Looked-after children and young people

Ensure that the care network around a looked-after child or young person consists of positive relationships. These are characterised by:

• genuine caring – being treated by carers as 'one of their own'

• availability – being there when needed

• reliability – providing promised support in a timely manner

• listening that is engaged and non-judgemental

• continuity of relationships

• promoting agency and shared decision making that is appropriate to developmental age

• providing well-communicated and fair discipline and boundaries

• persistence and understanding, to respond to behaviours that challenge and to support positive behaviours

• positive role models who offer guidance.

If the looked-after child or young person has speech, language and communication problems (whether or not these have been previously diagnosed), refer them to speech and language therapists, if needed, for assessment and for advice on how to communicate effectively with them.

Consider interventions and support to improve the relationship between siblings in care, including biological siblings who live apart and non-biological siblings who live together (for example, other looked-after children or young people in the placement, and the carer's biological or adopted children). Take into account safeguarding issues and the looked-after child or young person's preferences.

For primary-school-aged children, or those needing greater assistance, ensure that the primary carers are present during interventions to improve relationships between siblings in care. Components of this intervention should include:

• structured conversation around relationships and conflict resolution

• incentivised cooperation, for example shared activities and outings to encourage prosocial, cooperative behaviour

• shared activities with coaching in prosocial skills using life story work.

Consider relationship coaching independently from the carer for adolescent siblings in care.

Offer carers support to help them understand and maintain stable sibling relationships before offering interventions to improve the relationship between siblings in care.

Respect the wishes of looked-after children and young people about contact arrangements (where and who with) and take them into account when making plans. Balance them against safeguarding considerations and the risk of repeating trauma.

Provide contact supervisors for contact with birth families if this is necessary for safeguarding, or if it will help support the relationship between the looked-after child or young person and the birth family. Ensure that the looked-after child or young person always has the same contact supervisor if possible.

Contact supervisors should receive training in:

• safeguarding the looked-after child or young person, including trauma-informed training in recognising signs of distress (including in babies and in non-verbal children and young people) and how and when to end a session

• providing emotional support for the looked-after child or young person, including in transition to and from contact with the birth family

• providing support for and feedback to birth parents to help them build positive relationships during contact

• knowing when to support, and how to reduce support when necessary

• record keeping and sharing information with the broader care team.

Consider the need for more intense contact supervision (in terms of monitoring and feedback provided) between the birth family and looked-after child or young person in the early stages of care placements, with reduced intensity as needs decrease over time.

Provide interpreting services for contact supervisors if the people taking part in contact are non-English speaking. Consider any additional communication support as needed, for example sign language.

Think about using text, email or social media to support contact for looked-after children and young people. Safeguarding plans should also take account of the possibility of ongoing unmonitored online contact and ensure that the time spent in digital or social media contact and the content of these interactions is appropriate.

Consider the contact needs of children placed out of their local area – for example, additional support for the birth family to attend contact centres.

Support the looked-after child or young person's allocated social worker, to reduce professional turnover. Support could include, for example:

• supervision with regular meetings to check on the wellbeing of workers, and reflect on practices that promote positive relationships (see recommendation 1.2.1)

• consultation for complex and specialist problems (see recommendation 1.4.3)

• trauma-informed training in communication skills to support positive relationships (see also recommendation 1.3.18).

Managers of social workers should use and review ways of working to reduce duplication of effort, increase staff retention and enable more one-to-one time between social workers and looked-after children and young people (for example, by improving administrative support).

Local authorities and partner agencies should collect and review data on staff turnover to assess the impact on looked-after children and young people and the success of existing staff support systems. They should use this data to inform action plans to support greater continuity of practitioners working directly with looked-after people and care leavers.

If possible, social workers should tell looked-after children, young people, care leavers, and primary carers pre-emptively, and in a manner appropriate to developmental age, about upcoming changes in their job that will affect their relationship with the looked-after child or young person. This should include a joint meeting in person between the previous and new social worker and the looked-after child or young person. Recognise the emotional impact of such changes and provide an opportunity to say goodbye.

Consider programmes (with professional oversight) to support mentoring relationships. For example, by pairing looked-after young people with near peers with care experience to provide positive role models, particularly for looked-after young people with social, emotional and mental wellbeing needs.

