at age 5'.
c) Data collected through the Children looked after return (SSDA903) and reported in the Department for Education Statistical first release: outcomes for children looked after by local authorities in England include information on the percentage of young people who were looked after at 16 and who were not in education, employment or training at 19.

Definitions

Designated teacher
Department for Education statutory guidance The role and responsibilities of the designated teacher: statutory guidance for school governing bodies sets out the responsibilities of designated teachers in working to promote the educational achievement of looked-after children.
Supportive pathways into higher education and training
NICE public health guidance 28/SCIE guide 40 recommendation 44 sets out support that helps young people in care to access higher education and training. This includes information and personal support before and during the application process, information about bursaries, good quality accommodation, returning to care where possible, and continued support after leaving education.
Information may also be provided about further and higher education institutions that attain the Frank Buttle UK quality mark. This recognises further and higher education institutions that provide additional and targeted support to students who have been looked after.

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.

Support to move to independence

These quality statements are taken from the looked-after children and young people quality standard. The quality standard defines best practice for the health and wellbeing of looked-after children and young people and should be read in full.

Quality statement

Care leavers move to independence at their own pace.

Rationale

The transition to adulthood can be difficult for young people in care. As with all young people, those leaving care value being able to move to independence at their own pace. This needs effective pathway planning and discussions.
Services designed for young people and delivered by friendly, approachable professionals can help young people find practical and emotional support and advice, at the right time, to prepare for independence.

Quality measure

Structure
a) Evidence of local arrangements to ensure pathway planning is responsive to the needs of young people preparing to leave care and equips them with the skills they need to live independently.
b) Evidence of local arrangements to ensure that care leavers are given the option to remain in a stable foster home or residential home beyond the age of 18, and to return to the care of the local authority, including their previous placement (if possible), if they experience difficulty in moving to live independently.
c) Evidence that a range of accommodation and support is available for care leavers.
Outcome
a) Feedback from care leavers that they felt supported to move to live independently at their own pace.
b) Care leaver satisfaction with their accommodation.
c) Accommodation status of young people leaving care.

Description of what the quality statement means for each audience

Young people leaving care have a pathway plan that prepares them for leaving care and have continued access to and support from services to ensure that they move to independence at their own pace.
Local authorities and other commissioning services ensure they commission services that develop responsive pathway plans with young people preparing to live independently, and that provide continued access to and support to ensure care leavers move to independence at their own pace.
Organisations providing care ensure arrangements are in place to develop responsive pathway plans with young people preparing to live independently, and that young people have continued access to and support from services to ensure that they move to independence at their own pace.
Social care, education and healthcare staff develop responsive pathway plans with young people preparing to live independently and offer continued access to and support from services to ensure that they move to independence at their own pace.

Source guidance

NICE public health guidance 28/SCIE guide 40 recommendations 46, 47 and 48.

Data source

Structure
a), b) and c) Local data collection. Data collected through the Children looked after return (SSDA903) and reported in the Department for Education Statistical first release: outcomes for children looked after by local authorities in England include information on the percentage of children leaving care after the age of 16 who remained looked after until their 18th birthday.
Outcome
a) Local data collection and the Children’s Commissioner for England State of the Nation: children in care and care leavers survey.
b) Local data collection.
c) Data collected through the Children looked after return (SSDA903) and reported in the Department for Education Statistical first release: Outcomes for children looked after by local authorities in England include information on the percentage of care leavers in suitable accommodation.

Definitions

Carers
Carers include foster carers (including family and friends carers), residential carers and supported lodging providers.
Pathway plan
The Children Act 1989 guidance and regulations volume 2: care planning, placement and case review states that a pathway plan must be prepared for all eligible children and continued for all relevant and former relevant children. Each young person's pathway plan will be based on and include their care plan and will set out the actions that must be taken by the responsible authority, the young person, their parents, their carers and the full range of agencies, so that each young person is provided with the services they need to enable them to achieve their aspirations and make a successful transition to adulthood.
Range of housing options
The Children Act 1989 guidance and regulations volume 3: planning transition to adulthood for care leavers sets out a range of semi-independent and independent accommodation options for care leavers, including:
  • enabling young people to remain in the accommodation in which they lived whilst being looked after, for example, by converting a foster placement to a post-18 arrangement or supported lodgings
  • supported lodgings, other than with former carers
  • foyers and other supported housing, combining accommodation with support and opportunities for education, training and employment
  • trainer flats where young people can practice living more independently without compromising their future housing options
  • specialist accommodation, for example self-contained accommodation with personal assistance support, or therapeutic placements for young people with specific support needs
  • independent accommodation in the social or private rented sectors, with flexible floating support as needed
  • living with birth families.
Skills to live independently
Support to develop skills to live independently will vary according the needs and preferences of individual young people. Examples of skills include:
  • skills to manage everyday living with confidence, including support with personal relationships and money management
  • learning practical skills, such as cooking and shopping.

