Looked-after children and young people

Why the committee made the recommendation

The committee noted that children and young people with certain protected characteristics may be over-represented among looked-after children and young people, for example through race or sexuality. They also understood that looked-after children and young people themselves constitute a vulnerable group and therefore certain subgroups of looked-after children and young people may be disadvantaged in multiple ways. Based on their own knowledge and experience, as well as focus group and interview-based evidence, the committee recognised that ensuring these groups are not marginalised, and that their needs are met, may need additional attention and expertise.

How the recommendation might affect practice

This recommendation is not expected to need significant additional resources. It is the statutory duty of local authorities to ensure that children and young people in their care are not disadvantaged or marginalised as a result of their protected characteristics.

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Why the committee made the recommendations

How the recommendations might affect practice

Trauma-informed training may have a limited resource impact because it could be incorporated into existing training for social workers. The committee recognised that existing training has limited capacity for additional material, but they agreed that trauma-informed training was a priority for inclusion. There are freely available resources for trauma-informed training and, although there would be a cost associated with adapting these resources for purpose, these costs are expected to be minimal.

Supervision with regular check-ins to support the social worker is likely to need more personnel time from the social workers and their supervisors. It may also need a culture change that focuses on reflective practice and increasing the amount of direct one-to-one time social workers get with looked-after people. Improving systems to increase professional retention, enable more one-to-one time between social workers and looked-after children and young people, and reduce duplication of effort, could be less costly than purchasing additional social worker time.

Collection and review of data on staff turnover, and development of action plans to address high levels of turnover, are likely to be associated with administrative costs in collating data that is already collected. However, lower levels of staff turnover would allow for better continuity of care and minimise the negative impact of personnel changes on looked-after children and young people, the benefits of which are considered to outweigh the small costs associated with this recommendation.

Providing consultation for complex and specialist problems is likely to need additional personnel time and resources to implement. The committee noted that expertise for this can often be found 'in-house' rather than needing to fund a new role or external training agency, but in some cases an initial investment may be needed to build up expertise within the local authority. Where consultation can be from more advanced social workers or from multiagency professionals in the network, this should not incur significant cost. Consultation provided by specialist agencies and professions may need to be bought in, for example from experts on sexually harmful behaviour.

There are currently limited services specifically aimed at siblings, although there is generally funding already available for shared activities and days out for siblings from local authority leisure budgets. Interventions to promote sibling relationships are potentially costly, but if they could be delivered by trained youth workers rather than graduate-level practitioners, or if existing roles could be adapted to deliver these interventions, this could help contain costs. Similarly, funding to support contact with friends could come from local authority leisure budgets, and there are several activities that are freely available, such as visits to local parks.

Mentoring interventions by peers with experience of the care process would often be carried out on a voluntary basis or through informal peer-to-peer interactions and would not need an increase in resources. Some additional costs may be incurred in providing professional oversight to mentoring programmes, which would need organisation and the processing of, for example, DBS (Disclosure and Barring Service) checks.

Contact supervisors are already a part of the care team, and any additional training needed could be incorporated into existing training, so the recommendation is expected to have a small impact on resource use. Similarly, translation services are already available in NHS settings when needed, so these should not be a substantial extra cost. A child's right of expression is mandated by statutory guidance so expenditures on translation services are justified.

Facilitating online contact, and the additional safeguarding considerations, is not expected to have an impact on current resource use because these contacts are likely to replace other forms of contact that would need similar management.

Resources needed to support the birth family to attend contact centres for children placed outside of their local area are most likely to consist of travel expenses. Although there may be some financial implications as a result of this recommendation, facilitating contact is a statutory duty and so expenditure by local authorities is justified.

Multidimensional treatment foster care is a resource-intensive intervention and will be associated with high implementation and running costs. But when used in adolescents with a history of persistent offending behaviour, these upfront costs are likely to be offset by the lower recurring monthly costs and additional health and social benefits from the intervention compared with usual residential care. A costing analysis comparing these costs of multidimensional treatment foster care with residential care is detailed in evidence review F: interventions to promote physical, mental, and emotional health and wellbeing of looked-after children, young people and care leavers. Additionally, improving the outcomes for adolescents who are offenders will reduce the greater impact on social care and judicial sectors.

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Why the committee made the recommendations

The committee discussed UK-based interview and focus group evidence that carers often feel their input is not valued. They agreed that carers have the most intimate knowledge of the looked-after child or young person, so their perspective and the information they provide are important alongside professional input for decision making by the broader care team.

Studies showed that carers could feel 'left alone' to deal with severe problems on evenings or weekends, and lack of out-of-hours support can make them feel isolated. The committee agreed that out-of-hours support services are important, but recognised that employing an on-call social worker may need substantial changes to contracts and expenses. So, they agreed that various alternatives might be used to fill this gap. For completeness of records and continuation of professional oversight, the committee also agreed that carers should log any help sought outside usual operational hours.

Many UK-based interview and focus group studies looked at the value of peer support, and the committee also heard from experts that peer support could help fill the gaps in support left by overburdened social care systems and social workers. Carers may offer support to each other that is more accessible and available than from practitioners, and such support only needs to be facilitated and moderated to prevent the transfer of misinformation. Creating online spaces for this could be both cheaper and more accessible than hosting in-person groups.

The committee discussed UK-based interview and focus group evidence showing that respite (or support) care was valued. They agreed that it was vitally important to offer carers rest, to prevent burnout and subsequent placement breakdown. They noted that some carers may feel that their caregiving duties prevent them from going on holiday or travelling.

The committee discussed that it is helpful if respite (or support) care is provided by a person the child or young person knows, to prevent the feeling that they are being 'sent away'. This also builds up a network of supportive adults for the child or young person and childcare options for carers. In addition, the respite (or support) care period can be more easily seen as being in the best interests of the looked-after child or young person if it is an enjoyable break for them – for example, through short breaks to stay with relatives.

Based on their own knowledge and experience, and some UK-based interview and focus group data, the committee discussed that planned and proactive offers of respite (or support) care are more effective than respite (or support) care offered reactively in response to crisis, when it may already be too late to prevent placement breakdown. They also discussed the importance of the person who is providing respite (or support) care having the skills needed to support the individual needs of the looked-after child or young person.

The committee looked at UK-based interview and focus group evidence on resource constraints, stretched services, information gaps between carers and practitioners and reactive care (responding to problems as they arise, rather than anticipating). They found that carers were often unaware of the services available for support from their local authority and partner agencies, and therefore felt as though certain services had been kept hidden to save costs. The committee agreed that carers need to be fully informed about the support available before the placement starts. This enables carers to negotiate the support they need, and empowers them to act on a more equal footing with practitioners.

The committee saw UK-based interview and focus group evidence showing that carers (particularly shorter-term foster carers) are often unaware of ongoing interventions for a child placed with them, such as life story or relationship work. They agreed that informing carers about the contents and aims of interventions to support placement stability was in the best interests of the child, and would improve continuity of care with marginal costs.

The committee recognised that there was an additional set of recommendations for carers in the NICE guideline on supporting adult carers, and that these recommendations may be relevant for some carers of older looked-after children and young people.

How the recommendations might affect practice

Using alternatives to on-call social workers will mitigate the cost of increasing out-of-hours support. A range of possible ways in which out-of-hours support could be offered was included in the recommendation to allow local authorities to use a system that works best for them, both logistically and financially. Some of the options listed would be more affordable, such as the use of volunteer-operated helplines or peer support or advocacy groups. Local foster carer associations may have people working on-call, or provide round the clock access to a peer support network. The use of generic emergency duty teams may also reduce funding pressures.

However, the committee recognised that the availability of alternative options may vary between local authorities. To provide out-of-hours services with social workers 'on call' would need a contract change for social workers, but they agreed this could be done by reallocating existing social worker time from day work to out-of-hours work. This contract change and reallocation would have cost implications, but the committee agreed that having social worker availability for out-of-hours emergencies and urgent problems could allow for problems to be addressed more quickly. This would help to avoid more significant costs and adverse consequences (for example, placement breakdown, self-harm, hospital visits and police being called).

Facilitating accessible peer support for carers is unlikely to have a substantial impact on resources, because most would be peer led and would not need much additional personnel time or physical resources from the local authority. Message boards may need to be moderated to prevent misinformation, but this could save time and resources by helping to resolve issues that would otherwise need the attention of care staff.

Respite (or support) care for carers to prevent placement breakdown is already broadly available in the care system. Costs vary depending on individual needs and local funding streams. The committee recommended the approach to respite (or support) care that should be taken if respite (or support) care is needed, rather than necessarily recommending additional respite (or support) care beyond what is already provided.

