In 2003, the government published a Green Paper called Every Child Matters. This was published alongside the formal response to the report into the death of Victoria Climbié, the young girl who was horrifically abused, tortured, and eventually killed by her great aunt and the man with whom they lived. The Every Child Matters (ECM) Green Paper identified the five outcomes that are most important to children and young people, which include being healthy, staying safe, enjoying and achieving, making a positive contribution and achieving economic well-being. These five outcomes are universal ambitions for every child and young person, whatever their background and circumstances (DfES, 2003). The outcomes are mutually reinforcing, for example “children and young people learn to thrive when they are healthy, safe and engaged, and the evidence shows clearly that educational achievement is the most effective route out of poverty” (DfES, 2003). Therefore in this essay I am going to critically evaluate the current legislation, policies and procedures that impact on looked-after children (LAC) with reference to two of the five ECM outcomes: being healthy and enjoying and achieving.
CONTEXT FOR LAC
Under the Children Act 1989, a child is looked after by a local authority if he/she is in their care or provided with accommodation for more than 24 hours by the local authority. This includes children who are accommodated under a voluntary agreement with their parents (section 20), children who are the subject of a care order (section 31) or interim care order (section 38) and children who are the subject of emergency orders (section 44) (opsi.gov.uk).
The Department for Children, Schools and Families (DCSF) national statistics for LAC in England (including adoption and care leavers) for the year ending 31 March 2009 noted that there were approximately 60,900 LAC, which is 2% more than last year’s figure of 59,400 and relatively unchanged compared to 2005 (61,000). The majority (73%) of children were of White British origin, with the remaining 27 per cent being from a variety of other ethnic backgrounds (DCSF, 2009). The majority of LAC – 73 per cent – are looked after by foster carers, with 1 in 6 of these placed with family and friends. A small number of children (290 in 2007) live in secure children’s homes, either as ‘welfare’ placements or placed by the Youth Justice Board. Nearly a third of children (30%) are placed outside of their local authority boundary, although around half of these still live within 20 miles of their home. This has implications for how services are commissioned for these children. The government therefore developed policies and legislation which highlight a drive towards significantly improving the future outcomes of all LAC.
HEALTH OF LOOKED-AFTER CHILDREN
It is important to note that children and young people should enjoy the best physical, emotional, mental and spiritual health and development so that they feel good about themselves and their lives (CYPNow, 2009). The National Service Framework for Children and Young People (DoH, 2004) also states that all children should achieve the best physical and emotional well-being. But research has shown that LAC’s physical and mental health is known to be significantly poorer than that of the general child population.
LAC are amongst the most socially excluded of all young people. They are frequently reported in government research, policy and guidance to have greater needs than their peers yet are less likely to receive adequate healthcare and treatment (DoH, 2004). Meltzer et al. (2003) found that almost two-thirds of all LAC were reported to have at least one physical complaint. The most frequently reported were eye and/or sight problems, speech or language problems, bed-wetting (including among older children), difficulty with coordination, and asthma (DCSF, 2008).
A study examining the immunisation status of over 3,000 children looked after by nine health authorities across England found that they were more than twice as likely as children living at home not to have received the meningococcal C vaccine (Hill, Mather et al., 2003). A study in Wales reported that children who had been in public care for at least six months were significantly less likely than children living in their own homes to have received immunisations against tetanus, pertussis and polio (DoH, 2002).
However all these studies were undertaken in the early 2000s and improvements in the health needs of vulnerable young people have since been recorded by most local authorities. For example, the average immunisation rate rose from 76.5 per cent in 2005 to 80 per cent in 2007 (DoH, 2008). This increase was influenced by the launch of the Quality Protects Initiative (1998) and the 2002 Department of Health Guidance on Promoting the Health of LAC which influenced many local authorities in the country to have local health teams dedicated to working with LAC. This holistic model of health in the 2002 guidance uses the domains of the Framework for the Assessment of Children in Need and their families (DH, 2000b). This is merged with the LAC system to create the Integrated Children’s System (DH, 2002) which provides the common framework for assessment, intervention and planning for all children in need including LAC. The guidance states that when a child enters the care system, they should receive a health assessment by a registered medical practitioner within 14 days, which provides a basis for a health plan which will then be reviewed annually (DH, 2002).
