Research: How Scotland is failing young people in residential care

(Picture: Aftercare services are detracting from good work in children’s homes, suggests the research. Model released, from Alamy)

Social worker Maggie Mellon reviews findings that show worrying knowledge gaps on the effectiveness of services

KEY WORDS: Residential care ❙ Scotland ❙ children in care

Title: Getting it right for children in residential care, 2010, Audit Scotland. 48 pages

Aim: To examine the extent to which expenditure on residential care services in Scotland achieves the best possible value for money and adheres to the highest standards of financial management.

Methodology: A survey of 32 councils sampling of voluntary and private residential child care providers; interviews with selections of officers and elected members in five councils; meetings with stakeholders; reading files of 60 children and young people in residential care. Advice on calculating cost of residential care obtained from the Centre for Child and Family Research, Loughborough University.

Conclusion: Councils cannot demonstrate value for money or that they are achieving an appropriate quality of service for the costs involved.

Findings

There are about 1,600 children and young people in residential care in Scotland at an estimated cost of £250m. The spend on each person is, on average, £156,250 a year, or just over £3,000 a week. This is the most expensive form of care for children who are “looked after and accommodated” by councils. The conclusion of the study – that “councils cannot demonstrate value for money or that they are achieving an appropriate quality of service for the costs involved” – is disappointing, but perhaps should not have been unexpected.

Despite the high per capita costs, and the disproportionate share of overall children’s services budgets spent on residential care, there has been little research carried out on outcomes of residential care in Scotland, or more widely across the UK. As this expenditure is predicated on being targeted at the most vulnerable children and young people, with complex needs, it is important that the services bought are justified.

What is known is that these children as adults are disproportionately represented in the ranks of the homeless, those in prison, those with mental illness or poor mental health, those without qualifications, and unemployed. The argument may be advanced that these are much-damaged children whose life prospects are poor, and that the fault or problem lies in the damage done by their families of origin before council intervention.

Without research findings to support this view, it would be important and relevant if councils could demonstrate best practice in following regulation and guidance in deciding how services are planned, commissioned and managed, and in how decisions are made about individual young people.

The Audit Scotland study provides little comfort to councils on these basic building blocks of management and practice. The study found that “improvements in the way councils manage these services would contribute to improving the care and the longer-term outcomes for the children and young people concerned”. It also concluded that:

● Councils do not always have clear strategies and plans in place, either for the service overall or for the care of individual children.

● There are weaknesses in how councils commission services from independent providers and monitor a child’s progress.

● Where there is good practice, it is not shared well.

● Improvements are needed in management information.

● Councils are not fully aware of all the costs involved for in-house and independent provision and what factors lead to better long-term outcomes for the children.

Outcomes

Children’s hearings in Scotland make decisions about the care and placement of children. Referrals are made on a range of grounds, which include abandonment, abuse, avoidable impairment of health or development, failure to attend school, and offending.

The Children (Scotland) Act 1995, like the Children Act (England and Wales) 1989, requires that hearing decisions are made “in the best interests of the child”. It is important that councils ensure the maximum value they can for the high expenditure, and that measurable outcomes are demonstrably better than any other intervention or indeed better than no intervention at all.

It is difficult to prove definitive connections between one or more social work interventions and the long-term outcomes. However, unless children’s hearings can rely on well evidenced recommendations of social workers as being likely to produce better outcomes, they risk doing harm.

The Audit Scotland report also criticises much of the care planning found in the sample of 60 case files as short-term and task-focused at the expense of more long-term and outcome-focused planning, rather than located within a longer-term vision for the young person as they make the transition into adult life.

Research gaps

It would be useful to know if the Getting it Right for Every Child reforms (the equivalent to England’s Every Child Matters reforms) is making a difference in this respect. Although there is a more holistic approach in the desired outcomes stated – “Shanari”, meaning safe, healthy, achieving, nourished, active, responsible, included – these aims could be interpreted in a short-term way.

Certainly, there is not a research base upon which to build a stronger foundation for longer-term care planning. Nor is there sufficient comparative information between residential care and foster care, which tend to be provided and evaluated in silos.

A response to the critical attention on the poor outcomes for residential care is often that, although residential care provides well for many young people while they are there, poor aftercare service undoes this and leaves young people vulnerable to homelessness, imprisonment and poverty. It would be important to establish to what extent poor outcomes are related to the nature and quality of the intervention, to the early withdrawal of care and support, and to a failure of through-care services. The latter was the view taken by the Sweet 16? report of Scotland’s Commissioner for Children and Young People.

Despite the level of expenditure and the apparently poor results, there has been no investment by government or councils in quantitative, comparative, longitudinal research to follow selected samples of the children and young people who have been in care into adult life, and to compare within their numbers and with other wider groups of children.

The preference of government and councils over recent years has been to fund small-scale one-off evaluations rather than broader and less qualitative programmes that might provide substantial evidence so badly needed. These evaluations are limited in value and usually funded to show a link between a programme and an outcome. Outcomes claimed are necessarily short-term and often confused with outputs.

The Edinburgh Study of Youth Transitions and Crime, which started with a cohort of all children in the capital entering secondary school in 1998, lost its funding just when it could have begun to provide this kind of information. This has provided a stream of authoritative and challenging findings about the long-term impact of decisions about young people over the longer term and in greater numbers. The funding that it would have required to have continued to follow all or even substantial samples from within the full cohort was barely that paid for two average residential care placements for one year.

Practice implications

For government:

● Fund properly resourced long-term and large-scale social research to provide adequate, comparable and verifiable information and analysis on which to base policy and practice decisions rather than myriad small-scale evaluations.

● When commissioning and funding reviews of services, ensure that these are about the outcomes for children and not the needs and practices of the service silo.

● Establish long-term, measurable outcomes for the care population: for example, the percentage over periods of two, four or six years of those who are in education, work or training, in stable accommodation, in good health and ensure that the focus remains on these over a sustained period after leaving care.

For directors of children’s services:

● Collaborate to fund the research necessary to underpin good decisions and to ensure that best practice is shared across councils.

● Ensure that there are good long-term services to follow and support young people in adult life.

● Ensure that expensive out-of-council residential care placements are not being demanded and purchased because of poor quality and poorly resourced interventions.

For children’s hearings panels:

● Ask for evidenced recommendations for commencing and terminating residential care arrangements, and ensure that there are arrangements in place to maintain contact with children and young people.

For social workers:

● Read the relevant research, define desired outcomes for residential care placement in partnership with the children, young people and their families, and measure the results with them. Ensure that your commissioners know the results and act accordingly.

Further reading

● Scottish Institute for Residential Child Care, Higher Aspirations, Brighter Futures, National Residential Child Care Initiative Report, 2009

● Scotland’s Commissioner for Children and Young People, Sweet 16? The Age of Leaving Care in Scotland, 2008

● Smith D, McAra L, McVie S, Edinburgh Study of Youth Crime and Transitions, University of Edinburgh School of Law 1998-continuing

● United Nations Convention on the Rights of the Child, report on Great Britain and Northern Ireland, 2008  

About the author: Maggie Mellon is a children’s services consultant and registered social worker

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