Return to recommendations

Why the committee made the recommendations

Based on their experience and knowledge, the committee recognised that, in practice, training – such as behaviour management training – is often delivered reactively, in response to difficulties that a carer is currently experiencing. This threatens placement stability because the carer may feel underprepared and under-supported to continue the placement. The committee advocated a greater emphasis on forward planning support for carers (before placement) based on the recognised and documented needs of the individual child, and involving other agencies as needed.

The committee discussed evidence, from robustly designed studies, on the effectiveness of parent-training interventions (some of which also included child-training components). This evidence covered a wide range of training programmes. The committee agreed that the evidence broadly supported the benefit of parent-training interventions in tackling child behaviour problems, and in improving the child–carer relationship.

However, they noted that the components of these training interventions may differ. Common components in the interventions studied included teaching and information giving focused on different aspects of parenting theory such as sensitive caregiving, attachment, social interaction learning theory, being trauma informed and broader behavioural management techniques. To support teaching, some interventions used video-feedback techniques, and others used homework or home assignments, role play, coaching, practical activities and follow-up booster sessions.

The committee noted that training can be expensive, and it is likely that different carers would need a different intensity of training. To reduce costs, a mandatory schedule of training could be delivered as a tutorial (perhaps virtually) to all carers. The committee were aware that mandatory training, for example for foster carers, may already be extensive. However, rather than recommending additional capacity to deliver more training, the committee sought to recommend which topics were most important to include in existing training schedules for carers. In addition to these, more intensive methods could be used with carers of looked-after children and young people who have more severe emotional and behavioural problems.

Based on their experience and knowledge, they agreed that how to provide consistent, child-focused and planned life story work to promote positive self-identity, would be an important addition to the mandatory schedule of training for all foster carers.

The committee were not aware of any widely available training for carers on how to be an educational advocate. In their experience, some carers are good at it naturally, but this is not consistent. For example, some may feel a responsibility for providing a home for their child but not see educational advocacy as part of their 'role'. The committee agreed such training is necessary as part of the mandatory training for carers. The importance of involving the primary carer was backed up by UK-based interview and focus group evidence suggesting that looked-after children and young people preferred carer-delivered educational support (as opposed to interventions delivered by other adults or professionals), because of fears of yet more transient practitioners developing a relationship with them and then leaving.

The committee discussed subgroups of carers who may need more individualised training. Using their own experience and knowledge, they considered birth parents in situations in which reunification is a possibility or when the child or young person remains in placement with the birth parent. They recognised that joining mandatory training schedules may not be ideal for birth parents who may have significant personal challenges to overcome and need additional support.

The committee used UK-based interview and focus group studies and their own experience and knowledge to consider other subgroups of carers who may need specialised training. They looked at evidence highlighting the challenges for carers of adapting to a looked-after child or young person's cultural, religious or dietary needs. For example, the committee recognised that certain ethnic groups may have hair and skin care needs that a carer would be expected to support. Likewise, carers of looked-after children and young people with special educational needs, long-term health conditions and disabilities may need specific training.

UK-based interview and focus group evidence and expert testimony both suggested the importance of a knowledge of trauma in those caring for the looked-after population. Based on their experience and knowledge, the committee agreed what trauma-informed training should cover. They recognised that there are multiple levels to this training, from simple awareness of trauma-related issues (for all carers and practitioners working with looked-after children and young people) to training in trauma-responsive care, which may be needed for more specialised carers and practitioners. For effective delivery of training programmes, the committee agreed it was important for trainers themselves to have a good understanding of trauma and attachment disorders as well as the various effective therapeutic approaches.

The committee also discussed evidence on a parent-training intervention for looked-after young people with behaviour that challenges or more severe mental health problems who are moving out of restrictive care and into the community. This showed that it could help maintain their school placement and prevent a return to that care. The committee agreed that, in temporary placements for which training and development needs had been identified and delivered for current carers, new carers in the follow-on or permanent placements would need the same training to provide consistent care. This would help continuity of behaviour management approaches and trauma- and attachment-informed, high-support and high-nurturing relational care. The committee noted that this was particularly true for connected carers, who enter the fostering system quicker than mainstream carers. Often a child or young person is placed with them while assessments are ongoing and there is little time for preparation and training.

How the recommendations might affect practice

Family support services already offer behavioural management support to birth families, but available training for foster carers and, particularly, other kinds of carers, is more variable.

Training in educational advocacy for carers would be delivered by the virtual school. This could be delivered at low cost, virtually or in person.

Tailored support and training for birth parents if reunification is a possibility should already be available through transition plans with family support teams, and should not incur additional cost.

Cultural or religious needs, or needs related to race or ethnicity may need more tailored training for carers who have no expertise in these areas. Although this may come at some additional cost to time or resources, these looked-after children and young people form a minority of the overall looked-after population. In addition, it is a statutory duty to ensure that looked-after children and young people do not receive poorer care on the basis of race or religion.

Tailored support and training for carers if there are special educational needs and disabilities can be provided through specialist healthcare teams and voluntary organisations (for example, the National Autistic Society and the Independent Provider of Special Education Advice), thereby helping to keep costs down. Trauma-informed training and therapeutic parenting training for all foster carers is part of current practice in some local authorities. The recommendations will reduce variation in practice across the country. Intensive, specialist training given in the home is likely to incur substantial costs in some areas that do not already provide it, but these could be partially offset by preventing placement breakdown. Placement breakdown is associated with significant short-term costs because of increased social care case management work and the need for additional placement arrangements, some of which will be high-cost emergency placements. In addition, placement instability can have long-term consequences, contributing to further disruption of looked-after children and young people's social and emotional relationships, sense of belonging and educational outcomes.

Mandatory training schedules already exist for carers (particularly foster carers) and it is anticipated that trauma-informed training, and other recommended training components, could be incorporated into these sessions without the need for extra training capacity in many cases. For example, the committee noted that there is often already mandatory training on de-escalation that could feasibly be altered or updated to include trauma-informed practice. There are freely available resources for trauma-informed training and other kinds of training. Although there would be a cost associated with adapting these resources for purpose, these costs are expected to be minimal.

Return to recommendations

Why the committee made the recommendations

The committee heard from experts about looked-after children who are at risk of criminal exploitation or going missing or are placed out of area. The experts highlighted the importance of multiagency working and appropriate data sharing for safeguarding looked-after children. They gave examples showing how important moments had been missed for sharing information between agencies (for example, policing and social services), and how these missed moments had led to extremely negative outcomes for the looked-after child or young person involved. Although the committee noted that statutory safeguarding procedures exist, they agreed that once a child or young person had become 'looked after', any further safeguarding issues were often dealt with 'in-house' in the care system. Whichever safeguarding system was used, the committee considered the need for it to be as thorough as statutory systems of safeguarding while also addressing additional contextual safeguarding risks. These risks are more commonly an issue among those in care.

The committee discussed ways in which local authorities could facilitate multiagency working and data sharing. They suggested that meetings were needed to bring together practitioners and facilitate information exchange. Based on expert testimony and their own experience, the committee agreed that representatives from education, care, healthcare for looked-after children, and external services could provide vital perspectives on safeguarding looked-after children and young people. Experts told the committee that it was very important to include the views of looked-after children (particularly those with special educational needs or disabilities) and their carers when shaping responses to exploitation and missing children. This supports shared decision making and makes responses effective, accessible and acceptable to looked-after children and young people and their carers.

Based on expert testimony, the committee considered that leadership was needed to organise successful multiagency review meetings, bring practitioners on board and help define clear lines of accountability. The committee considered that leadership in multiagency working would be best provided by a specialist in contextual safeguarding, exploitation and missing children in the looked-after population. If such a practitioner was not readily available, the committee considered that local authorities could build capacity by investing in training a trauma-informed specialist with knowledge of exploitation and safeguarding issues in the looked-after population.

Based on expert testimony, the committee discussed the kinds of data that are most readily available and useful across agencies to inform the safeguarding of looked-after children and young people, and assess the risk of exploitation in any given placement. The committee considered routinely collected indicators at the community level: area deprivation indexes, community-level health and mental health data, number of county lines operating in a single area and missing person reports per 1,000 population (which were considered particularly linked to risk of trafficking).

The committee, in light of their experience and expert testimony, noted that risks and 'red flags' may be different for certain subgroups, such as young girls and boys and unaccompanied asylum-seeking children, as well as the approaches needed to protect from exploitation or going missing. For example, young girls in particular may be at risk of sexual assault, domestic abuse, and attempts through social media and otherwise to coerce and undermine self-esteem.

The committee heard from experts about the need for practitioners and carers working with looked-after children and young people to be able to spot and communicate safeguarding risks. Based on this, the committee discussed the training needs of practitioners working with looked-after children and young people. The committee acknowledged that training is not inexpensive. However, training on the signs of exploitation or abuse, and 'red flags' for going missing, and how to 'flag' or report concerns about these could be included in the regular training schedule for all practitioners working with looked-after children and young people.

