Briefing 232

May 2018

Analysis of Outcomes for Children and Young People 4 to 5 Years after a Final Care Order

Summary

This briefing is on an “Analysis of Outcomes for Children and Young People 4 to 5 Years after a Final Care Order” commissioned by the Welsh Government from the Institute of Public Care (IPC). It was published on 15th May 2018 and is available at https://gov.wales/statistics-and-research/analysis-outcomes-children-young-people-4-5-years-after-final-care-order/?lang=en

The study explores the placement journeys for children in care in Wales, how these compare with the outcomes aspired to in their Care Plan and the factors associated with more positive placement outcomes for children with a Care Order. 

The study involved a large-scale analysis of all the children with a final Care Order made in Wales between April 2012 and March 2013, 1,076 children, and a more in depth look at a sub-sample of 79 children from five local authorities. The study presents a positive picture of the outcomes for most children in terms of placement stability and the progress they have made. It identifies the characteristics associated with positive and negative outcomes and the significant challenges for children in care in Wales. 

Introduction

The study starts by acknowledging that much UK research has suggested that outcomes for looked after children are less favourable than for other children outside the care system.  Recent research has challenged this overall negative view showing that many children do relatively well in care when compared to those with similar backgrounds who return to live at home.  This provides context for the decision of the Welsh Government, through the Ministerial Advisory Group on Improving Outcomes for Children, to commission this study as part of its wider programme of work. 

Study Method

Stage one of the study was an analysis of the placement trajectories for all children in Wales with a final Care Order in the financial year 2012-2013. This was a sample of 1,076 children.  The major limitation for this part of the study was that the planned outcome presented to court when the Care Order was made was not available.  This was because the expected data was not available from Cafcass Cymru.  This meant this part of the study could not ascertain the proportion of children for whom an overall desired placement outcome was achieved, not achieved or partially achieved.

Stage two was a more in-depth analysis of child histories, Care Plans, placements, supports and outcomes for a representative sub-sample of 79 children from five local authorities achieved through 120 interviews with social workers, team managers and Independent Reviewing Officers (IROs).  The major limitations of this part of the study were sample size, which was not sufficient for statistical analysis, and that children and young people were not able to give their own perceptions.  This was not possible within the budget and timescales for the study. 

Findings of the Study

From the analysis of all children with a final Care Order in Wales from April 2012 to March 2013.

Child Characteristics

  • 50.3% boys and 49.7% girls. Very similar to the whole child population.
  • 4.7% were recorded as having a disability with 10.6% where disability was not known.
  • 95% white and 3% mixed ethnicity and under 1% Asian, Asian British, Black African, Caribbean or Black British. This is broadly in line with the Welsh population of children but the proportion of Asian and Asian British was slightly lower.
  • 49.4% of the Care Orders were for children under 5 years, with 25% 5 to 9 yrs and a slightly lower proportion aged 10 to 15.
  • 64% were part of a sibling group.  Over 75% of the sibling groups were of 2 or 3 children.  The largest sibling group was of 8 children.

Reasons for a Final Care Order

  • 78% were recorded as having a primary need for care related to abuse or neglect with 10% family dysfunction and 6% family in acute stress

Placement Journey

  • 30% of children experienced no moves.
  • 46% one move. The range of number of moves was between 0 and 17

Figure 1 Number of Placement Moves

The child with 28 placements appears to have had a series of regular short term placements.

The number of placements varied by age with older children, particularly those aged 10-15 yrs, experiencing more moves. 

55% of the children had ceased to be looked after by 31 March 2017.  Of these 59% had been adopted, 11% returned home, 7% Special Guardianship Orders and 19% care leavers.  Overall 32% of the total cohort became adopted.

Children who became adopted after the final Care Order included more children in relation to whom a final Care Order had been granted without siblings 50%, than in the overall cohort of looked after children 36%. Where adopted children did have siblings subject to a final Care Order at the same time 56% were adopted as an intact sibling group, 18% adopted with some of their siblings and 25% adopted on their own.

Younger children were more likely to be adopted than older ones.

Figure 2 Number of Children Adopted by Age at Final Care Order

63 children returned home to live with parents, relatives or another person with parental responsibility. Of these 4 became looked after again.

Of the children remaining looked after at 31 March 2017 66% were in agency or local authority foster care with the numbers in each almost equal.  Other placements included with relative or friend, own parents, residential care and placed for adoption.