Equality and diversity considerations

Some groups of young people may need additional support in leaving care, such as young people with physical or learning disabilities, unaccompanied asylum seekers, children with special education needs and children with 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.

Continuity of services for placements outside the local authority or health boundary

These quality statements are taken from the looked-after children and young people quality standard. The quality standard defines best practice for the health and wellbeing of looked-after children and young people and should be read in full.

Quality statement

Looked-after children and young people who move across local authority or health boundaries continue to receive the services they need.

Rationale

Looked-after children and young people should not be disadvantaged when they move across local authority or health boundaries and should continue to receive the services they need. Good transition planning enables transfer of relevant information and continuity of services. Looked-after children and young people also value continued contact with the same professionals when they move areas.

Quality measure

Structure
a) Evidence of local arrangements to ensure the placing authority shares relevant information before a child or young person is placed across a local authority or health boundary.
b) Evidence of local arrangements to ensure that an assessment of health needs has been carried out before a child or young person is placed across a local authority or health boundary.
c) Evidence of local arrangements to ensure there is agreement between placing and receiving teams about schooling and healthcare arrangements before a child or young person is placed across a local authority or health boundary.
d) Evidence of local arrangements to ensure that looked-after children and young people have continued contact with key professionals when they are placed across a local authority or health boundary.
Process
a) Proportion of looked-after children and young people placed across a local authority or health boundary for whom relevant information was shared before the placement took place.
Numerator – the number of people in the denominator for whom all relevant information was shared before the placement took place.
Denominator – the number of looked-after children and young people placed across a local authority or health boundary.
b) Proportion of looked-after children and young people for whom an assessment of health needs was carried out before they were placed across a local authority or health boundary.
Numerator – the number of people in the denominator who received an assessment of health needs before they were placed across a local authority or health boundary.
Denominator – the number of looked-after children and young people placed across a local authority or health boundary.
Outcome
a) Feedback from looked-after children and young people that they remain in contact with key professionals when they move across a local authority or health boundary.
b) Carer satisfaction with the arrangements made for children and young people placed with them from a different area.

Description of what the quality statement means for each audience

Looked-after children and young people continue to receive services they need and remain in contact with key professionals if they are moved across local authority or health boundaries.
Carers of looked-after children and young people are supported to meet the needs of the child or young person through looked-after children and young people having continued access to services they need and continued contact with key professionals if they move across local authority or health boundaries.
Local authorities and other commissioning services ensure they commission services with local arrangements for necessary services to be in place, for relevant information to be transferred, and for continued contact with key professionals before looked-after children and young people are moved across local authority or health boundaries.
Organisations providing care ensure there are local arrangements for necessary services to be in place, for relevant information to be transferred and for continued contact with key professionals before looked-after children and young people are moved across local authority or health boundaries.
Social care, education and healthcare staff ensure all relevant information for looked-after children and young people is transferred before they move across local authority or health boundaries, and that contact is maintained with key professionals.

Source guidance

NICE public health guidance 28/SCIE guide 40 recommendations 3, 12, 20, 43.

Data source

Structure
a) Local data collection. Data collected through the Children looked after return (SSDA903) and reported in the Department for Education Statistical first release: outcomes for children looked after by local authorities in England includes information on the percentage of looked-after children placed outside the local authority boundary and more than 20 miles from where they used to live.
b), c) and d) Local data collection.
Process
a) and b) Local data collection. Providers may consider using the NMHDU/NCSS self-assessment tool (data systems adapted to produce specific transition reports, including monitoring outcomes for all young people with ongoing needs at the point of transition).
Outcome
a) and b) Local data collection.

Definitions

Carers
Carers include foster carers (including family and friends carers), residential carers and supported lodging providers.
Placements outside the local authority or health boundary
Placements outside the local authority or health boundary are when a child or young person moves to a new home outside the geographical boundaries of the local authority that looks after them, or the health boundary, and they use the services (for example, education, health, leisure or housing) of the local authority area they have moved into.
Relevant information
The placing authority should inform the relevant health organisations in both the placing and receiving local authority and transfer multiagency information to the receiving authority before a child or young person is placed across a local authority or health boundary.