The committee discussed how else multiagency working and review meetings could help to re-enforce and educate about 'reachable or critical moments'. That is, moments when looked-after children and young people at risk of criminal exploitation and grooming could be spotted and interventions employed at the earliest possible moment, particularly when looked-after children and young people could be more open to change and receiving support. Experts told the committee that any intervention could constitute a critical moment, for example attending an A&E department.

Likewise, evidence based on UK-based interview and focus group studies and expert testimony about gangs, criminal exploitation and going missing from care strongly suggested that establishing a network of strong, supportive, positive relationships is the primary mechanism to protect looked-after people from these risks.

Experts also suggested to the committee that certain subgroups of looked-after young people may need more tailored care to address issues that increase their risk. These groups include young girls, who may have issues of low self-esteem, and be at risk of targeting on social media; children with a history of trafficking; and unaccompanied asylum-seeking children who have been subject to previous trauma or exploitation. The committee were aware that tailored support for these groups is already offered through well-established organisations such as Abianda.

Based on their experience and knowledge, and on hearing from experts, the committee discussed that safeguarding meetings offer an opportunity to educate and inform health and social care practitioners (for example, by bringing the perspective of emergency services to social workers). The committee were keen that learning opportunities were not lost and that a review of case files could help to spot mistakes or areas in which best practice could improve.

How the recommendations might affect practice

Tailored support for groups at particular risk from exploitation groups is an important and necessary safeguarding consideration for vulnerable groups. Existing organisations that already focus on these groups can help to supply such support, so this recommendation is unlikely to have a substantial additional resource impact. As well as improving outcomes for these groups, this tailored support may help to avoid future costs associated with negative outcomes, for example legal costs and costs associated with placement breakdown if relationships have deteriorated.

Necessary data are captured in most areas, but the information often needs to be better shared. This is unlikely to need increased resources because the data sharing mechanisms and roles for multidisciplinary teams already exist, and the emphasis of the recommendations is on bringing this work together. Using standardised language for things such as risk assessment tools, processes and personnel titles across agencies and geographical areas is not expected to be resource intensive. It can be achieved over time by greater communication between agencies and local authorities.

Training in risk indicators is unlikely to have a substantial resource impact because it would probably be absorbed into and prioritised in existing staff training. Likewise, training to recognise suitable moments to reach out to the child could be incorporated into existing training for foster carers and social workers.

Return to recommendations

Why the committee made the recommendations

The committee considered UK-based evidence from interview and focus group studies and heard from experts about the high prevalence of trauma in looked-after children and young people. Based on this and their own experience and knowledge, the committee agreed that all practitioners working with looked-after children and young people need greater awareness of the impact of trauma, including developmental trauma and attachment difficulties. Such awareness is vital for spotting safeguarding situations. It can also help practitioners working with looked-after children and young people to better understand them and communicate more effectively with them.

UK-based evidence from interview and focus group studies and expert testimony highlighted specific issues faced by unaccompanied asylum-seeking children. The committee agreed that those who were working with unaccompanied asylum-seeking children needed to have additional awareness of the specific risks facing this group and issues that may arise when providing care.

The committee noted that when social workers or other care professionals are trauma informed, they can make sense and meaning of how the child or young person is forming and maintaining relationships, in the context of their experiences. As the lead practitioner, they can influence how the network views the child or young person, what language is used and how it will be most helpful to support them in more helpful positive relationships. This is the ripple effect of different levels of trauma training for the network.

How the recommendations might affect practice

Additional training on the specific needs of unaccompanied asylum-seeking children, including invited feedback from children that were once cared for in these circumstances, and specialist organisations in the voluntary sector, could be provided as part of existing in-house training. Funding should already be available through general funds that support routine training and activities (for example, team awareness days) for healthcare professionals.

Consultation may be provided from more experienced social workers or from multiagency professionals in the network, so it should not incur cost. However, the committee were aware that such consultation work would mean less time for case work, and therefore would incur some time costs. Consultation provided by specialist agencies and professions may need to be bought in, for example experts on sexually harmful behaviour.

Return to recommendations

Why the committee made the recommendations

There is a statutory requirement for the responsible authority to notify in writing the child or young person's healthcare team (for example, the specialist looked-after children's health team), clinical commissioning group and registered medical practitioner about arrangements for the child or young person's placement. But based on their own experience and knowledge, the committee noted that this was often not sufficiently carried out in practice. That is, the notification is often delayed, or does not give both the looked-after child or young person's legal status and the reason why they have been entered into care.

The committee considered the importance of keeping good health records for looked-after children and young people. This should be a summary for ease of reading, with references to sections that give more detail. Based on some interview and focus group-based evidence and the committee's own experience and knowledge, the committee considered that it was important to obtain a full health record from the birth parents, particularly information about antenatal and postnatal health. They noted that gaining consent for this may be a difficult or lengthy process. So the committee discussed the importance of attempting to gain this consent as soon as possible in the care process, to prevent missing important health information that could be important for directing the plan of care. If social workers supplied relevant information and consent to health teams before the initial health assessment, this could support health teams to make a good health plan. The committee also considered that the request for the initial health assessment should be detailed enough to provide the social care context for the child or young person coming into care.

UK-based interview and focus group studies frequently emphasised that looked-after children and young people and their carers appreciate continuity of care practitioners. The committee discussed the importance of having a continuous healthcare professional who is familiar with the looked-after child or young person, and their medical and social history, to perform routine health assessments. They agreed this is important both to promote a trusting relationship between the child or young person and the medical practitioner and to improve adherence with health plans, and to help the practitioner to spot changes in the health needs of the child or young person to support better care.

Based on their own experience and knowledge, the committee considered the needs of children and young people trying to access confidential healthcare. For example, use of the phone or internet may be restricted, particularly in residential care. The committee recognised that these measures may be in place to support safeguarding, but an unintended consequence could be difficulty or embarrassment when trying to access sexual health advice or treatment.

The committee highlighted that the initial health assessment is an important event for looked-after children and young people because it allows their existing needs to be identified and forms the base of an individualised care plan. The committee were therefore concerned that the initial health assessment should include an accurate and comprehensive review of the person's health history.

Evidence from UK-based interview and focus group studies suggested the need for carers to receive more complete and better-quality information about the child or young person at the start of care, which could include a compilation and summary of health records. The committee noted that work to compile records is done inconsistently across local authorities. The committee considered that compiling good records had the potential to transform the care of looked-after children and young people by facilitating the flow of information between agencies and preventing identified needs and actions in the health plan from becoming lost.

Using some interview and focus group-based studies and their own expertise and knowledge, the committee considered the fact that care leavers very often request access to their health and social care records. Care leavers may do this to help make sense of their own journey through the care system. However, if the language used in the records is depersonalising or judgemental, this can result in significant emotional hurt and offence. The committee therefore agreed that health and social care practitioners should be aware of this risk.

Evidence from UK-based interview and focus group research and from expert testimony strongly supported the need for a culturally appropriate, registered interpreter to communicate in person with looked-after children and young people for the initial health assessment. And, if language remains a barrier to communication, for the same service at subsequent health and social care assessments. However, the committee noted this was particularly important for the first health assessment, which must be thorough and capture all aspects of health needs accurately to provide appropriate support. The committee considered in-person translations to be particularly important because of the difficulty receiving interpretation services over the phone. Unaccompanied asylum-seeking children were especially in need of these services.

Experts highlighted many specific health needs of unaccompanied asylum-seeking children compared with the broader population of looked-after children and young people in the UK. Unaccompanied asylum-seeking children were also frequently found to have problems with their sleep schedule as a result of travelling long distances, often with continuously disturbed sleep. So the committee agreed that tailored initial health assessments should address the additional risks to unaccompanied asylum-seeking children as a result of their country of origin and journey to the UK.

The committee considered mental health screening for children who were entering care. Some evidence (which had a higher risk of bias due to the study design) showed that using an in-depth assessment identified more children needing support and helped with providing early interventions than with the current initial health assessment. The committee agreed that current initial health assessments were often insufficiently detailed to pick up mental health needs and it was important for healthcare professionals to consider the need for a specialist mental and emotional health assessment after the initial health assessment. This is particularly important for babies and children because their mental health needs are often missed. Based on committee experience and knowledge, the committee noted that this second assessment is better carried out once the looked-after child or young person has begun to form a relationship with the primary carer because mental health may improve as a result of a secure attachment relationship.

The committee reflected on less robust evidence (not from randomised controlled trials) showing that auditing systems before and after health assessments improved the uptake of health actions. The committee also considered the problem of actions in the health plan not being followed up or completed (either within a reasonable timeframe or at all). Based on this evidence and their own experience, they agreed it was important that the completion of actions in the health plan be reviewed to ensure the agreed service has been provided. This would need multidisciplinary input because some actions may be undertaken by other agencies.