The mental health needs of LAC are widely known to be greater than those of the general population (Utting et al., 1997). Meltzer et al. (2003) found that 45 per cent of LAC aged 5 to 17 were assessed as having a mental disorder compared to 10 per cent of the general population, while a report by the National Foundation for Educational Research (2009) found that many care leavers were suffering from mental health problems (CYPNow, 2009). Early family experiences which may have resulted in the young person being in care, coupled with experiences within the care system such as frequent placement moves, bullying and abuse, may contribute to the high levels of mental health needs of LAC (Minty 1999 cited in Callahan et al., 2003).
In order to meet the needs of LAC with mental health problems, the Care Matters White Paper stated that the government “will use statutory guidance to ensure CAMHS (Child and Adolescent Mental Health Services) provide targeted and dedicated provision that appropriately prioritises children in care”. But the National Society for the Prevention of Cruelty to Children (NSPCC) saw a “startling discrepancy between assessed needs and service provision” for mental health. Research shows that up to 17, 000 children in care who have mental or emotional health needs received no support from CAMHS in 2006-07, leaving them reliant on voluntary sector provision (Ward et al., 2002).
A number of reasons are suggested to explain this mismatch of needs and services. Firstly, many general CAMHS use strict referral criteria to determine the appropriateness of referrals, and will only accept young people who meet those criteria. Long waiting lists further complicate issues for young people, and are an obvious way in which general CAMHS are unresponsive to the needs of vulnerable young people. Typically, young people are referred at a time of crisis. Although it is not necessarily appropriate for CAMHS to be entirely crisis responsive, it is nonetheless incredibly important for vulnerable young people to receive assistance at the point when they try to engage the system. Also many CAMHS services do not provide treatment at all for children in short-term placements or those deemed not stable, despite the fact that behavioural or emotional problems may prevent a child achieving stability. The result will be that each time a child moves placement they will have to be re-referred to CAMHS and start at the bottom of long waiting lists (Ward et al., 2002). For care leavers, it was noted that conflicting models of practice between child, adolescent and adult mental health services and higher thresholds for referrals into adult services affected professionals’ ability to provide care leavers with proper support (CYPNow, 2009).
Specialist teams and practitioners can improve the service children in care receive from mental health services by providing fast response and assessment, consultation to carers and social workers, placement support, and invaluable advocacy, as well as treatment (DoH, 2002). Also professionals and carers who work with vulnerable people need to be trained as they often find it difficult to identify mental health needs and to make appropriate referrals (Minnis and Del Priore 2001, cited in Harper and Dwivedi, 2004). The Audit Commission (1999) maintains that CAMHS should be planned in conjunction with other agencies, as the mental health of children and young people is the responsibility of all those directly involved with children and not just the responsibility of CAMHS (DfES, 2004), and this is in line with the Integrated Children’s System and the National Service Framework for Children and Young People (DfES, 2004).
EDUCATIONAL OUTCOMES OF LOOKED-AFTER CHILDREN
The importance of enjoying a good educational experience is fundamental for all children, and could be argued to be paramount for LAC and young people. The United Nations Convention on the Rights of the Child 1989, article 28 (1) states that “all children have the equal right to education” (cited by UNICEF, 2006). Jackson (1994) cited in Blyth and Milner (1996) points out that it is only through school that children earn a passport to a different kind of future as it improves the prospects for their employment, financial independence, personal and family life and health and well-being).Those without education are at a personal and institutional disadvantage. This is said to be one of the reasons why parents care so passionately: why they move house, take out insurance and even risk political censure to send their children to a school of their choice. Are local authorities prepared to make comparable sacrifices in their role as parents? Are they inspired to secure a different kind of future for “their” children? (Blyth and Milner, 1996)
Research shows that LAC achieve significantly poorer educational outcomes than other children. It has been noted that, in 2008-09, only 44 per cent of LAC had at least 1 GSCE or GNVQ compared to 46 per cent in 2007-8, and only 7 per cent obtained at least 5 GCSEs at grade A* to C, a figure which has remained the same over the last few years (DSCF, 2009).
