Quality standard
Quality statement 1: Warm, nurturing care
Quality statement 1: 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 measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
a) Evidence of local arrangements for all carers of looked-after children and young people to receive ongoing high-quality mandatory training and support packages that equip them to provide warm, nurturing care.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by health and social care professionals and provider organisations, for example from patient records.
b) Evidence of local arrangements to ensure that all carers of looked-after children and young people receive specialist training and support that helps them to develop positive attachments with children in their care.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by health and social care professionals and provider organisations, for example from patient records.
Outcome
a) Feedback from looked-after children and young people that they feel they receive warm, nurturing care.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by health and social care professionals and provider organisations, for example from patient records and surveys.
b) Looked-after children and young people's self-reported wellbeing and self-esteem.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by health and social care professionals and provider organisations, for example from patient records and surveys.
c) Carer satisfaction with provision of training and support.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by health and social care professionals and provider organisations, for example from carer surveys.
What the quality statement means for different audiences
Service providers (organisations providing care) ensure that systems are in place to provide all carers of looked-after children and young people with ongoing high-quality mandatory and specialist training and support to help them provide warm, nurturing care.
Carers of looked-after children and young people receive ongoing high-quality mandatory and specialist training and support to help them provide warm, nurturing care.
Commissioners (for example local authorities) ensure that they commission services that provide carers of looked-after children and young people with ongoing high-quality mandatory and specialist training and support to help them provide warm, nurturing care.
Looked-after children and young people experience warm, nurturing care.
Source guidance
Looked-after children and young people. NICE guideline NG205 (2021), recommendations 1.2.1 and 1.3.13
Definitions of terms used in this quality statement
Carers
Carers include foster carers (including family and friends carers), residential carers and supported lodging providers. [Adapted from NICE's guideline on looked-after children and young people, and expert opinion]
High-quality mandatory training
Training, delivered virtually or in person, that covers:
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Therapeutic, trauma-informed, parenting (covering attachment-informed, highly supportive and responsive relational care).
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Safeguarding procedures.
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How to communicate effectively and sensitively (for example, using de-escalation techniques).
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Life story work to promote a positive self-identity, which has a consistent, child-focused, and planned approach.
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How to be an educational advocate (this part of the training should be delivered by practitioners from the virtual school).
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Identifying problems with, and supporting, good oral health, diet, and personal hygiene (particularly among those coming into care).
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Encouraging positive relationships and sexual identity (covering issues such as consent, encouraging healthy intimate relationships, 'coming out' and transitioning).
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Self-care for carers, preventing burn-out, and coping with placements ending.
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The importance of health assessments, supporting attendance and issues of consent for medical treatment.
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Record keeping and sharing the information in the record with the looked-after child or young person in a constructive and positive way, considering the need for confidentiality, and the impact the record may have on the looked-after person.
[NICE's guideline on looked-after children and young people, recommendation 1.3.13]
Sense of permanence
A sense of permanence relates to emotional permanence, and ensuring that children have a secure, stable and loving family to support them through childhood and beyond. [Adapted from Department for Education's Children Act 1989 guidance and regulations volume 2: care planning, placement and case review]
Specialist training and support
Comprehensive education and training for potential carers to prepare them for the challenges involved in looking after children and young people with attachment difficulties. [NICE's guideline on children's attachment, recommendation 1.1.9]
Support packages
Support for primary carers, including:
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Involving and valuing the carer's input in decision-making in the broader care team.
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Keeping carers fully informed about a looked-after child or young person's care plan.
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Providing out-of-hours support services for carers to help resolve urgent problems.
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Facilitating peer support for carers at accessible times and places, including online if people may find it difficult to attend a physical meeting.
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Thinking about the need for planned respite care (or 'support care') for carers as part of the care plan.
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Keeping carers fully informed and updated about the support services available to carers and looked-after children and young people in their local authority.
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Informing the looked-after child or young person's carers about any interventions used to support the looked-after child or young person, including the purpose of these interventions.
[NICE's guideline on looked-after children and young people, recommendations 1.3.1, 1.3.2, 1.3.4, 1.3.5, 1.3.8 and 1.3.9]
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.
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.