The committee recognised the higher prevalence of attention deficit hyperactivity disorder, autism and post-traumatic stress disorder among looked-after children and young people. They were aware of existing NICE guidelines on the identification and diagnosis of these conditions and their subsequent management, and agreed to cross-refer to these.

How the recommendations might affect practice

The initial health assessment is a statutory requirement so there should not be any additional costs to the system, although auditing the health plan may need additional time from the team of health professionals involved. A detailed and well-documented plan can help with timely provision of care, thereby avoiding costs of delay and an overall negative experience for the looked-after child or young person.

Healthcare professionals performing the initial health assessment for unaccompanied asylum-seeking children may need additional training on the specific physical and emotional needs of these children, and on risk factors associated with specific countries of origin or route of travel, and the context of the child's journey. This training, including feedback from children that were once cared for in these circumstances and testimonies from specialist organisations in the voluntary sector, could be provided as part of existing in-house training. Funding should already be available through general funds that support routine training and activities (for example, team awareness days) for healthcare professionals.

Specialised interpretation services incur costs, but a child's right of expression is mandated by statutory guidance so expenditures on such services are justified.

Return to recommendations

Why the committee made the recommendations

UK-based evidence from interview and focus group studies frequently highlighted the frustration felt by looked-after children, young people and their carers about delays and waiting lists for mental health support. The committee considered the common problem of delayed support for child and adolescent mental health services (CAMHS), and systems that they had seen in practice to help avoid the delay of therapeutic support for looked-after children and young people. For example, therapeutic social workers, systems for outreach connected to CAMHS (for example, a psychologist or another worker embedded within CAMHS), or a specialist looked-after children and young people team within CAMHS.

However, other evidence, also from interview and focus group studies, highlighted the harm that can be done by introducing a child or young person to a new therapist, only for the therapist to change once CAMHS have taken over care. This can lead to demoralisation and disengagement from mental health interventions. Therefore, the committee agreed that intermediate therapeutic or specialist support should be provided for the care network around looked-after children and young people, rather than to looked-after people themselves. The committee were keen to stress that this intermediate support was only to address the delay, and should not be a replacement for CAMHS itself.

Further interview-based and focus group-based evidence and expert testimony reflected how CAMHS are often inappropriate and not designed for the needs of looked-after children and young people. Traditional techniques such as behavioural-therapy-based interventions are not always suitable for looked-after children and young people, who may need interventions that are more relationship based and trauma informed.

One committee member stated that some CAMHS teams have specialist looked-after children's services, but this is variable across the UK. The committee agreed it was important to encourage prioritised specialist services to be incorporated into CAMHS, to prevent the need for tier 3 or 4 services further down the line.

Based on their own experience, the committee were aware that children and young people could lose their place in the waiting list for CAMHS as a result of moving placements to a new location. This may be more likely to happen to children and young people who most need the attention of CAMHS to help maintain placement stability. Committee members were aware that continuity of CAMHS waiting lists could be maintained by virtual schools co-opting CAMHS or other dedicated services for looked-after children and young people in CAMHS.

Expert testimony highlighted the likelihood that all unaccompanied asylum-seeking children had experienced some form of trauma, as a minimum through the separation from their own parents, and that health and social care practitioners supplying care for this vulnerable population need specialist training. The committee agreed the importance of taking into account the different perspectives of unaccompanied asylum-seeking children in a mental health service setting.

UK-based evidence from interview and focus group studies and expert testimony also reflected the importance of cultural sensitivity and awareness of potential traumatic symptoms in unaccompanied asylum-seeking children. For example, they may have highly stigmatising views of mental health problems, based on previous cultural ideas, and may be reluctant to admit the experience of trauma or problems with mental health.

The committee noted that unaccompanied asylum-seeking children were likely to need a tailored approach to mental health support, but there was insufficient evidence to recommend any specific intervention. Therefore, they made a recommendation for research on supporting mental health of unaccompanied asylum-seeking children.

How the recommendations might affect practice

Providing dedicated CAMHS services for looked-after children and young people may have substantial resource implications if an expansion of the existing CAMHS services and capacity is needed. However, these dedicated services for looked-after children and young people are mandated by statutory guidance and the recommendations are only reinforcing the statutory provision of these services. Alternative interventions (trauma-informed and those focusing more on relationships) may not necessarily come at greater cost than traditional behavioural approaches. However, tailored approaches would have greater adherence (for example, fewer non-attendances and less disengagement), thereby resulting in greater effectiveness. The committee considered that greater engagement in mental health services at an earlier stage can reduce the risk of more serious mental health problems, avoid the substantial long-term costs and consequences incurred when these issues go unidentified, and reduce the need for the higher tier treatments later down the line (where the greatest pressure on CAMHS services was suggested to be).

Intermediate therapeutic or specialist support for the care network around looked-after children and young people, to reduce waiting times, may need some restructuring of services and additional cost. However, in some parts of the country, existing services could fill this gap – for example, therapeutic social workers, CAMHS outreach systems (for example, a psychologist or another worker embedded within CAMHS), or a specialist looked-after children and young people team within CAMHS.

Return to recommendations

Why the committee made the recommendations

UK-based evidence based on interview and focus group studies showed that forming positive relationships was probably the best possible intervention to prevent placement instability. Life story work has the potential for building relationships (for example, by sharing joint activities). In addition, it is a trauma-focused technique that could help with discussing and negotiating care plans (by outlining felt priorities and experiences). However, evidence showed that life story work was often neglected or poorly completed in practice, was often started late in the care process, and was given little priority or investment. This supported the committee's own experience and knowledge. The committee discussed the importance of standardising life story work and starting it at the earliest opportunity after entry into care. They agreed this could support placement and emotional stability by helping the looked-after child or young person make sense of their journey through care.

Based on UK-based interview and focus group evidence and committee experience, the committee discussed the importance of time for life story work being clearly set aside, with a named practitioner to ensure there is time for it to be completed to a sufficient standard. The relational aspect of this intervention could also be supported by having it conducted by a carer or practitioner that the looked-after child or young person has a close and continuous relationship with. The committee agreed it was important for this work to take place in the context of a safe and continuous relationship, because conversations would be of a personal nature.

The committee discussed the key components of life story work, based on their experience and knowledge. They agreed that this work consists of building a narrative that focuses first on the present identity and strengths before moving onto the past and reasons for entering care, and finally turning thoughts to planning for and building hope towards the future.

Based on committee experience and knowledge, and some interview and focus group evidence, the committee then considered how this may be achieved. Techniques such as life mapping, use of pictures, art, written narratives, toys and play have been used successfully. The committee agreed that these discussions should be compiled in 1 place and built on during regular sessions. They thought that the approach should be flexible according to the needs and response of the looked-after child or young person and should be a shared experience, in a setting preferred by the looked-after child or young person. However, they recognised that compiling life story work in 1 physical place could come with the danger of sensitive information being read by others (for example, peers in residential care).

The committee took into account their own experience and knowledge in considering the role that life story work could play in cultivating a positive self-image and identity – that is, one that embraces the looked-after child or young person's ethnic, cultural or religious differences, as well as sexual identity and disabilities.

The committee stated that the effectiveness of the life story work was closely related to its quality, and agreed that having social worker oversight could help to maintain standards. It would also allow the social worker to provide additional information to support the carer or practitioner carrying out the life story work.

Based on their own experience, the committee considered life story work that involves more people than the practitioner and the looked-after child or young person. For example, sometimes it may be useful to carry out life story work with siblings as a group or pair, because they may have had very different perspectives of shared life events that need to be reconciled. The committee agreed that the need for shared life story work should be carefully planned to ensure it did not destabilise sibling relationships, for example by divulging sensitive information. In addition, particularly for complex situations such as these, it was important for the experience and skillset of the practitioner carrying out the life story work to match the complexity of the care situation. This may need the direct attention of a social worker rather than the primary carer.

Based on their own experience and knowledge, the committee agreed that the network around looked-after children and young people was important to support ongoing life story work. The committee considered it vital that the idea and purpose of life story work and its importance was expressed to the social work team, carers, educational staff, and birth family. Broader social networks can then be engaged in the work when needed. Birth families may need to encourage consistency in narratives explored and reframing previous relationships.

How the recommendations might affect practice

Life story work is mandated by statutory guidance for all looked-after children and young people with a plan for adoption. It is already current practice and these recommendations can be easily integrated into the process. Although the recommendations may necessitate a higher standard of life story work (for example, with more detail and more time devoted to it) in some cases, the committee agreed that these changes were necessary for the work to be effective and achieve its aims. Training to ensure a consistent approach to life story work could be incorporated into existing training. Social worker oversight for life story work conducted by another practitioner is anticipated to have minimal resource implications because the work is either already being conducted by the social worker or would simply need the social worker to be informed of the content of that work.

