Entering care is an opportunity to evaluate a child’s emotional well-being and improve their mental health

By Louise Bazalgette, development manager for looked-after children at the NSPCC.

Concepts of prevention and early intervention can seem like an awkward fit with the care system. It’s sometimes viewed as the end of the road, when other interventions have failed. But a child’s entry to care can represent a new phase and an important opportunity to re-evaluate their emotional and behavioural development.

The research recently carried out by the Rees centre, commissioned by the NSPCC, about the mental health of looked after children has powerful messages for professionals. Many of these messages reflect conversations with young people, carers and frontline professionals that have taken place in the course of our own work:

#1. We need to tighten up decision-making

The Rees Centre study shows that good decision-making is a crucial factor in avoiding instability caused by children’s repeated entries to care. Placements are more likely to succeed if children are taken into care as soon as necessary, rather than being left to drift on the edge of care.

During our own work, some young people told us they felt the reasoning behind their entry to care was not properly explained to them, leading to feelings of confusion, frustration and distress when they entered care. Some young people drew a clear link between feeling isolated, stressed or unhappy and ‘acting out’.

#2. We need to improve assessment of mental health and make better use of SDQ data

Some young people explained that challenging behaviour is often a way of expressing difficult feelings, while others reminded us that mental health needs of ‘the quiet ones’ may be less noticeable but are just as acute.

The Rees Centre study points out that important information about children and young people’s mental health is already being collected by English local authorities through the Strengths and Difficulties Questionnaire (SDQ) – a statutory requirement for children in care aged between 4 and 16.

However, such tools could be used much more effectively to identify children who may be having difficulties and to monitor children’s wellbeing over time.

#3. We need to invest in the recruitment, training and supervision of carers – and building evidence about what works

Caring can be a challenging task and carers need high quality training and supervision to ensure that they are well supported in their role. The quality of this relationship has a critical impact on children’s emotional wellbeing.

The Rees Centre’s research found that we currently lack proven models for selecting, training and supporting carers but it is possible to draw some messages from research on promising practice:

• Interventions to support carers with children’s behavioural problems are more effective when they are based on a combination of attachment theory and social learning theory. This includes helping caregivers to be sensitive to children’s needs, strengthen their relationship with the child and give praise and boundaries

• Interventions should seek to improve caregivers’ understanding of the causes of children’s behaviour and help the young person to understand their own emotions and identity

• The foster care training programme Fostering Changes had the strongest evidence base of the interventions reviewed

Therefore, while there are no quick fixes for children who enter care with poor mental health, there are practical measures that can be taken to promote positive emotional wellbeing for children.

Above all, it’s essential that we remember that every child in care is an individual. Each child we spoke to defined good emotional wellbeing in a different way, ranging from “feeling calm” and “being yourself”, to “having someone to talk to,” “feeling loved” and “knowing that you belong.”

We must transform the care system to ensure that it can offer every child the strong relationships, support and flexibility they need to realise their own definition of positive emotional wellbeing.