To support overnight stays with friends, ensure that safeguarding checks are completed in good time so as not to cause a barrier to relationships.

Consider providing funding to support contact with friends (for example, for travel or activities), particularly for friendships that existed before the looked-after child or young person entered care.

Provide out-of-hours support services (separate from those provided for carers) for looked-after children and young people to help resolve urgent problems, and tell looked-after children and young people about these options. Services could be provided, for example, through social workers 'on call', voluntary or independent agency helplines or advocacy organisations.

Adopt a proactive approach to identify children and young people who may be likely to present out-of-hours (for example, they may show early warning signs such as skipping school, lying or stealing), for whom out-of-hours support could be planned ahead of time.

Discuss the priorities and needs of carers sensitively and transparently with the looked-after child or young person in a manner appropriate to developmental age. For example, if placements are at risk of breakdown, social workers should facilitate communication between the carers and the looked-after child or young person (and birth parents if relevant) to try to resolve problems.

If a placement changes:

• Discuss the reasons for this with the looked-after child or young person in a way they can understand and that is appropriate to their developmental age.

• Offer the child or young person emotional support, if possible by a practitioner they have an existing relationship with.

• Use ongoing life story work to help them process changes in placement.

Provide the new carer with appropriate health information in good time before the new placement starts (for example, the health plan recommendations, any new health concerns, health contacts and upcoming health appointments).

Consider multidimensional treatment foster care for looked-after adolescents with a history of persistent offending behaviour.

For guidance on service design and delivery for learning disabilities and behaviour that challenges, see NICE's guideline on learning disabilities and behaviour that challenges.

For guidance on attachment difficulties, see the NICE guideline on children's attachment.

Involve and value the carer's input in decision making in the broader care team, and keep carers fully informed about a looked-after child or young person's care plan.

Provide out-of-hours support services for carers to help resolve urgent problems, for example through social workers working 'on call', emergency duty teams or out-of-hours service, voluntary or independent agency helplines, or carer peer support associations.

Ensure that carers log any help sought outside of usual operational hours as part of their routine and urgent reports.

Facilitate peer support for carers at accessible times and places, including online if people may find it difficult to attend a physical meeting.

As part of the care plan, think about the need for planned respite care (or 'support care') for carers.

Ensure that respite (or support) care is used in the looked-after child or young person's best interests and explain this to the looked-after child or young person. For example, make use of short breaks that are fun for the child or young person, such as staying with relatives or extended carer family.

Use a respite (or support care) carer who the child or young person is familiar with if possible, and take into account the skills or training needed to meet the looked-after child or young person's assessed need.

Keep carers fully informed and updated about the support services available to carers and looked-after children and young people in their local authority.

Inform the looked-after child or young person's carers about any interventions used to support the looked-after child or young person, including the purpose of these interventions.

For further guidance on support for adult carers, follow the NICE guideline on supporting adult carers.

Plan training for carers so that it is delivered before it is needed. Think about the need for multiagency involvement in training programmes and ensure that the organisations involved agree the source of funding between them.

Supervising social workers should work with carers to assess the needs of the looked-after child or young person, to inform and tailor training and development needs for the carers.

Provide a schedule of mandatory training for carers, excluding birth parents. Ensure that this training covers:

• Therapeutic, trauma-informed parenting (covering attachment-informed, highly supportive and responsive relational care).

• Safeguarding procedures.

• How to communicate effectively and sensitively (for example, using de-escalation techniques).

• Life story work to promote a positive self-identity, which has a consistent, child-focused and planned approach (see the section on life story work for identity and wellbeing).

• How to be an educational advocate (this part of the training should be delivered by practitioners from the virtual school).

• Identifying problems with, and supporting, good oral health, diet and personal hygiene (particularly among those coming into care).

• Encouraging positive relationships and sexual identity (covering issues such as consent, encouraging healthy intimate relationships, 'coming out' and transitioning).

• Self-care for carers, preventing burnout and coping with placements ending.

• The importance of health assessments, supporting attendance and issues of consent for medical treatment.