Return to recommendations

Why the committee made the recommendations

UK-based interview and focus group-based evidence frequently emphasised that positive relationships were the most important aspect of care to looked-after children and young people and care leavers, and that, along with placement stability, they are most linked to social, emotional and mental wellbeing. They discussed that the cornerstone of positive relationships was the relationship with the primary carer. So they agreed that, before recommending specific interventions to support social, emotional and mental wellbeing, the focus of support needs to start with a stable care placement and a strong supportive relationship with the primary carer.

Interview-based and focus group-based evidence showed that some primary carers, for example in residential care or foster care, had concerns about giving physical touch and affection to looked-after children and young people. The committee discussed that physical affection, particularly for younger looked-after children, could be a major source of emotional stability and wellbeing, and yet it may be denied in some cases because of the primary carers' desire to be protected from any form of allegation. They agreed that, in some cases, it may be necessary to proactively promote or encourage appropriate physical affection (for example, through play) and that the need for physical touch and affection as a part of a healthy relationship with the primary carer should be taken into account in safer caring plans.

A variety of evidence reflected the importance of shared activities to help bond relationships with peers, practitioners or carers. The committee considered that peer support could be particularly important among looked-after children and young people because, given the absence of strong family ties, they may place more emotional investment in friendships and other non-conventional relationships (for example, with care practitioners). They agreed that it was important to support the interests and hobbies of looked-after children and young people by setting aside time for outings that would help them invest in these interests, as well as in their close relationships.

The committee considered that looked-after children and young people are more likely to be overweight and obese than standard norms and many come into care with a poor nutritional status. They recognised a gap in good quality research for interventions to help improve diet and exercise, as well as other lifestyle factors such as drug and alcohol use, among looked-after children and young people, and made a recommendation for research on promoting physical exercise, and a healthy diet and lifestyle. In the absence of good quality research to support interventions to improve diet and exercise among looked-after children and young people, the committee cross-referred to existing NICE guidance on physical activity, obesity prevention and weight management in children and young people.

How the recommendations might affect practice

Facilitating and supporting activities such as school clubs would be unlikely to have a significant resource impact. Funding for group activities may have more substantial resource implications, so these would need to be limited to freely available or inexpensive activities. Some group activities, particularly school clubs, could be prioritised for funding through the pupil premium grant.

Return to recommendations

Why the committee made the recommendations

The committee considered US-based evidence on therapeutic playgroups for children in kindergarten entering second grade aged 7 to 8. These resulted in improved parent-rated social competence and emotional stability. But this evidence was from a small trial with no long-term follow up. Because of this, and the expense of running therapeutic playgroups, the committee did not recommend them specifically. But they agreed that early years education should include opportunities to improve socialisation, such as early years education in playgroups, as well as other opportunities to encourage child-led play.

The committee considered evidence from robustly designed studies on transition-to-school programmes for looked-after children of primary school age. These programmes resulted in improved early literacy skills, self-regulatory skills, self-competence, and attitudes towards alcohol and antisocial behaviour, as well as days free from internalising symptoms. They also reduced aggressive behaviours. A similar programme for secondary-school-aged children resulted in improved emotional, social and behavioural scores, and reduced substance use.

The committee considered the broadly positive findings for readiness for school interventions, alongside the problems with study quality and assessment of effectiveness. But they highlighted that, particularly for a child returning to school after prolonged absence, the need of a child to cope with the possibility of peers and parents of other children finding out about their 'looked-after' situation could be traumatic, and that this is particularly a risk if the child is receiving special interventions for education. Other evidence from UK-based interview and focus group studies suggested that looked-after children and young people did not necessarily want more professionals or programmes in their lives.

The committee therefore agreed there was a broad benefit of tailored transition support into new school placements. However, they favoured approaches that would help ease the looked-after child or young person into the new school placement but not single them out. The committee also agreed that transition to a new school placement may need input from professionals beyond those in education.

How the recommendations might affect practice

The resource impact of these recommendations is expected to be low. Early years support should already be provided as a statutory service, so little additional resource expenditure should be needed, other than greater prioritisation of playgroups from existing funds. Transition support and services are also currently supported by the virtual school. Additional interventions to support the transition can be prioritised through the pupil premium grant, which is part of statutory education funding provision for looked-after children and young people.

Return to recommendations

Why the committee made the recommendations

The committee heard from experts that educational resources were available to support looked-after children and young people, but they may not be being spent in the most effective way. The committee agreed that ensuring that looked-after people and their carers know about their rights to educational support (for example, the purpose of the pupil premium grant for education, and how it is distributed), and including special educational provision under the special educational needs and disabilities (SEND) legal framework, would encourage accountability in spending.

The committee discussed the importance of trauma-informed practices for all practitioners working with looked-after people. Based on expert testimony, and on interview and focus group-based evidence describing the needs of looked-after people with trauma, the committee considered that standard behavioural policies in schools may not be adequate or may even be harmful for young people with a history of trauma and disorganised attachment. They agreed that it was important for schools and regulators to understand the impact of behaviour management policies on trauma.

UK-based interview and focus group evidence showed that looked-after children and young people experienced a shortage of adults who have higher expectations and aspirations for their education, as well as positive role models and tailored (individualised) support for education. Based on expert testimony and their own experience, the committee discussed the need for a strong educational advocate for looked-after children and young people. This would be someone who is invested in and supportive of the person's education and is willing and informed enough to fight for the educational provisions that a looked-after child or young person should receive by statutory right (and beyond). The committee agreed that this role is most readily fulfilled by the designated teacher. As well as having a committed educational advocate on the school site, the committee agreed that educational advocacy needs should also come from the primary carer. However, the committee agreed that, in many cases, the foster carer's role in their child's education had not been sufficiently encouraged.

The committee agreed that the role of the designated teacher is carried out with variable quality across the UK. Therefore, the committee felt it important to outline the key principles of practice that this role should include to improve the advocacy relationship with the looked-after child or young person in school settings. They discussed the need for the designated teacher to collaborate with those who have the best information to support and direct the looked-after child or young person's educational path. The committee used their own experience and knowledge to identify personnel as useful partners for this.

The committee used interview and focus group-based evidence and their own experience and knowledge to clarify the role further. They discussed evidence in which carers had identified and organised the diagnosis of educational issues themselves (such as dyslexia). They considered that it would be better for the on-site educational advocate (the designated teacher) to identify and organise such assessments, and in a more timely manner. Therefore, the committee agreed that the designated teacher should ensure ongoing monitoring of learning needs, particularly during placement transition (which can be a time of greater educational and emotional challenges).

The committee also considered that multiagency review meetings, including those from the virtual school and the designated teacher, may need input from professionals beyond those in education. Therefore, they agreed that a designated teacher needs to be sufficiently competent to refer for specialist support if necessary.

The committee emphasised that 1 of the most important roles of the designated teacher (acting as educational advocate) was to 'check in' with the looked-after child or young person regularly, whether or not they have any special educational needs. Check-ins can help to develop a rapport with the looked-after child or young person and build a supportive relationship. Because interview and focus group-based evidence highlighted the importance of maintaining confidentiality about care status whenever possible, especially in school, the committee were keen that these check-ins should not add more stigmatising and formal meetings to the looked-after child or young person's schedule. Rather, the designated teacher could have regular one-to-one informal conversations with them. The committee agreed that the frequency of these conversations should be informed by the looked-after child or young person themselves, because some may favour less intense supervision.

How the recommendations might affect practice

Advocacy by a named teacher is not anticipated to need significant additional resources because this is already part of the statutory role of the designated teacher. The committee recognised that there are time-resource implications in performing this role to a high standard.

Return to recommendations

Why the committee made the recommendations

The committee noted that no consistent model of a virtual school was apparent across the country but that some common features could be identified. As part of this, there was a discussion about the constituent members within a virtual school and the external services that should be linked through the virtual school.

The committee discussed including early years practitioners within the virtual school. Based on expert testimony and their own experience, they noted that early years expertise was not statutory in virtual schools. Smaller numbers of looked-after children in the early years group meant they were often allocated relatively small budgets. The same was true at the other end of the educational age range: early years and over‑16 groups are not well provisioned, with most money devoted to school-aged children and young people.

The committee considered there was a need for early years expertise alongside the virtual school head to provide oversight of interventions to support the early years education of looked-after children, and champion educational services for children during the pivotal younger years. Based on their experience and knowledge, the committee suggested that information to support this role needed to be brought in through collaboration with nurseries and health visitors and using routinely collected data.