Findings from the In-depth Analysis of Outcomes for Children in Five Local Authority Areas

This more detailed part of the study provides valuable additional information about the characteristics of the children and their families. These included:

  • While only 14% of this smaller cohort of 79 children had a disability recorded the case file analysis showed an additional 16 children who had a recognised form of disability e.g. mild to moderate learning disability, autistic spectrum disorder or statement of special educational need for emotional and behavioural difficulties. Overall 34% of this group had a recognisable disability which is a significant difference from the reported statistics and for consideration of educational and health outcomes for these children.
  • 44% had a diagnosed attachment disorder or recognised issues with attachment. Previous research suggests this may under represent the true prevalence of attachment difficulties.
  • 29% had recognisable emotional and behavioural difficulties at the time of the final Care Order. This was 43% of the 5 to 17 yrs cohort.
  • All of the children had experienced some form of abuse or neglect.  77% had experienced neglect, 38% had experienced or witnessed the physical abuse of a child in the family, 24% had experienced emotional abuse. There were evidence-based concerns about sexual abuse for 25% of the children.
  • Three very prevalent adverse childhood experiences in this group were parents with substance misuse problems 76%, domestic abuse 68% and parental mental health problems 47%. In 27% of case all three issues were present.
  • 11% of the children had experienced the sudden death of a natural parent or grandparent in a key carer role around the time of care proceedings or final Care Order. Some of these were violent i.e. murder or suicide.

Table 1. Placement Outcomes in the Plan Presented to the Court at the Time of the Final Care Order

Overall desired placement type  No. of children in the cohort  % of children in the cohort 
Long term foster care  33  42%
Adoption  23  29%
Long term kinship care  14 18% 
Placement with a parent (including by gradual rehabilitation home initially)  5  6%
Long term residential care  3 4% 
Remain in hospital until able to be discharged  1  1%

The extent to which the placement plan was fulfilled was looked at in the short and longer term.

Table 2. Achievement of Placement Plans in the Short Term by Placement Type

Placement type   Achieved Not achieved 
Adoption only  16 (76%)  5 (24%)
Adoption or long term foster care  2 (100%)  
Long term foster care  24 (73%)  9 (27%)
Specified residential care  2 (67%)  1 (33%)
Placement with parent(s) at home  5 (100%)  
Long term kinship care  14 (100%)  
Remain in hospital until discharged  1 (100%)  


The study found adoption easier to achieve for younger children.  The children for whom the plan for long term foster care was not achieved in the short term were characterised by chronic histories of abuse and neglect 8/9 cases, having been exposed to extreme trauma particularly in the form of physical and sexual abuse 5/9 or being part of a sibling group intended to be fostered together 6/9.

The three children for whom residential care was the plan had severe attachment disorders identified at the time of care proceedings.

Over the longer term some of the initially achieved placements broke down.

  • 3 of the 5 placements with parents were not sustained. The children with not sustained placements were older and the placements broke down because parents could not sustain improvements in lifestyle. In one other case social services had become involved again.
  • 8 of 24 long term foster placements were not sustained. In 3 of the 8 the child was doing well but there had been a subsequent court order that they should return home. In 4 out of 5 of the other cases the children achieved permanence in another placement.
  • 4 of 14 kinships placements were not sustained. In 2 of the 4 cases the child or a sibling was abused by their carer and in 2 of 4 it became clear the kinship carers did not understand the child’s needs and could not respond appropriately.

Some children where the Placement Plan was not initially achieved subsequently achieved permanence in another placement for example 4 out of 5 children with a plan for adoption which was not achieved subsequently achieved permanence through long term fostering. 

There was a proportion, 9 out of 15, whose placement plan was not initially achieved who still did not have an alternative permanent placement 4-5 years after the making of their Care Order.  Almost all these children, 8 out of 9, experienced at least two and most experienced several placement breakdowns.

Outcomes for the Children

Amongst the outcomes the study comments on are:

  • 56 of the 79 71% of the children based on evidence from the case files, interviews and assumed success of the sustained adoptive placements have overall positive outcomes 4-5 years after the final Care Order.
  • 15/79 19% mixed outcomes and
  • 8/79 10% negative outcomes.
  • 66/79 84% were considered to be in stable and happy placements with good communication and attachments.
  • 45/72 62.5% of the children were in full time education employment or training (EET) and achieving well with reference to their cognitive ability.
    17/72 23.6% were in full time EET and achieving partially well and
  • 4/72 5.5% in part time EET and achieving partially well. 
  • 6/72 8.3% were children in either full or part time EET and failing to achieve.
  • 64/75 85% of the children where there was sufficient information had good physical health outcomes.
  • Of the 40 children old enough to have an outcome in relation to offending 88% were not offending and of the remaining 5 children only 1 was offending consistently including serious offences.
  • For emotional health and wellbeing there was insufficient information for two children. For the other 77 36 out of 77 47% were considered to have good emotional health and wellbeing with 25 out of 77 32% had partially good emotional health and wellbeing and 15 out of 77 19% were considered to be emotionally unhealthy or unstable.