• Record keeping and sharing the information in the record with the looked-after child or young person in a constructive and positive way, considering the need for confidentiality, and the impact the record may have on the looked-after child or young person.
  
  Training can be delivered in person (for example, at home or in community group settings) or virtually.

Provide targeted support and training for birth parents if reunification is a possibility or if the child or young person is to remain in placement with the birth parent. This should be provided through transition planning with family support teams.

Think about providing tailored training for carers if there are specific needs related to race, ethnicity and culture. This could include, for example, understanding and respecting cultural and religious identity (including dietary requirements or preferences), and understanding specific hair and skin care needs.

Provide tailored training for carers if there are specific needs relating to special educational needs, long-term health conditions and disabilities, for example sensory and communication needs. Training could be provided through specialist healthcare teams and voluntary organisations.

Based on the individual needs and developmental age of the looked-after child or young person, consider more intensive training methods for carers to support the delivery of therapeutic, trauma-informed caregiving. These methods should use video feedback, coaching and observation, role play, and follow-up booster sessions and be delivered by trained facilitators.

Ensure that trauma-informed training covers:

• understanding behaviour as a form of communication and as a response to trauma

• understanding, recognising and processing triggers for trauma responses

• understanding attachment and loss.

Ensure that trainers for carers are trauma informed and have a good understanding of attachment issues and therapeutic approaches.

Ensure that new permanent or long-term carers are trained and prepared so that there is continuity of care and support, including therapeutic support if needed, between placements.

Ensure that all practitioners working with looked-after children and young people are aware of the impact of trauma (including developmental trauma) and attachment difficulties and appropriate responses to these, to help them build positive relationships and communicate well.

Ensure that practitioners and carers working with unaccompanied asylum-seeking children are aware of the issues that affect this group, including health needs, safeguarding issues, language and culturally sensitive care needs, and the danger of going missing.

Ensure that there is sufficient specialist professional expertise to support, and provide consultation for, looked-after children and young people with more complex needs. This could be provided through more intensive (responsive) trauma-informed training, or by sharing expertise across agencies.

In line with statutory guidance, when a child or young person enters care, local authorities must ensure that healthcare teams are informed as soon as possible about the legal status of the looked-after child or young person and why they have entered care (within 5 working days, as specified by the Care Planning, Placement and Case Review Regulations 2010). Get consent to share this information from an adult with parental responsibility, or from the looked-after child or young person directly if appropriate.

When a child or young person enters care, social workers should:

• Make a formal request for the initial health assessment, giving the reasons that the child or young person is coming into the care system.

• Ask for consent from the birth parents (or from another adult with parental responsibility, or from the looked-after young person directly if appropriate) to access and share information from the child health record.

• Ask for consent from the birth parents to share their own health information, and ask them to complete a parental health questionnaire to help with this. If the birth mother has agreed to share her health information, ask the relevant hospital about her health during pregnancy.
  
  All this information should be available in time for the looked-after child or young person's initial health assessment.

Ensure that statutory review health assessments for a looked-after child or young person are carried out by the same healthcare professional each time, if possible.

Consider the need for confidential and private access to healthcare for looked-after young people, for example if phone use or internet use are restricted because of safeguarding needs, or when seeking out sexual health advice or treatment. For guidance on one-to-one interventions to prevent sexually transmitted infections (STIs) and contraceptive services, see NICE's guidelines on STIs and contraceptive services.

Healthcare professionals should compile a history of the looked-after child or young person's health from the information they hold in the health records and additional information given to healthcare professionals from other teams, to give practitioners and carers a clear sense of their past, present, and likely future physical and mental health needs.

Be aware that care leavers are very likely to request access to their health and social care records. Practitioners should ensure that the language used in the records and the way events are captured are sensitive and empathetic.

Offer a culturally appropriate, registered interpreter to communicate in person with looked-after children and young people for the initial health assessment if language is a barrier to communication. If language remains a barrier to communication, think about the need for a culturally appropriate, registered interpreter to be available in person for subsequent health and social care assessments.