Even though the government has initiated some policies and schemes to improve the educational attainment of LAC, wide-scale improvement has been much slower than anticipated. Some of the policies initiated include Quality Protects (1998), Children (Leaving Care) Act 2000, the Care Standards Act 2000, Every Child Matters Green Paper 2003 leading to the Children Act 2004, Education and Inspections Act 2006 and Care Matters: Time for Change White Paper 2007. Hayden (2005) states that “the main reasons for poor educational outcomes include: inadequate corporate parenting, the care environment, a failure to prioritise education, inappropriate expectations, placement instability and disrupted schooling as well as pre-care experiences” (Hayden, 2005: 343).
The Social Exclusion Unit report ‘A Better Education for Children in Care’ identified key areas for action based on improving the educational attainment of children in care. One was to minimise school absenteeism and exclusion of LAC in schools. This has been addressed by the Social Exclusion Policy Unit which was launched in 1997 and the Guidance on the Education of Young People in Public Care (2000) which states that LAC should not be permanently excluded and that exclusion is to be used only as a last resort (DfES, 2000).
Although national targets were set to reduce the number of school exclusions by one third before the year 2002, the scale of the problem is hard to quantify. Statistics on children permanently excluded represent only a proportion of exclusions, but over recent years numbers appear to have been rising consistently, especially among younger pupils. Social disadvantage is a common theme: children in public care, travellers, young carers and children with SEN, African Caribbean pupils and boys are particularly at risk. It has been estimated that up to 30% of children in public care are out of mainstream education at any moment whether through exclusion or truancy (DH, 2000). Separate on-site support units have yet to have much positive impact on exclusion or suspension figures, though school-based social workers and education welfare officers have been shown to be effective (Department of Health research in practice, 2000).
The use of designated teachers to work with LAC in schools was introduced by the government guidance ‘Supporting and Promoting the Education Achievement of Young People in Public Care’ (2000), and is also stated in section 20 of the Children and Young Persons Act 2008. The role of the designated teacher is to act as an advocate for LAC within their school and to work in partnership with other professionals when preparing a Personal Education Plan (PEP).
The Social Exclusion Unit (SEU) report found that although some schools actively promoted the use of designated teachers, other schools provided designated teachers with few or no additional resources (SEU, 2003). Fletcher-Campbell et al. (2003) cited in Petch (2009) found that there were difficulties in ensuring that all children in care actually had a PEP. Some teachers interviewed in their study felt that PEPs were just a paper exercise. Harker et al. (2003) reported a lack of understanding in some schools of the PEPs and the designated teacher’s role. Only 42 per cent of the young people in their study had heard of PEPs, and not all of those actually had one.
Out-of-school-hours educational support and extra-curricular activities can have a positive effect on educational outcomes and can play an important role in ensuring that looked-after young people are ‘enjoying and achieving’, an important objective in Every Child Matters (DfES, 2003). Article 31 of the UN Convention on the Rights of the Child also states that all children have the right to participate in leisure, cultural and artistic activities (UNICEF, 2008).
However, research has shown that current out-of-school-hours study support and extra-curricular provision for looked-after children vary a great deal by area. The Social Exclusion Unit found that only three quarters of the 2,000 children in care that it surveyed had access to after-school activities and clubs, and only two thirds used them (SEU, 2003). Those living in residential homes or with parents, as opposed to foster carers, had lower levels of access. Similarly, a study of sport found that more than one third of LAC not currently playing sport would like to, and 91 per cent of young people in care who were questioned identified at least one barrier to participation that they personally faced: cost (Who Cares? Trust, 2004).