Un-planned Placement Breakdown and the Factors Associated with These

There were 60 unplanned placement breakdowns affecting 26 of the 79 children.

Factors which sometimes overlapped included:

  • 43 instances where child challenging behaviour appeared to be the main or one of the main causes of un-planned placement breakdown.
  • 28 instances where carer or placement factors appeared to be the main or one of the main causes of un-planned placement breakdown.
  • 14 instances where both carer / placement factors and child factors appeared to be significant influences on the un-planned placement breakdown.
  • 14 instances where carer only factors appeared to be significant, for example where the foster carer wished to retire or stop for any other reason, and there were no significant child factors.

Whole System Factors

The study asked social workers, team mangers and Independent Reviewing Officers (IRO) about whole system factors that are helpful, what improvements can be made and about the role of the IRO.

Amongst the areas identified as currently helpful were:

  • Introduction of the Public Law Outline and the target timescale for care proceedings.
  • The quality and commitment of carers.
  • Having good links with schools who understand the needs of looked after children.
  • Good support for social works from managers who know the children.
  • Maintaining an experienced, stable workforce of social workers who can form positive stable relationships with the children.

Amongst the responses to a question about improvements that could be made were:

  • More choice of placements was the most common response.
  • Flexibility on the 26 week target for completion of care proceedings.
  • Need to prioritise children’s emotional health needs and provide therapeutic support.
  • Reasonable caseloads for social workers.

Responses about the IRO role included:

  • Overwhelmingly social workers and team managers valued the role including their independence, support for individual children to articulate their views and to advocate for them and ability to support the broader family on their rights and the process.
  • Variability in implementation of the role which can be positive but overall a desire for more consistency.
  • The role being compromised by high caseloads.
  • Greater involvement in the court process especially at the end so IROs are clear about the court agreed final care plan.
  • Most interviewees believed the existing processes for raising and resolving issues are clear.

Conclusions

This study suggests that many children and young people are doing well in care.  There are positive findings for the children in relation to their educational, social, physical and sexual health outcomes.

The study supports key findings from other research including that:

  • Younger entry to care is associated with better outcomes.
  • That the extent of exposure to chronic abuse and neglect is a strong indicator of negative outcomes.
  • A key factor associated with good outcomes is the quality of care provided in foster, kinship or residential care.
  • That the basic characteristics of good care are:
    • Stability;
    • Warm and nurturing homes;
    • Committed, proactive and inclusive care; and
    • Treating the child as a child of the family.
  • Children with more challenging behaviours are likely to cause stress for kinship and foster carers.

The study highlights that the proportion of children in care with a disability may be much higher than reported.

The study identifies some significant challenges for the children in Wales including:

  • Their exposure to early childhood trauma and disturbances in attachment patterns that are likely to affect the quality of subsequent relationships.
  • Child mental health and wellbeing in relation to issues of exposure to trauma, including through abuse and neglect, bereavements or separations in early childhood.
  • Achieving a good quality permanent home for children in sibling groups and for older children.
  • Maintaining safe, nurturing permanent placements as previous research has identified ‘compassion fatigue’ that cares can sometimes feel as a result of caring for children with complex needs.

The study makes the following recommendations

  1. It supports and finds evidence for the positive impact of recent policy initiatives including support for looked after children in education.
  2. Improvements may be needed to ensure that:
    1. Known or likely attachment difficulties are more formally recognised in commissioning and delivery of care placements and in better support for children in care. This support is unlikely to be provided within traditional specialist services such as Child and Adolescent mental Health Services.
    2. The emotional health and wellbeing need of children in care are addressed in a more pro-active way, recognising many will require some form of therapeutic support.
    3. There is increased availability of high quality long term foster care placements.
    4. Children with some form of disability are supported in a pro-active way.
    5. Children returning home or to live with kinship carers are protected from abuse and neglect and the children in these placements and their families are supported to achieve good outcomes.

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