Offer unaccompanied asylum-seeking children tailored initial health assessments that address risks arising from their country of origin and journey to the UK. Include:

• diet and nutrition, including nutritional deficiencies such as vitamin D deficiency

• gastrointestinal symptoms

• oral health

• tuberculosis screening and general immunisation status

• sexual health, tailored to the individual (for example, testing for sexually transmitted diseases; and being aware of signs of assault and abuse, including abuse linked to faith and culture such as female genital mutilation and breast flattening). For guidance on one-to-one interventions to prevent sexually transmitted infections (STIs) and under‑18 conceptions, see NICE's guidelines on STIs and contraceptive services

• other infectious diseases and bloodborne infections, for example HIV and hepatitis testing

• sensory issues not previously identified because of lack of screening, for example hearing, vision or mobility problems

• an assessment of mental health, with referral to specialist mental health teams if indicated

• sleep disturbances.

After looked-after children and young people (including babies) have had their initial health assessment, consider the need for an additional specialist mental and emotional health assessment once the looked-after child or young person has begun to form a relationship with the primary carer. This could be, for example, up to a year or by the first review health assessment.

Healthcare professionals responsible for the care of looked-after children and young people should review whether care recommendations in the health plan have been completed, particularly if the child or young person has been moved out of area, checking with the professionals concerned across agencies.

For guidance on the diagnosis and management of attention deficit hyperactivity disorder (ADHD) in children and young people, see NICE's guideline on ADHD.

For guidance on the recognition, referral and diagnosis of autistic spectrum disorder, see NICE's guideline on autism spectrum disorder in under 19s: recognition, referral and diagnosis.

For guidance on the recognition, assessment and treatment of post-traumatic stress disorder (PTSD), see NICE's guideline on PTSD.

To avoid delays in care, provide intermediate therapeutic or specialist support for the care network around looked-after children and young people who are on a waiting list for child and adolescent mental health services (CAMHS), for example a specialist outreach team. This should not be used as a replacement for CAMHS.

Offer a range of dedicated CAMHS that are tailored to the needs of looked-after children and young people – for example, making them longer term, more trauma informed and relationship based.

Offer preventive services based on assessed need (see recommendation 1.5.12), with timely delivery to prevent serious mental health problems that need tier 3 or 4 specialist services.

Be aware that children moving placements must not lose their place in the waiting list for CAMHS, as there is a statutory right to not lose a place in a waiting list for a health service.

Provide specialist, trauma-informed mental health and emotional wellbeing support for unaccompanied asylum-seeking children. Take into account cultural sensitivities (for example, the different perspectives of unaccompanied asylum-seeking children about mental health services) and that symptoms of trauma could come to the surface over the long term.

Start life story work as soon as possible after the looked-after child or young person enters care, to support care placement and emotional stability, rather than as an intervention to deliver once placements are stable.

Schedule regular, dedicated times for life story work to help the looked-after child or young person make sense of their journey through the care system and beyond, their significant relationships and their identity.

Ensure that life story work is done in the setting preferred by the looked-after child or young person, and conducted by a named carer or practitioner with whom they have a continuous and close relationship. This named person may change over the period in care.

Include the following in life story work for looked-after children and young people:

• the present – identity, strengths and significant relationships

• the past – reasons for entering care and for any placement breakdowns, important memories and relationships

• the future – building independence, careers, hopes and dreams.

Take a flexible approach to life story work, and tailor it to the developmental age and needs of the looked-after child or young person. The content could include life mapping, pictures, art, narratives, and toys or play.

Compile life story work in 1 place (such as a ring binder) and build on this in each session. Give the child or young person control over who this is shared with and how it is stored. Help them to choose a safe and secure storage option.

Ensure that life story work for looked-after children and young people captures and embraces ethnicity, cultural and religious identity, as well as other personal aspects of identity, for example, sexual identity or disabilities.

Ensure that a social worker oversees the life story work if another carer or practitioner is carrying out the work. For example, the social worker may share background information to support the carer or practitioner carrying out life story work, with the looked-after child or young person's consent.

Think about and plan how to carry out life story work for looked-after children and young people, with sibling groups, in a manner appropriate to developmental age. This may include:

• preparing siblings for navigating conversations with older siblings or siblings not in care

• deciding whether it is appropriate to deliver life story work sessions in a sibling group or individually

• determining whether conversations will include sensitive information.