The government developed the Department for Education and Skills Guidance (DfES 2006) which states that schools can use their delegated budgets to subsidise extended activities that bring an educational benefit for vulnerable children and young people, including LAC. The Green Paper ‘Care Matters: Transforming the Lives of Children and Young People’ (DfES, 2006) also encouraged local authorities to provide free access for children in care to all their facilities including leisure centres, sports grounds and youth clubs. However, the impact of these provisions on out-of-school-hours learning activities for LAC seems to vary across different schools and local authorities and still needs to be closely monitored.
On care leavers, studies have shown that the consequences of failing to obtain educational qualifications are very serious, often condemning young people to life on the margins of society (Biehal et al., 1995). Their chances to have a good and stable life are damaged by the lack of support and services offered whilst in care and during the critical transition to adult life.
Since the pioneering research of Stein and Carey (1986) cited in Biehal et al., 2004, the difficulties and challenges facing young people leaving care have been more widely recognised. For example, care leavers make up 30 per cent of homeless young people (Hutson, 1997). An inquiry by the Howard League into the use of prison custody for teenage girls found that 40 per cent of 15- to 17-year-olds had been in care (Biehal, et al, 1995). These effects are not short-term; with fewer jobs available for poorly educated people, the employment prospects of those formerly in care get progressively worse as they grow older and their opportunities for participation in mainstream society decrease (Biehal et al., 1995).
However, even though there is evidence of some progress in GCSE performance and in post-16 education and employment since the introduction of the Children (Leaving Care) Act 2000 (Petch, 2009), reports indicate that many young people are still leaving care early and that the main elements of transition to adulthood tend to be compressed and accelerated (McNeish et al., 2002). This therefore shows that social workers and other professionals involved with children in care still need to do a lot in making sure that young people are given all the support they need before moving out of care.
The importance of inter-agency working among professionals working with LAC has been stressed in numerous policies and legislation to improve their outcomes. For example, the Audit Commission report, Seen but not Heard (1994), cited in Alcock et al. (2008) stressed the necessity to accept shared responsibility when responding to the educational needs of LAC and young people:
“Social Services and education need to accept joint ownership of the problem of disrupted education of LAC and work together to find solutions” (Audit Commission, 1994, p. 25).
Most recently there has been Working Together to Safeguard Children (2006), which states that, “a shared responsibility and the need for effective joint working between agencies and professionals that have different roles and expertise are required if children are to be protected from harm and their welfare promoted” (DCSF, 2006: p.10). Successful inter-agency working is not always achieved as social workers and teachers have different professional cultures, and in today’s world have separate targets and goals, which are set by the Government. Current policies have identified social workers as being key to improving the standards of LAC’s education, as they advocate on behalf of LAC, initiate Personal Education Plans, arrange LAC reviews and liaise with all professionals involved in a LAC’s life. However the attitudes and actions of social workers have been considered as causal to the poor achievement of LAC. Specifically they have been criticised for giving education a low priority, having low expectations of LAC and failing to value the importance of education as a way of improving self-esteem (Iwaniec and Hill, 2000). Aldgate et al. (1993) reported that just 2% of social workers consider the support of educational attainment as an important aspect of their job. Harker et al. (2003) also suggest that the pressures of a social worker’s heavy caseload may result in them giving greater priority to issues they consider to be more important than the education of LAC.
Even though the government has launched a number of initiatives to improve the health and educational outcomes of LAC, progress has been slow and there is a lack of consistency across the country. Multi-disciplinary working has been identified as being central to ensuring that LAC are provided with the best opportunity to reach their full potential. The General Social Care Council (GSCC) code of practice states that social workers should “recognise and respect the roles and expertise of workers from other agencies and working in partnership with them” (GSCC, 2002). However, this is not always happening, as poor communication between social workers and teachers has been cited as a cause for concern in a number of studies. Therefore social work practitioners need to reassess their level of