Equality and diversity considerations

Continuity of services should take account of the diverse needs of looked-after children and young people, including (but not limited to):
  • babies and young children
  • children and young people with special educational needs
  • children and young people with learning or physical disabilities
  • children and young people with speech, language and communication difficulties
  • children and young people with a hearing or visual impairment
  • unaccompanied asylum-seeking children and young people.

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.

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

NICE has produced resources to help implement its guidance on:

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

Principles and values

The recommendations in this pathway are supported by the following principlesThese were based on the principles in the Promoting the health and well-being of looked after children: revised guidance (Department for Children, Schools and Families and DH 2009), the 6 entitlements of the National Children's Bureau 'National healthy care standard' (see its website) and discussion of a quality of care index developed by David Berridge and colleagues. For details of the index, see Stein M, editor (2009) Quality matters in children's services: messages from research. London: Jessica Kingsley Publishers. .
  • Put the voices of children, young people and their families at the heart of service design and delivery.
  • Deliver services that are tailored to the individual and diverse needs of children and young people by ensuring effective joint commissioning and integrated professional working.
  • Develop services that address health and wellbeing and promote high-quality care.
  • Encourage warm and caring relationships between child and carer that nurture attachment and create a sense of belonging so that the child or young person feels safe, valued and protected.
  • Help children and young people to develop a strong sense of personal identity and maintain the cultural and religious beliefs they choose.
  • Ensure young people are prepared for, and supported in their transition to, adulthood.
  • Support the child or young person to participate in the wider network of peer, school and community activities to help build resilience and a sense of belonging.
  • Ensure children and young people have a stable experience of education that encourages high aspiration and supports them in achieving their potential.

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

Background on 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.

Background on 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.

Care planning, placements and case reviews

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.

Background on 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.

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.

Placements: background

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.

Background on 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.

Background on support for 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.

Background on 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.

Background on 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.

Diversity

A disproportionate number of looked-after children and young people are from black and minority ethnic backgrounds and have particular needs. Other 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.

Background on 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.

Background on 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.

Background on 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.

Background on 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.

Background on 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.

More information on these documents

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.