Ensure that the experience and skillset of the practitioner or carer delivering life story work for looked-after children and young people is sufficient to deliver good quality work, particularly in complex situations.

Explain to the looked-after child or young person's wider support network that life story work is ongoing, so that they can support it as needed. For example, if sensitive or emotional information has been discussed with the child or young person during life story work, schools may need to be informed.

Plan regular reviews of how life story work may affect contact arrangements and the looked-after child or young person's relationship with their birth family. Use information from these reviews to adjust the support provided. This could include, for example, involving birth families in life story work to encourage consistencies in narratives explored, and helping the looked-after child or young person with reframing previous relationships.

Promote a positive relationship between the primary carer and the looked-after child or young person as the main way to support the social, emotional and mental wellbeing of the looked-after child or young person.

When making safer caring plans, think about a looked-after child or young person's need for:

• Physical touch and affection as a part of a healthy relationship with male and female primary carers. Take into account any adverse childhood experiences.

• Play, particularly for babies and young children.

Develop the interests of looked-after children and young people to help them develop their identity and to find peer support and new friendships. Do this by helping them to find, and setting aside time, for outings, interest groups and other activities that will help them to build skills. These may include:

• one-to-one activities accompanied by the primary carer (at least initially) to promote opportunities for listening and positive relationship building (for example, visiting outdoor green spaces such as parks)

• funded, supported and facilitated activities (such as school clubs, for example making use of the pupil premium grant as determined in the personal education plan) specifically to address emotional health and wellbeing needs

• activities or outings to support identity, for example community support groups, cultural or religious activities, events or festivals

• activities to bring together children, carers and practitioners in informal settings, for example group outdoor activities.

For guidance on managing obesity and promoting physical activity, follow NICE's guidelines on preventing obesity, identifying, assessing and managing obesity, weight management and physical activity for children and young people.

Consider the following to support social competence and emotional stability in looked-after children:

• early years education, including playgroups

• other opportunities to encourage child-led play.

The virtual school should plan bespoke, individual transition support for supporting readiness for school and resilience in looked-after children and young people moving between schools and settings (including those moving out of care to permanency). This includes:

• moving from preschool to primary school

• moving from primary to secondary school

• moving in the middle of a school year

• returning to school after an extended absence.
  
  Individual transition support for school moves may include structured visits to the school beforehand, school preparation for the carer, meeting the designated teacher, catch-up support and handover between designated teachers (for example, drawing from weekly diaries and life story work).

Think about providing multidisciplinary specialist support for transition between school placements, tailored to the looked-after child or young person's needs and alongside or part of the virtual school and the team around the child – for example, including healthcare professionals in transition support for looked-after people who have health conditions that affect their education.

Inform looked-after children and young people and their carers of:

• their rights to educational support and

• the purpose of the pupil premium grant for education and how it is distributed by the virtual school.

Schools should ensure that behavioural management policies reflect trauma-informed practices and cover attachment issues.

Schools should ensure that the designated teacher is a consistent advocate for the looked-after child or young person's educational progress.

The designated teacher should:

• collaborate with school staff (who the looked-after child or young person is most comfortable with), primary carers and named practitioners in the personal education plan and the education health and care plan

• provide timely assessment and ongoing monitoring of learning needs, particularly in times of transition between educational placements

• refer for specialist support when needed (for example, educational or clinical psychology), and be aware of the impact of trauma on learning and behaviour

• be aware of special educational needs and link up with the special educational needs coordinator

• liaise with specialist looked-after children nurse teams if a health problem has been identified that affects education

• work to ensure that young people are able to access the most appropriate and inspirational educational opportunities, especially post‑16

• have regular one-to-one informal conversations with the looked-after child or young person and their primary carer, at a frequency informed by the looked-after child or young person.

Ensure that the virtual school includes all of the following:

• early years expertise

• a special educational needs coordinator

• a post‑16 coordinator.

Ensure that the virtual school covers early years provision, incorporating information from nurseries and health visitors (such as the Ages and Stages Questionnaire) and other involved health services. Complete the early years personal education plan and link it to the foundation stage profile if possible.

