***Update: we have also released a podcast on this topic***
In January, we published a new research report on children with complex needs in children’s homes. The report was based on a national survey of local authorities and children’s home providers across England to help us understand the extent of the difficulties they have when finding homes for children with these needs, and the barriers homes face in accepting them. We also carried out 10 case studies to identify good practice among local authorities and children’s homes, as well as the barriers they face and how practice could improve.
As we previously reported, the term ‘children with complex needs’ was used to describe children who have multiple needs of different types, and who require care and support from an array of professionals to meet their needs. These are typically children with severe mental health difficulties, or whose needs can manifest in behaviours that place the child or others at risk.
If you run a home that cares for children with complex needs, you may want to consider the good practice discussed here, and whether these examples can help you provide good experiences for the children in your care, and ensure they make progress.
What we found
The research revealed a challenging national picture:
- most local authorities (more than 9 out of 10) struggle to find homes for children with complex needs
- children sometimes wait years for a suitable placement
- many children with complex needs are living alone in homes, which risks leaving them isolated and vulnerable.
Good practice
However, we did find some common practices that resulted in good experiences for children. These included:
- considering a child’s needs and preferences
- providing consistency, through relationships, education and other activities
- getting children access to the right services and placements
- facilitating a sense of belonging for children, through helping them understand that staff will not give up on them and that this is their long-term home
Collaboration between agencies was also a vital common thread. When all the necessary information about a child’s needs is available to all relevant parties, decision-makers can tell whether a home will be a good fit. Joint working was also necessary to create bespoke placements targeted at a child’s individual needs.
These features are important for any child in care. But for children with complex needs, they are vital. We will deal with each of these elements in turn below.
Considering a child’s preferences
Involving children in decisions means they are more likely to feel positive about a placement or engage more readily with a service. It is also important to keep children informed about their options, how their preferences are being implemented, and any changes in their care.
Through the case studies in this research, we saw examples of how staff considered and implemented children’s preferences when children were moving into a new home – which can be disruptive and scary for any child. Where we saw this done well, it was because the child’s preferences led the transition process.
In one example, the child was asked whether they wanted to visit the home first. Because they didn’t want to, the home staff and social worker found other ways to introduce them to the home and make them feel comfortable. This included giving them video tours and providing a book with pictures of the staff and text about who they were.
Before the child’s arrival the home staff found out the child’s favourite meal, so that this could be prepared for their first night, and the room was decorated in the colours the child liked.
We heard examples of smaller decisions that children were included in, such as where they would take trips, the décor of the house, or what food to have. Having input in daily matters, or even seemingly trivial things, made children feel more comfortable in their environment and know that their views mattered.
Providing consistency
Maintaining some consistency for a child during a move into a new home, and then while they live there, is also important.
It allows the child the time and opportunity to:
- develop relationships with the adults and other children at the home
- develop routines
- settle into education and local clubs or activities
- make friends.
When a child first moved into a home, some professionals were able to:
- arrange for staff to move with the child
- make sure the child maintained their place in the same school
- find ways for the child to maintain relationships with key adults in their lives, such as certain teachers or therapists.
Once the child was in the home, we saw positive ways of maintaining stable staffing or finding ways to support them through changes. These included:
- making sure their favourite staff member was also on shift when a new member of staff was working
- arranging more visits with the child’s social worker or other trusted professionals, or family, when changes were occurring at the home.
Getting children access to the right services and placements
We know it is difficult to get access to external services for children, particularly mental health support. This is especially true for children with complex needs, as they often live in homes outside their original local authority and are some of those most in need of mental health support. Through the case studies, we saw various ways that children’s home staff were helping children to access mental health services.
There were some examples of home staff working jointly with child and adolescent mental health services (CAMHS) teams to set up in-house therapeutic support for a child. CAMHS provided support and supervision for the home staff and shared creative ideas tailored to the home and the child.
In some homes, in-house therapeutic support was available for children. This was bolstered with extra input from external services when necessary. Such an approach was a common and effective model for many children with complex needs.
Finding the right education placement for a child is also really important. We saw through our case studies that when children engaged with an education placement that suited their needs, the positive effects spilled over into many areas of their lives.
Facilitating a sense of belonging
Children feel more stable and have a greater sense of belonging when they know the long-term plans for their care. This removes uncertainty for them and helps them to feel more invested in making a placement work and seeing where they live as their home. The relationships children had with staff were also crucial in making them feel at home and like they belong. When staffing was consistent, this benefited relationships. But, most importantly, children’s sense of belonging was strengthened when staff were able to demonstrate their commitment to children.
We saw lots of examples of how staff demonstrated their commitment to children, helping them to understand that staff are there for them and genuinely care about them. These included:
- helping children to do the activities they love/pursue their interests and hobbies
- helping children to develop their cultural identity
- showing resilience and understanding after children express their frustration through aggressive behaviour.
This had a strong impact on children, many of whom have had many placement moves, when they understood and felt that staff won’t give up on them.
Inspections of home caring for children with complex needs
We know that some homes still hesitate to accept referrals for children with complex needs because they are concerned about how it might affect their Ofsted inspection outcomes. As we’ve said before, there is no need to worry about this. The inspection grades among homes that care for children with complex needs are no lower than among all homes generally.
But we know the perception persists and could limit the number of homes available for the children who absolutely need residential care. So, we continue trying to address homes’ concerns and reassure you that accepting children with complex needs will not affect your inspection outcome. Indeed, we mostly see children with wide-ranging needs supported well in caring homes.
As professionals with many years of experience in the sector, we know that children’s progress will not be linear. There will be crises and setbacks in their journey. Packages of support will need to be reviewed and adapted. And we know that we might need to look beyond what is happening on a particular day to consider the children’s care and support over a longer period.
We intentionally designed the SCCIF to focus on children’s experiences and progress, rather than their outcomes at a moment in time. The framework is intended to look at what adults are doing to help the children in their care have the best possible experiences and make progress that is individual to them.
We know we have more to do to reassure commissioners and providers, and we will continue to work with the sector to manage these sensitivities.
One of the topics raised in the Big Listen was children with multiple and complex needs. We are considering all the feedback and will respond in the coming weeks.
Although this research highlighted persistent challenges in the sector, many of the case studies provided uplifting examples of the good work being done to support vulnerable children with multiple and varied needs.