Expert testimony highlighted the need for closer working between the virtual school head and the special educational needs (SEN) service. The virtual school team needs to have a breadth and depth of knowledge across social care, education and health and to understand the legislation for each area. Very few social care staff have a working knowledge of the SEN code of practice or the legislation that underpins it. As a result, the committee considered the need for someone with SEN experience in the virtual school, ideally a special educational needs coordinator or someone with SEN specialism or training.

Based on their own expertise, the committee considered that the inclusion of a post‑16 coordinator in the virtual school could help bridge the gap in information for those in care hoping to achieve higher or further education – for example, by helping with the application processes for entrance to college, university or further training (and support while there). Therefore, help was needed to help looked-after young people aspiring to further education to navigate the available support.

The committee recognised that the expertise needed within the virtual school was likely to vary based on the demographics of the population being served. Therefore, they considered the need to take into account the prevalence of groups of special interest in each local authority when expertise for the virtual school is being recruited. They noted that the prevalence of some groups of special interest varied significantly between local authorities.

As a result of expert testimony, the committee recognised that often, virtual school heads had not been properly empowered or used, and their role had not been properly defined. In some cases, the virtual school head may be a peripheral figure, rather than a key leader enacting change in the local authority. Therefore, the committee agreed that, to be able to complete its statutory duties, the virtual school head should be considered the key leader and enabler for the collaboration of educational services for looked-after children and young people.

Expert testimony outlined the range of professionals with a statutory remit to work with, and promote, the needs and wellbeing of children and young people in care and education. These professionals are asked to work together, but the expert noted that this often does not happen sufficiently in practice. In the experience of the expert, a clear bridge is needed between the services, and when this role is taken up by the virtual school, the links work much better. The committee agreed and outlined a list of services for which the virtual school head should act as a 'bridge'.

Based on their expertise and knowledge, the committee noted that simplifying and merging looked-after children review meetings would support multiagency working. For example, merging annual reviews and personal education plan meetings could make it easier for specialists in education and social care to communicate, while also reducing the number of overall meetings that looked-after children and young people need to attend. The committee also considered the importance of including the health perspective in multiagency review meetings when health problems impacted education.

How the recommendations might affect practice

Every school in the UK is obliged to employ a special educational needs coordinator, so ensuring that one is part of the virtual school team would not incur additional resources. Some virtual schools may not have an existing early years practitioner, so there would be resource implications from adding another staff member to the team. However, it is possible that such expertise could be found, or developed (using training), in existing professionals in the virtual school.

Reviewing meeting structures and condensing them into fewer meetings if possible would not need additional resources because it would reduce the number of meetings being organised and held.

The recommendation for virtual school heads to form a bridge between named specialists in education, social, health and mental healthcare is not anticipated to have a significant resource impact because these roles already exist and would not need an additional staff member at the virtual school.

Return to recommendations

Why the committee made the recommendations

The committee considered evidence from robustly designed studies about interventions tested mainly in primary-school-aged children. There was some evidence that tutoring by foster parents or volunteers improved maths and some literacy scores; these were outcomes that the committee considered to be important. However, the evidence base had some problems in quality and the committee noted that some carers may not want to take on the responsibility for tutoring because this can blur the line between the carer and educator roles.

The committee considered that flexibility was important when choosing the tutoring style that best suits the child and the placement. Evidence from studies with weaker designs (non-randomised controlled trial) showed that a paired reading intervention greatly improved reading age over the course of the intervention. Although, again, the evidence was limited, the committee were impressed by the reported size of effect.

The committee considered that paired reading had potential for increasing communication and engagement between foster carers and schools. In addition, it was a simple, cheap and already widely used intervention in primary schools (with parents often encouraged to take part). It showed good evidence of effectiveness, and had historical use, beyond looked-after children. Paired reading was also considered to have a relational aspect, improving quality time spent between carer and child. Older students in primary school could engage in paired reading with younger students, which may also provide an important mentoring role.

The committee discussed tutoring among looked-after young people attending secondary school. They noted that a large amount of money is spent on tutoring, but there is a lack of evidence on its effectiveness for looked-after young people. The committee therefore did not recommend a specific intervention but instead agreed, based on their own experience, that interventions for improving education in secondary-school-aged looked-after children are regularly evaluated.

UK-based evidence from interviews and focus group studies and expert testimony showed the importance that unaccompanied asylum-seeking children placed on educational attainment and learning English. The committee agreed that teaching an unaccompanied asylum-seeking child to speak English fluently was 1 of the first steps to helping them acclimatise to the country, settle with their primary carer, build positive social networks and succeed educationally. Therefore, the committee agreed that English language lessons were important for those who are not fluent, and recommended that intensive lessons be considered for those with no previous knowledge of English.

Likewise, the committee recognised that additional support would be necessary in mainstream educational settings for those who did not speak English fluently. So they agreed that virtual schools should consider increased specialist educational provision for unaccompanied asylum-seeking children.

The committee noted a gap in the evidence base on the use of therapeutic interventions in current practice such as art therapy, play therapy, occupational therapy, music therapy and psychotherapy. The committee highlighted these interventions as being known to have a positive impact on educational, social and emotional outcomes in broader populations of children. They made a recommendation for research on therapeutic interventions for promoting school stability and learning to assess the effectiveness of these interventions on improved learning outcomes, school attendance and exclusion to help address this evidence gap.

How the recommendations might affect practice

There was no published cost-effectiveness evidence for most of the learning interventions but the resource impact for the recommended interventions is expected to be low. There may be some hidden costs such as carer or volunteer time, training, travel and administrative support.

Paired reading is currently provided to all children in primary schools, so no additional resource is needed. Infrastructure may be needed for extra support or training for foster carers on active reading and to train volunteer paired readers. Virtual schools may be best placed to deliver training in paired reading to foster parents. The only extra costs involved should be for foster carers actually attending training, and costs may be even lower if delivered virtually.

Individual or small group tutoring delivered by trained foster carers or trained volunteers would have a low resource impact, but using professional tutors would have higher cost implications.

These interventions can be prioritised for funding through the pupil premium grant, which is part of statutory education funding provision for looked-after children and young people.

This trauma-informed training for teachers could be incorporated into the existing provision for behavioural management training, so is not anticipated to have a substantial resource impact.

Return to recommendations

Why the committee made the recommendations

Evidence from expert testimony highlighted the importance of developing systems of accountability by gathering and sharing data that could help monitor and evaluate services around education for looked-after children and young people. They noted that no data was being collected on the responsibility of local authorities to secure education provision. For example, many looked-after children and young people are not placed on a school roll (defined by having a Department for Education number) by their corporate parent. In addition, there may be a culture of ignoring statutory responsibilities in this area because of lack of oversight, use of unregistered provision, and 'ghost rolls'.

The committee discussed evidence from expert testimony about placement of children in unregistered schools, which results in their data not being captured in national attainment figures. This may create a perverse incentive for local authorities not to secure appropriate provision in order to artificially improve national attainment figures. The committee agreed that local authorities should collect and publish information on the educational provision for looked-after children, with a particular focus on children missing education as well as the strategy for reducing that number.

The committee discussed expert testimony on the lack of accountability for how the pupil premium grant was being spent. Schools and local authorities do not routinely collect data to demonstrate that education funding for looked-after children and young people is being spent within the terms of the grant. This hampers the ability to evaluate the spending of the pupil premium grant to improve outcomes or to ensure that the funds are used directly for the benefit of looked-after children and young people. The committee noted that the Department for Education have acknowledged that they are not able to hold local authorities accountable for either spending of the pupil premium grant or provision of educational placements, because of the lack of available data. Therefore, the committee agreed that the spending of the total pupil premium grant within local authorities needs to be tracked to develop a mechanism of accountability.

How the recommendations might affect practice

Collecting and publishing information on the educational provision for looked-after children and young people, particularly those who are missing education, and a strategy for reducing the number of these children and young people, and developing a checking mechanism for the spending of the pupil premium grant, is unlikely to have a significant resource impact. Although this data is not currently collected consistently across local authorities, there are existing mechanisms to do so. There are also existing mechanisms for checking local authority spending, so checking educational spending for looked-after children and young people could be incorporated into existing spending checks.

Return to recommendations

Why the committee made the recommendations

The committee considered evidence from robustly designed studies on interventions to help looked-after young people aspire to, and be equipped for, higher education. They acknowledged that entry into further or higher education is very different for looked-after children and young people than for the wider population. For example, they have broadly lower expectations of ever attending higher education and may consider this to be something that they are not able to achieve. Interventions need to be tailored accordingly.

Particularly, evidence from a study of individual coaching and group mentoring, with a summer visit and stay at a university campus, showed improvements in several measures of readiness for post-secondary education. Most importantly, there was a considerable improvement in post-secondary participation at 6‑month follow-up in the intervention group.