Ensure that the virtual school special educational needs coordinator is trained in the special educational needs and disability legal framework so they can help looked-after children and young people access all the provision and support that the law entitles them to.

The post‑16 coordinator in the virtual school should help looked-after young people navigate opportunities for training and education (including further and higher education, and apprenticeships) and available funding streams to support these.

Ensure that the expertise in the virtual school reflects the needs and profile of the school-aged population it serves. For example, the population may include unaccompanied asylum-seeking children, trafficked children, children with a history of exploitation, and looked-after children on remand or in secure settings.

Make virtual school heads the key enabler for service collaboration and a link between named specialists in the following:

• social workers

• independent reviewing officers

• school admissions and further or higher education admissions

• other virtual schools if a looked-after child or young person is placed out of area

• designated teachers

• school improvement services

• designated practitioners working with looked-after children and young people who have a health need, including mental health services or therapeutic services.

Local authorities should simplify and merge meetings about looked-after children and young people if possible. For example, education, health and care plan meetings for looked-after children and young people and personal education plan meetings may benefit from occurring together.

Include healthcare professionals in multiagency review meetings for looked-after children and young people who have additional health needs that affect their education.

To improve educational outcomes, such as literacy and numeracy, in primary-school-aged looked-after children:

• offer paired reading

• consider individual or small group tutoring (for example, by trained foster carers, trained volunteers or professional tutors).

Ensure that interventions for improving education in secondary-school-aged looked-after young people are regularly evaluated to check they are appropriate for the user and effective as part of the personal education plan.

Assess the language and communication needs of unaccompanied asylum-seeking children:

• Offer English language lessons to those who are not fluent in English.

• Consider intensive English lessons for those with no previous knowledge of English.

Consider the need for virtual schools to increase specialist education support for unaccompanied asylum-seeking children – for example, by providing designated staff members, and additional English for Speakers of Other Languages (ESOL) support.

The responsible local authorities should collect, publish and monitor information on educational provision for their looked-after children and young people, in particular those missing education (for example, those in schools that do not have a Department for Education number, or those on permanent or fixed-term exclusions). This may include unaccompanied asylum-seeking children and those with a history, or high risk of, exploitation.

Local authorities should agree and share a strategy for reducing the number of looked-after children and young people missing from education.

Local authorities, working with the virtual school, should develop a mechanism to check the spending of the total pupil premium grant, beyond the information recorded in the personal education plan, and evaluate the impact of the spending on the looked after child or young person.

Virtual schools should collaborate with universities and colleges to support looked-after young people to access higher or further education. Ways to do this could include:

• residential experiences and visits to university or college campuses, mentoring by near peers in higher or further education, and coaching

• local opportunities such as university access schemes and college support programmes

• encouraging self-identification as a care leaver, once in university or college, to help them access support such as financial bursaries.

Ensure that looked-after young people are aware of the possibility of re-entering education when older (up to age 25) with the financial support of their local authority.

Personal advisers, with the support of the post‑16 coordinator, should help care leavers to understand the funding and support available for re-entering education, as part of the care offer, once they have left care.

Virtual schools should support a looked-after young person's entry into careers and training. Ways to do this could include providing:

• careers support and advice

• current local opportunities such as work experience placements, apprenticeships and internships (particularly those targeted at looked-after young people and care leavers).

When planning transition between care placements, social workers should aim to have a good match between the permanent carers and the looked-after child or young person:

• assess the child or young person's case history and care needs, and the carers' strengths, support and training needs (including the length of time needed for training), then

• discuss relationship dynamics with the looked-after child or young person and their prospective carers.

During the transition period, support the foster carer and permanent carer relationship. Help to manage foster carer expectations during the planning stage (for example, the need for the permanent carer to be in the foster carer's house at times, using non-judgemental supportive language with new carers and understanding the emotional challenges for the foster carer of 'letting go').

In the planning stage, discuss the need for longer-term contact and longer-term contact arrangements with the current foster carer, for example contact by letter or email or meeting up once the looked-after child or young person has settled in their new placement.

Encourage and help the permanent carer's family and support network, including other children in the home, to be involved when a looked-after child or young person moves into their new placement – for example, by offering a family and friends training day before the placement.