Glossary

a process in which an independent person (an advocate) helps another person express their views and wishes. Advocacy for children and young people has been defined as 'speaking up' for them. It aims to empower them and make sure that their views are heard and their rights are respected for example, when planning care
a secure relationship with a main caregiver, usually a parent, allowing a baby or child to grow and develop physically, emotionally and intellectually. Babies and children need to feel safe, protected and nurtured by caregivers who identify and respond appropriately to their needs. Unmet attachment needs may lead to social, behavioural or emotional difficulties, which can affect the child's physical and emotional development and learning
biological parents, sometimes referred to as 'natural parents'
care provided by friends and relatives for a looked-after child or young person. Previously referred to as 'kinship care'. Recent government guidance also uses the term 'connected care'
a document that sets out the actions to be taken to meet the child's needs and records the person responsible for taking each identified action. The local authority is responsible for ensuring that it is regularly reviewed and that the identified actions happen
child and adolescent mental health services (CAMHS) are specialist NHS mental health services for children and young people up to the age of 18
the process by which agencies such as local authorities and commissioners of health services, jointly or separately, identify needs and then plan and deliver services within their own resources or from a range of service providers. It includes monitoring the delivery and quality of services and their responsiveness to defined need. Service providers may include GPs, hospitals, mental health trusts and voluntary and independent organisations
children may have complex needs as a result of physical disability or impairment, learning disability or a long-term health condition. Complex needs can encompass physical, emotional, behavioural and health needs and may require help from a number of different sources
a term used to describe the responsibility of any local authority as 'corporate parents' to all the children and young people who are in the care of that local authority (children and young people who are 'looked after' or 'in care'). A 'corporate parent' has a legal responsibility to ensure that the needs of children and young people in their care are prioritised in the same way as any concerned parent would want for their own children. The term covers all the members of the local council and any services provided by the local council
a doctor or nurse who has responsibility for looked-after children and young people and an understanding of their particular healthcare needs. They have the authority to make things happen both for an individual child and for looked-after children generally in their locality. They also have a strategic role to assist commissioners of health services to fulfil their responsibilities to meet the needs of looked-after children and young people. The post holders may monitor commissioned services or provide direct services to individual children
similar to a designated health professional – a teacher who has particular responsibility for looked-after children and young people and an understanding of their care needs and their impact on education. They also have sufficient authority to make things happen both for an individual child and for looked-after children across the school in general. They act as an advocate for looked-after children; ensure speedy transfer of information; ensure that each looked after child has their personal education plan and a home-school agreement drawn up with the primary carer. Every school should have a designated teacher
this term is used to cover a person's learning, emotional, or comprehension abilities, which may change with time and may not be related to chronological age. For children and young people who are looked after, their developmental capacity may affect their overall ability to stay safe and become independent
in this guidance, 'diversity' is used as a general term to draw attention to groups of children and young people in the care system who may have a range of particular needs as a consequence of their cultural background, sexual orientation, physical or learning disabilities or faith. It is a way of identifying groups of children and young people and ensuring they are treated the same as their peers but also have opportunities to use services that meet their particular needs
the situation of children or young people who spend years passing (or 'drifting') through a series of placements in residential or foster care
a phrase used to indicate that a looked-after child or young person is able to stay in the same place of education for an extended period, which should encourage them to engage with learning and achieve. Often placement and educational stability are linked: when a child has to change their care placement they may have to leave their school
independent (private) and third-sector agencies (either for profit or not for profit) that recruit and provide foster carers
the person (or people) who ensure/s that the health and welfare of looked-after children and young people are prioritised, that they have completed and accurate care plans in place (which are regularly reviewed and updated), that any physical, emotional health or wellbeing needs or assessments identified by their care plans are met or completed, and that their views and wishes, and those of their families, are heard
a plan that sets out the strategies being used by a school to ensure that a child or young person who has particular learning or physical disabilities gets the support they need to learn and achieve to the best of their ability
services to prepare and support looked-after young people when they are planning to leave care and live independently. They are sometimes called 'transitional support services'
this is about helping a child or young person create a personal or family history by gathering and talking about information (such as photos and letters) about their life now or before they came into care, to help them develop a sense of identity. Life-story work can be an organised activity with a person trained to support this type of work, or an informal process reflected in the everyday conversations between carers and looked-after children or young people
a description for services that involve more than one agency (for example NHS and social work). Children's services carry responsibility for the care plan of a looked-after child or young person, but different agencies and professionals contribute to it, for example, the school, the GP, the looked-after children's nurse, and adult services for the parent or for the young person as they approach adulthood. A range of professionals also have a role in assessing a child's general wellbeing and development
a term used to describe the background of an individual whose family members may be descended from two or more cultural groups, but not necessarily different racial groups. For example, the term could apply equally to someone with a white British father and a white French mother; and to a person with white Irish, British Asian and African-American grandparents. Sometimes used inter changeably with the terms 'mixed race' or 'bi-racial'
a pastoral support plan (PSP) is a school-based programme which is intended to help a child or young person to improve their social, emotional and behavioural skills. The PSP will identify precise and specific targets for the child or young person to work towards and should include the child or young person, their carers, parents or social workers (as appropriate) in the drafting process
the plan that sets out the activities and support for any looked-after young person planning to move to independent living. The pathway plan builds on and replaces the care plan, and young people are eligible for one from the age of 16
achieving a legally permanent, nurturing family for a looked-after child or young person
a fund held by the local authority that can be used, at their discretion, to help looked-after young people pursue their education (including further and higher education)
a document describing the assessment and plan to meet the educational needs of a looked-after child or young person, and help them reach their full potential in education and afterwards. It forms part of the care plan
the foster or residential home where the child or young person is living. A child or young person may also be 'placed' with their family at home if they are in care under a court order
care for children and young people living away from home in children's homes and residential special schools
resilience is a term used to describe a person's responses to difficult or potentially damaging experiences. As a quality in a person, it implies that the experience does not appear to have had a lasting, detrimental impact on mental or physical health. Understanding resilience is important to help develop useful interventions in the hope of lessening the long-term consequences of a damaging event. It is important for looked-after children or young people in particular as some manage to lead happy, fulfilled lives despite serious adverse experiences in life while others struggle to do so
a meeting or meetings where the care plan is considered, reconfirmed or changed and such decisions agreed and recorded in consultation with all those who have an interest in the child's life, including the child
a collaborative team of key professionals and frontline practitioners to support a child or young person. The team may include foster or residential carers
a phase or period of time when a person experiences significant change, some of which may be challenging. Some changes are experienced only by looked-after children or young people, for example, becoming looked after, changing placement, changing social worker or leaving care. Some looked-after children and young people experience loss, separation and varying degrees of trauma at these changes
an unaccompanied asylum seeker is a child or young person who is under 18 years of age, and who travels to a new country alone without a parent, carer or other adult who, by law or custom, is responsible for them (Department of Health, Social Services Inspectorate 1995)
a senior member of staff in a local authority, who has responsibility for overseeing a coordinated system of support for looked-after children and improving their educational achievements

Paths in this pathway

Pathway created: April 2013 Last updated: December 2016

© NICE 2017

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