Based on evidence from robustly designed studies, and some interview and focus group-based evidence, the committee considered that residential experiences, university campus visits, and coaching and mentoring by near peers in higher education could have profoundly beneficial effects on looked-after young people considering higher education. In addition, the committee agreed that university access schemes (offered by several UK universities) can give important support for looked-after young people in navigating the application process and receiving assisted entry to courses. The committee also considered the importance of encouraging people to self-identify as care leavers once they are in university or college because this may give them opportunities to receive additional support. However, they also recognised that care leavers often want to keep their care history private.

Based on their own experience and knowledge, the committee also weighed up the potential harm caused by pushing looked-after young people into higher education when this might not be the best option for them. The evidence did not report whether looked-after young people enrolled in college or higher education thrived or completed their courses. But this is a concern that applies to all young people not just those who are looked after.

The committee also considered that looked-after young people may be more ready to re-enter education when older. They discussed that their personal advisers are well placed to outline the options to do this. However, the young people would benefit from the support of post‑16 coordinators who would have more in-depth knowledge of the funding and support available.

Based on their own experience and knowledge, the committee agreed that support was also important for looked-after young people considering other routes into further education and training. The committee believed careers support and advice, work experience placements, and internships to be useful and available routes into good careers for looked-after young people. Careers support and advice was strongly needed, targeted at looked-after young people because they need an extra level of support and signposting.

How the recommendations might affect practice

The resource impact of these recommendations to help looked-after young people enter higher or further education or training is expected to be low, although some apparently low-cost interventions funded by local authorities, such as volunteer coaching programmes, are likely to be associated with expenses for travel, management and administration. But the resource impact generally is expected to be small compared with the potential benefits of improved education, employability and independence. In addition, there is a possibility that the UK pupil premium grant may be extended to 16- and 17‑year‑olds in the near future.

It is not possible to make a robust judgement about the potential resource impact to local authorities of recommendations on university access schemes, residential experience and visits on university campus, mentoring by near peers in higher education, and coaching, because uptake is too uncertain to predict. Interventions such as residential experiences and campus visits would be delivered by universities and colleges themselves, although facilitated by the virtual school. Likewise, some interventions may simply involve signposting people to local programmes and schemes that are university, college or third-sector funded, so the resource impact for local authorities would be low.

Return to recommendations

Why the committee made the recommendations

Drawing on UK-based evidence from interview and focus group studies indicating it was important to have a good match between carers and the looked-after children and young people, the committee recommended that careful consideration in transition planning should be given to the matching of carers and the looked-after child or young person. In assessing the strengths of the carers, committee members described how they translate the child's needs into what the parenting challenge and task looks like for the carers, and how the carers can best bolster the placement and help meet these needs.

UK-based evidence from interview and focus group studies and expert testimony also highlighted how the relationship between foster carer and adopter could support the move into permanency. Good communication and support can improve this relationship, for example by helping to manage expectations of the foster carer during the planning stage. These measures could help to avoid an adversarial relationship forming between carers, rather than a supportive relationship that allows for a more integrated experience for the looked-after child or young person during transition.

The committee disagreed with perspectives in some of the interview and focus group-based evidence that suggested it was beneficial for the looked-after child or young person to experience the short sharp shock of a foster carer stepping away completely and immediately. Rather, they supported a less traumatic approach that facilitated ongoing communication with current carers if the child or young person wanted this.

The committee looked at interview and focus group-based evidence on facilitating the involvement of the new permanent or long-term carer's extended family. For example, the extended family may help by providing respite (or support) care. The committee agreed that involving family and friends early in the placement was particularly important for helping them to engage with the new family relationship. But they stated that respite (or support) care in the early stages could damage the formation of attachment with the primary carer. Based on their own knowledge and expert testimony, the committee noted that family and friends training days, which are offered through adoption agencies in some local authorities, were helpful.

For birth families involved in substance misuse, the committee considered evidence on 2 interventions to support reunification: recovery coaching and family drug and alcohol courts. This included evidence based on robust study designs, and some weaker forms of evidence (not from randomised controlled trials). Recovery coaching was associated with greater reunification and more stable and long-lasting relationships than services as usual. UK family drug and alcohol courts were associated with improvements in reunification and longevity of reunification compared with ordinary care proceedings. The committee considered that providing independent support for families at the same time as child welfare court processes could support reunification. They agreed that, if reunification had occurred, support needed to continue after reunification to help the permanent placement to last, with clear plans for follow-up. Instead of recommending recovery coaching specifically, the committee recommended substance and alcohol misuse support, by trained staff, with a cross referral to NICE lifestyle and wellbeing guidance (which includes managing substance and alcohol addiction, and behaviour change).

The committee noted that there is evidence for the use of drug and alcohol courts to aid reunification by intervening and providing support for birth parents with drug addiction. However, rates of mental health problems are also high among birth parents who have had a child removed, and these problems may also contribute to the reasons for children going into care. Based on their own experience, the committee also recommended that mental health support continues alongside court processes. The committee made a recommendation for research about the benefit of mental health support to promote reunification.

There was evidence, based on studies with non-randomised designs as well as focus group and interview-based studies, that concurrent planning significantly reduced the likelihood of multiple moves before finding permanency and the time to finding a permanent placement. But evidence also showed 2 particular issues with it. One was that prospective adopters and birth parents found that late changes in the care plan could be particularly distressing for them. And prospective adoptive parents found that the intensive contact arrangements could be taxing for both themselves and the child (in terms of frequency and distance travelled while establishing new routines and building relationships).

The committee discussed concurrent planning as something that was already practised, with success, in certain parts of the UK. However, they considered that carers and birth parents should be well informed of the inherent difficulties of such a strategy and the possibility of late changes to the care plan meaning that adoption or reunification may not occur as anticipated.

How the recommendations might affect practice

It is not possible to make a robust judgement about the potential resource impact of setting up concurrent planning processes to speed up transition time to permanency, or of carrying out substance and alcohol misuse support alongside court processes, because uptake is too uncertain to predict. However, these processes are already available in some parts of the UK.

Some local authorities already offer family and friends training days through adoption agencies, and there is existing provision for this training, so it is unlikely that extending this to all areas will have large resource implications.

Return to recommendations

Why the committee made the recommendations

UK-based evidence from interview and focus group studies suggested the need for a more integrated experience for looked-after children and young people that takes into account the significance of previous caregiving relationships. For example, the importance of foster carers for preparing and supporting adoptive parents, focusing on the emotional state of the child or young person during the busy transition out of care, and prospective adoptive carers wanting more information about previous care experiences and health.

The committee agreed that, beyond the benefits for prospective adopters offered by foster carers in terms of sharing information, it was also beneficial for the looked-after child or young person to see positive relationships forming between their current carers and their prospective permanent carers in the period before and after transition.

Based on their own experience and knowledge, and as part of the more integrated experience of transition described above, the committee considered the social network around the looked-after child or young person. They thought that contact arrangements, which may be focused on the birth family, should also take into account whether the looked-after child or young person has other significant relationships with which they would like support to maintain. Such support could help create a more overlapping transition that gives more time for new connections to form and to process the loss of old ones.

Based on interview and focus group evidence about how child-focused the transition period was, the committee agreed it was important to have a practitioner regularly 'check in' with the child or young person to ensure that the transition process was going well for them and to keep the process child-centred. The committee noted that for children not yet able to talk, the primary carer may need to be present and advocacy services may also be needed.

UK-based evidence from interview and focus group studies showed that good clear information before transition was extremely important to new foster carers and prospective adopters. The committee considered the types of information that should be given to a new carer during the process of transition between care placements or out of care, based on their own knowledge and expertise. It was important that this should give new carers a clear sense of the chronology of the care process for the child or young person.

To avoid the information being handed over in an overwhelming quantity, the committee agreed that the information needs to include a clear summary. This will provide the information they need to help carers carry out their nurturing and safeguarding role. They also agreed the importance of briefing the new carer in person, rather than leaving the carer to make sense of the information by themselves. A social care practitioner who has had continuous oversight of the child or young person's history in care would be ideally placed to do this.

The committee considered their own experience and knowledge, and some interview and focus group-based evidence showing the concerns of new carers adopting looked-after children with medical conditions they were not familiar with, and of the need for information about previous placements. The committee discussed what information would be helpful for new carers and prospective adopters, to cover the needs of the new placement, including personal health history. It also included birth family health history; the committee were keen that this was collected for all children entering care, not just during adoption processes. The committee agreed it should also cover behaviour with the potential for significant harm to others (for example, sexual, violent or fire-setting). However, they highlighted it was important for prospective carers to have the context to these events so they could assess them properly.