Consider support, by trained staff, for birth parents with substance and alcohol misuse to support reunification. If the support is given, carry it out alongside court processes, such as family drug and alcohol courts.

Think about providing relational, emotional and mental health support for birth parents and families, alongside court processes, to support reunification.

Continue mental health support and support for drug and alcohol abstinence after reunification.

Consider concurrent planning to speed up the transition to permanent placements. If concurrent planning is used, ensure that carers and birth parents are well informed about the risk of late changes to the permanency plan.

For guidance on support for drug and alcohol abstinence and behaviour change, follow NICE's guidance on lifestyle and wellbeing.

During transition to a new permanent or long-term placement, think about the need for a more integrated experience for looked-after children (including non-verbal children) and young people that takes into account previous significant caregiving relationships. This could be achieved, for example, by creating opportunities for current and new carers to meet, developing positive carer-to-carer relationships and sharing information (such as familiar routines, emotional responses and diet) before the placement move.

When a looked-after child or young person moves between care placements or out of care to permanent placements, ensure that:

• contact support takes into account the need for continuity with their existing social network (for example, previous friendships), especially if the care or educational placement is in a new area and

• the transition period allows sufficient time for new social connections to form and for coming to terms with the loss of previous relationships.

To ensure that the permanency process is focused on the looked-after child or young person, set aside time for 'checking in' with them. Checking in should consist of careful observation and listening, writing a record of the conversation, and sharing the perspective of the looked-after child or young person to feed into shared decision making about transition arrangements.

In line with statutory guidance, advocacy services must be provided with communication support. The primary carer should also be present during check-ins, particularly for non-verbal children and young people, and children and young people with learning difficulties.

During transition to any new placement, social workers should give prospective carers a profile of the child and their care journey as a history of the care the looked-after child or young person has received. The information can be obtained from the statutory health reports, reports from school and the social worker's assessment.

Give all new carers a history of the looked-after child or young person's care. Create a summary for ease of reading with references to sections that give more detail. Gain consent for information that involves third parties and share only what is directly relevant. Include:

• Risk factors for placement instability and long-term physical and emotional health, such as:

  • family health history

  • previous exposures to drug or substance use, domestic violence and abuse, or neglect

  • other medical history, including antenatal health problems and antenatal exposure to alcohol or illicit drugs (see recommendation 1.5.4)

  • significant relationships and previous significant conflicts in these relationships (especially concerning contact)

  • significant negative events, for example behaviour with potential for harm to others (with context and timeline of previous events)

  • previous placement moves and reasons for them.

• Protective factors to build on, from life story work:

  • strengths and hopes for the future

  • significant positive relationships with family members, friends and adults

  • how behaviours have been successfully supported in previous settings

  • faith, communities and religion

  • routines

  • 'things that are enjoyed', such as games, shopping and favourite food

  • interests, activities and achievements.

For emergency care placements that become long-term placements, review what information the carer has been given about the child or young person, and give them more if needed.

Ensure that there is continuity of the care practitioners who help in the handover of information for new carers, if possible.

Ensure that there is continuity of education (through virtual schools with oversight of a virtual school head) when a looked-after child or young person is placed out of their local authority area. Ensure that the current school provides a handover of information to the new school as part of the personal education plan.

Ensure that there is continuity of healthcare for the looked-after child or young person so that any physical and mental health and wellbeing support can continue in the new placement. This includes making sure that any ongoing referrals and existing specialist care are transferred to healthcare services in the new location, before their move to a new placement.

When supporting adoptive parents or other carers, recognise that they may still be learning to parent. Use non-judgemental language and ensure that they are aware of their rights to receive support.

When social workers give information about a looked-after child or young person's care history to the new carer, they should:

• involve the looked-after child or young person, if appropriate and the child or young person is willing, drawing from continuous life story work

• think about involving the child or young person in sharing information, after enough time has passed for a relationship of trust to form with the new carer.

Ensure that the looked-after child or young person can keep in contact with their previous carers and friends after the placement move, if the child or young person wants to and would benefit from it.

Agencies should seek feedback from carers and adopters and the child or young person to improve their transition services, after the adoption order is made.

