A team-around-the-child solution is preventing placement breakdown among looked-after children with complex mental health needs, reports Louise Hunt
● Project name: Tiered Camhs approach for looked-after children.
● Aims and objectives: To improve access to mental health services for looked-after children and reduce placement breakdowns.
● Number of service users: 32 child recipients with high-level needs and 35 on lower-level support.
● Cost of project: About £200,000 a year for dedicated Camhs looked-after children team. Service delivered within existing social care budgets.
Statistics suggest that just under half of all looked-after children have a mental health disorder. For those in residential care, this figure rises to 72%. This compares with 10% of children as a whole. Yet many in this client group face long waits or are denied access to child and adolescent mental health services (Camhs), which in turn can lead to successive placement breakdowns.
The 2008 Care Matters implementation plan highlighted high thresholds, overstretched services and long waiting lists as the main barriers looked-after children faced when accessing Camhs. It said services tended to be reactive and failed to provide interventions for children in short-term or unstable placements.
Improvements in these areas have been patchy.
However, North Lincolnshire (North Lincs) Council, working with Rotherham Doncaster and South Humber (RDASH) Camhs, have developed a model that ensures all children in care are screened for mental health needs and, if need be, receive Camhs services for a range of need levels, without encountering a waiting list.
Paul Cowling, North Lincs service manager for children in care says, although the council always had good links with its local Camhs team, “we realised in 2005 that we needed more structured links to make sure the right kids were prioritised” which included getting fostering and other looked-after children teams on board.
Darren Brierley, consultant clinical psychologist for RDASH foundation trust, says they began by introducing the strengths and difficulties questionnaire, which has since become the national assessment tool for identifying levels of mental health need among looked-after children.
From the data collected they were able to target resources at those with the most complex needs. A team-around-the-child package of care was created, including a Camhs psychologist, family placement officer, social worker and foster carer, with other practitioners co-opted as required. The team meets monthly to ensure the psychological needs of the child are understood and acted upon.
The approach was piloted in 2006 and has now developed and expanded to address lower-level need. This means that all children in care are now screened annually for mental health needs and all foster carers receive mental health training. For those with low need there is group work available. Those with moderate needs receive assessment and consultation with a mental health team for up to six months. Those with moderate to high need or very high need have core group meetings and professionals undertake a great deal of direct work with the child.
Most of the looked-after children service users are at the high end of need; there are currently 32 children with a team-around-the-child support package. “Those children are targeted more effectively, but the approach means those with lower needs are also helped and their access to services is much quicker,” says Cowling.
One of the key aims of the model is to prevent local authority foster placement breakdown. “The team around the child approach makes foster carers feel more supported at times where families would have struggled with challenging behaviour. It gives them confidence when they know they can talk to psychologists about the child’s behaviour,” says Cowling.
He points out their rate of placement breakdown is now consistently low. “We recently carried out a survey with the carers involved in the team around the child package and the satisfaction rating was very high. From our point of view it is much more cost effective if there are stable placements.”
Brierley agrees: “Financially, when you consider a children’s home placement costs about £125,000 a year, and a foster placement is about £25,000, this is a very cost-effective solution.
“It is hard to say a child would have gone into a specialist placement without this approach, but we believe we have been able to keep very vulnerable young people in foster care placements because of this model.”
He adds that 47% of those with the highest need have also moved down the scale to low need within three years of engaging with the programme. This is rare he says. “Typically, complex cases move up the need scale, often ending up in the criminal justice system.”
Brierley also points out that the model has lifted some of the load off frontline social workers who no longer have to refer young people for mental health services. Because the Camhs team leads on the emotional needs assessments it also ensures valuable information is then shared with foster carers and social workers.
“When we do have to work with children placed in external agencies we find that the communication between other local authorities and Camhs tends to be quite poor. My guess is that around the country access for looked after children is still a problem,” adds Brierley.
‘He is hurting and wants me to feel the same way’
Foster carer Jackie Rose* knows there are no instant success stories when it comes to dealing with troubled children and their mental health needs. She looks after Liam*, 10, who has been with her family for six years in total, barring a break when an adoption placement failed after nine months.
Liam has already had three placements break down and has complex needs. He is receiving the team-around-the-child package offered by North Lincs. However, Rose believes that the psychological counselling has brought to the surface difficult emotions about rejection and, as a result, Liam has had relapses of aggressive behaviour, both physical and verbal. “He is angry and hurting and wants me to feel the same way,” she says, admitting she and her husband are at a low ebb.
Despite this she is adamant that the therapy is vitally important for Liam.
“He doesn’t know how to deal with his emotions. If he doesn’t get support now, as an adult his future will be no good.”
She is also positive about the programme, particularly the chance for foster carers to talk to the same child psychologist on a case.
“They know your emotions and parenting style and the child very well which makes such a difference,” she says.
In addition, the council has provided respite care once a month when another carer looks after Liam. Without this support, Rose says the placement could be in danger of breaking down.
“We don’t want the placement to break down. It would not be the right thing. He’s had a rough time. We just keep going and hope the therapy helps him and that he starts making the right choices. He is a lovely young man. He’s clever and good company when he’s not in a bad place.”
Caption for picture (top): For more complex cases, clinical psychologists have time to undertake more direct work with children. Pictured: clinical psychologist Donna Fisher at Rotherham Doncaster and South Humber
*Names have been changed
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