Based on their experience and knowledge, the committee also stated that this information giving should not simply be a record of negative life events, but that the record should lend equal weight to factors that could support the success of the placement. These include the looked-after child or young person's strengths, hopes for the future, significant positive relationships (with peers and adults), interests and activities, as well as how behaviours had been successfully supported in previous settings. The committee recognised the importance of ongoing life story work to draw out these factors.

The committee also considered the case of emergency foster placements, for which it may not be possible to deliver all information immediately. If it becomes clear these placements will be longer term, the carer may need more information to carry out their nurturing and safeguarding roles. For example, carers often need support to understand why a child or young person is behaving in a certain way in order to respond appropriately. As well as knowing about safeguarding issues, they need to know why children and young people are looked after, which family members pose a risk and why.

There was lot of UK-based evidence from interview and focus group studies showing that children and carers value continuity of care practitioners. The committee agreed that consistency in the practitioners who help in the handover of information for new permanent carers could reduce the sense of instability during transition, and support positive relationships.

Based on expert testimony and their own knowledge, the committee discussed the issue of a continuing education plan when a child or young person is moved outside their local authority area. The committee considered the need for someone who has an overview of the child or young person's educational needs and can help place the child or young person in education that matches their needs. They agreed that this could be assisted by having a transition plan and 'handover' from the old to the new school placement (for example, from 1 designated teacher to another) as part of the personal education plan.

Based on their experience and knowledge, the committee also discussed the need for continuity of healthcare as the looked-after child or young person moves to their new placement. The committee agreed that if regular mental health, physical health or dental support had been provided in the old placement, new referrals local to the new placement need to be in place before the transition, to promote continuity of care.

Expert testimony from an adoptive parent and organisations representing adopters highlighted the importance of language during the transition period. In particular, adoptive parents (who may have no experience of parenting) may feel judged by the child's foster carers. Often, adopters feel this is a highly sensitive time when they do not want to complain or do anything to jeopardise the placement. The committee therefore highlighted the need for transition teams and foster carers to consider these issues and adjust language accordingly.

How the recommendations might affect practice

Most recommendations are not particularly resource intensive, generally focusing on continuity of healthcare and education, parent and carer training, peer support and the detailed chronology of care process for the individual. Many recommendations focus on ensuring continuity of existing processes, or on processes that are already in place in some areas.

However, extra resources may be needed for those that need more professional time to produce (such as the summarised history of care) or training and preparation for long-term carers.

Giving opportunities for current and new carers to meet before a placement move, and facilitating ongoing communication, should not have substantial resource implications because these can be incorporated into existing transition planning. Similarly, supporting existing social networks to allow time in the transition period for the looked-after child or young person to form new social connections is not expected to be resource intensive because this can be incorporated into existing transition planning.

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Why the committee made the recommendations

The committee considered whether it would be useful for the looked-after child or young person to give their own perspective on their journey in care to their prospective carer if the child or young person is willing, drawing from existing life story work. This could aid transparency and help the looked-after child or young person feel in control of their information. However, the committee considered that this may be better occurring once the looked-after child or young person and carer have begun to develop a stronger attachment relationship.

UK-based evidence from interview and focus group studies and expert testimony highlighted the power imbalance perceived by adoptive parents, who may feel unable to complain about the transition process because of fears about jeopardising the placement. The committee considered that although there was little that could be done about this during the transition period (other than making permanency carers aware of their rights to receive support), agencies would benefit from seeking feedback from foster carers and adopters after the permanence order is made, and they could use this to improve the delivery of transition services.

There was very good UK-based interview and focus group evidence, supported by expert testimony, that peer support was useful for adopters and permanent carers. Peer support groups could often give the personalised support and availability that social care teams could not. The committee noted that effective peer support could be achieved in a variety of ways.

The committee noted, based on expert testimony, that there was also the potential for specialised peer support groups to help deal with specific problems in permanency placements. Experienced permanent carers could be linked up with other permanent carers in need of support to provide tailored advice and empathy that may not be covered by the expertise of the support team.

The committee noted that few studies reported long-term placement durability outcomes, including post-permanency outcomes showing that the looked-after child or young person was thriving in their new long-term placement. In addition, there was insufficient evidence on the perspective of adopters and long-term permanency carers about the transition out of care and how this could be improved. The committee therefore made a recommendation for research on interventions to support stability of permanent placements to encourage more evidence in these areas.

How the recommendations might affect practice

Facilitating accessible peer support for permanent carers (such as adopters) is unlikely to have a substantial impact on resources, because most would be peer led and not need much additional personnel time or physical resources from the local authority. Message boards may need to be moderated to prevent misinformation but, overall, peer support could save time and resources by helping to resolve issues that would otherwise need the attention of care staff, or that, if left without support, could lead to placement instability.

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Why the committee made the recommendations

How the recommendations might affect practice

Why the committee made the recommendations

Based on their own experience and knowledge, the committee discussed extended educational care. They noted that, for qualifying care leavers, extended support was often offered if the person was in full-time education. However, the definition of what constitutes full-time education may be too narrow for many who would benefit from it. For example, 1 of the committee members raised the example of a care leaver who received a scholarship to train with a sports team, who may not receive the same extended support as someone in university. The committee also considered the high prevalence of those with special educational needs or disabilities among care leavers. Because this group may not progress as quickly in education, the committee agreed that they, especially, may need extended educational support.

Based on their own experience and knowledge, the committee also discussed the issue of university students living away from home and agreed that continuity of housing during holidays was needed for care leavers in college or university to prevent housing instability between terms. This was supported by evidence showing that housing was often cited as the reason for care leavers dropping out of courses in higher and further education.

Based on their experience and knowledge, and evidence showing that isolation may remain a problem even with appropriate housing, the committee agreed that a good level of social support was needed from social care and university teams. Based on evidence showing the benefit of peer support and mentoring interventions, the committee agreed that facilitating a 'buddying system' for peer support, mentoring from older students on campus to tackle isolation during the holidays or providing other social opportunities for care leavers could be beneficial.

How the recommendations might affect practice

Housing support during university holidays may not cost a substantial amount because many universities already offer the option for care leavers to stay on in their halls of residence in holiday times.

Return to recommendations

Why the committee made the recommendations

Drawing on UK-based evidence from interview and focus group studies suggesting that shared decision making should be a cornerstone of care provided for looked-after children and young people, the committee discussed the need for a mechanism to incorporate the feedback of looked-after children, young people and care leavers moving into independence back into the services provided. Interview and focus group evidence suggested that children in care councils specifically may facilitate such feedback, although something more focused on care leavers, such as care leavers forums or surveys, was needed to improve services during the transition into independence.

The committee recognised particularly that those who were looked after out of area may be most vulnerable to receiving inadequate statutory support. Therefore, they considered it important that the views of these looked-after children, young people and care leavers were captured and used to improve services.

How the recommendations might affect practice

These recommendations are not expected to have substantial resource costs, because care leavers may be encouraged to give feedback in numerous ways. Care leaver councils may have more running costs in terms of facilitation and organisation, but the extent to which local authorities will use these councils is uncertain.

Return to recommendations

Why the committee made the recommendations

Based on evidence from interview, focus group studies, studies with more robust study designs and committee experience and knowledge, the committee considered the benefit of facilitated multiagency working to help systems adapt to local challenges. They were particularly interested in the use of regular broad-system meetings, or forums, for care providers to exchange information and to provide the opportunity to adapt care systems to meet the needs of looked-after children and young people.

The committee considered that 1 of the key components was improving communication between disciplines (for example, health professionals, social care providers and carers) at all levels to ensure that statutory guidance was being adhered to. A forum could also display examples of exemplary practice, review recently published evidence, and align tools used for health and social care assessments. This would help educate leaders, which would enable information to be cascaded down to other professionals. Based on expert testimony, the committee also agreed that these meetings would help standardise the different agencies' use of language, risk-assessment tools, and job titles and roles. The committee agreed that such forums could adapt to situations specific to the local authority – for example, increasing numbers of unaccompanied asylum-seeking children or increasing risks of going missing in care. The committee agreed that risk-assessment tools were useful to determine increased risk of exploitation at the individual level (for example, someone placed out of area is at increased risk), but it needed to be standardised across local authorities and agencies.

How the recommendations might affect practice

There may be organisation and facilitation costs for starting a forum to bring together agencies and representatives providing care for looked-after children and young people within a local authority. However, these are justified by the benefits of facilitating communication between agencies, providing education, sharing tools and expertise, and giving examples of best practice. Virtual forums may also help to bring costs down.

The committee noted that, in many cases, various boards, groups and councils already exist within local authorities. Partnerships with these could be organised to bring leaders together from several sectors. Some examples of existing relevant boards, groups and councils include: corporate parenting boards; children's safeguarding boards; children's trust boards; health and wellbeing boards; children's care councils; youth councils; foster care liaison groups; and clinical commissioning groups.

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