Facilitate peer support for permanent carers – for example, by setting up and moderating social media networks and fun group outings for face-to-face peer support.

Ask experienced volunteer permanent carers to help permanent carers with strategies to manage more specialist problems – for example, when there is emotional distance in the relationship between adoptive parent and child, and with looked-after children and young people who have severe behavioural or mental health problems, or special educational needs.

Encourage and support young people leaving care to stay in their current care placement until at least age 18. Explore the possibility of staying with current carers beyond age 18.

Take into account the increased risk to young people (aged 16 to 17) posed by breakdowns in placement that lead to moves into inappropriate housing. Whenever possible, avoid using unregulated housing, particularly for young people at higher risk of exploitation or risk-taking behaviour. If a move to unregulated housing is planned, thoroughly document the risks and the plans to mitigate these, and review this regularly.

Personal advisers, working with social workers, should assess the needs of looked-after young people when transitioning out of care to independence. Take into account:

• previous life story work

• problem-solving skills and practical skills, including life skills such as financial literacy, budgeting and household management

• physical and mental health support and long-term health needs, for example managing treatments and appointments

• education, training and employment

• financial resources

• communication needs

• social network (assessing gaps, connectedness, isolation, and both negative and supportive relationships).

Based on the needs assessment, consider providing the following support for care leavers:

• Access to health services, including registering with a GP, dentist, optician, sexual health services and therapists (for those with complex healthcare needs), and extending access to CAMHS (to support continuity of care) or alternative emotional and wellbeing services such as online support, face-to-face counselling or group work. If needed, continue services beyond age 18 until care has been transferred to adult services.

• Support for gaps in social network.

• Life skills training.

• Support for pregnancy and parenting.

• Job preparation services, job searching and career advice.

• Flexible funding to support career development, for example for specialist equipment.

• Suitable and ongoing accommodation (through the leaving care team working together with other housing services), for example supported housing.

Provide the following services to give care leavers a safety net:

• drop-in services

• more frequent meetings with their personal adviser, if the care leaver wants them

• facilitated peer support groups.

Tell care leavers and their primary carers:

• about the rights of care leavers to statutory support (related to care-leaver status such as child in care and relevant child support) and extended support from age 18 to 25 (including reopening pathway planning and contact with the local authority)

• that care leavers can receive the full level of support to re-enter education up to age 25.

Explicitly outline the support available to care leavers in a care offer, and ensure that this can be accessed easily by care leavers up to age 25.

Consider using virtual meetings to help meet the needs of care leavers who are living outside of their responsible authority.

Schedule pathway plan reviews to occur near significant milestones if possible, for example education, training or employment application deadlines.

Explain to care leavers and their primary carers how the pathway plan works, and the care leaver's rights associated with pathway planning – for example, that they can request an additional pathway plan review.

Tell care leavers and their primary carers of the rights of care leavers to advocacy services, to ensure that they receive the statutory provision they are entitled to and that advocacy services are provided in good time to support them with significant milestones.

When developing pathway plans for care leavers, include clear timeframes for actions, and who is responsible for completing the action.

Quality assure and review pathway plans for care leavers to ensure that improvements in outcomes are achieved.

Personal advisers should tell care leavers about services available in their area to support independence. These could include work experience opportunities, apprenticeships and college support.

For further guidance on transition from child to adult services, particularly for those with complex health needs and disabilities, follow NICE's guideline on transition from children's to adults' services for young people using health or social care services.

Consider the need for extended care beyond age 18 for care leavers:

• in higher and further education

• with special educational needs and disabilities.

Virtual school heads should take into account educational opportunities for care leavers beyond traditional further or higher education when deciding whether to extend support.

For care leavers who move away to college or university, ensure that there is continuity of housing during holidays, with meaningful social support. This support could include 'buddying' systems for peer support, mentoring from older student volunteers on campus, and other social opportunities for care leavers to tackle isolation during the holidays.

Encourage children and young people in care and care leavers to give feedback about their care placement and the services they receive. This could be done, for example, through children in care councils, care leaver forums and surveys.

When seeking feedback, specifically seek out the views of children and young people who are looked after out of area.

Include feedback in decision making to improve services.