Children's homes commissioning plan
Children's homes commissioning plan
1 Children’s homes commissioning plan Authors: Kirsty Barrett, Ann James and Joanna Roberts Services for children and young people
2 Contents 1. Introduction . 4 1.1 Background . 4 1.2 Outcomes . 5 2. Legal and policy context . 5 2.1 Legal framework . 5 2.2 National policy . 6 2.3 Local policy and strategic objectives . 7 3. Commissioning principles and process . 8 3.1 Enabling commissioning framework . 8 3.2 Outcomes based approach . 8 3.3 Value for money . 9 3.4 Equalities . 9 4. Current services . 10 4.1 Overview . 10 4.2 National data comparisons .
10 4.3 In-house residential . 11 4.4 Independent residential homes . 14 5. Costs and benchmarking . 18 6. Needs analysis . 19 6.1 Profile of children and young people placed in children’s homes . 19 6.2 Placement pathways and histories . 21 6.3 Needs of young people in children’s homes . 24 6.4 Demand and forecasting . 25 6.5 Child in care overall trends (March 2013 . 27 6.6 Children’s homes placements trends . 30 7. Stakeholder feedback . 33
3 7.1 Views of children and young people . 33 7.2 Views of practitioners . 35 8. Research and good practice . 37 9. Challenges and potential for improvement . 41 9.1 Rising numbers and reducing budgets . 41 9.2 Complexity of needs . 42 9.3 Relationships and behaviour . 43 9.4 Involving children and young people . 44 9.5 Children who do not stay . 44 9.6 Moving on from children’s homes . 45 10. Commissioning recommendations . 46 10.1 Resources / budget . 46 10.2 Commissioning recommendations . 46 10.3 Options appraisal . 46 10.4 Indicative timetable . 47 Appendices Appendix 1 – Voice young people living in Bristol children’s homes Appendix 2 – Research messages: children’s homes Appendix 3 – Children’s homes research report summaries Appendix 4 – Draft outcomes matrix Appendix 5 – Equality impact assessment
4 1. Introduction 1.1 Background Bristol City Council is reviewing how it commissions placements for looked after children to make sure there are the right type of homes available for all children and young people in our care. Our objective is to commission a range of quality, local placements that achieve good outcomes for children and young people and provide value for money. To achieve this we have already done the following: Established a new arrangement for purchasing placements from Independent Foster Agencies Reviewed our in-house foster service to identify improvements and steps to increase the number of placements it provides Developed a commissioning plan for specialist accommodation and support services for young people with higher support needs under which new and revised services will start from December 2013.
The other work on-going to achieve the right balance of placement types includes: Reviewing specialist educational needs (SEN) provision in the city and developing a plan to make sure we have provision, in the right locations, that meets children’s needs. This will include consideration of what residential schools provision we need to commission. Developing a commissioning plan for services that provide short breaks to disabled children and their families, including residential short breaks. Consultation on this draft commissioning plan will start in December 2013. Setting up a specialist foster service for 7-11 year olds with complex emotional difficulties and challenging behaviour1 .
Establishing a parent and child assessment scheme to provide specialist foster placements and quality parenting assessments. This plan sets out how we intend to commission children’s home placements for children and young people in care. It does not deal with the commissioning of residential placements in Registered Special Schools or residential short breaks as those will be the subject of separate plans. It also does not cover secure placements. We will consult on this plan in November and December. We will then revise the plan, taking into account consultation feedback and invite the council’s Cabinet to adopt the plan, probably in February or March 2014.
1 This will be a multi-dimensional treatment foster care (MTFC) scheme and is being partly funded by the DfE as part of the DfE’s Evidence Based Intervention Programme.
5 1.2 Outcomes Across all types of placement for looked after children, we intend to commission placements that enable children to achieve their potential by providing them with stability and supporting them to achieve positive outcomes, both short-term and long-term. We will expect placement providers to focus on the outcomes below. Be safe Stable placements close to young people’s families Children and young people will report that they feel safer and happier than they did six months ago Fewer children will go missing from care Care leavers at 19 will live in suitable accommodation Be healthy, socially engaged and a successful learner Improved educational attainment Fewer fixed term exclusions from school Reduced offending and anti-social behaviour Care leavers at age 19 will be in education, employment or training Less problematic drug and alcohol use More involvement in regular organised activities Be supported Children and young people will report that they have someone to talk to about things that upset them 2.
Legal and policy context 2.1 Legal framework Registered children’s homes are covered by legislation and regulations and can only be provided to children who are in the care of the local authority. The following applies: Children Act 1989 Part 3, ss. 20-22 set out the circumstances under which the local authority must look after a child and provide that child with accommodation. These provisions also require that local authority makes sure there is sufficient local accommodation, with foster carers and in children homes, to meet the needs of its looked after children and other children it has a duty to accommodate.
The Children's Homes Regulations 2001 (amended by the Children’s Homes (Amendment) Regulations 2011) set out how children’s homes should be managed so that they offer children reliable, safe and stable care.
6 The National Minimum Standards for Children’s Homes are issued by the Secretary of State under section 23 of the Care Standards Act 2000. Together with the Children’s Homes Regulations they form the regulatory framework for the conduct of children’s home providers. Minimum standards do not mean standardisation of provision. Instead, the standards are designed to apply to the wide variety of different types of children’s homes.
They aim to enable, rather than prevent, individual providers to develop their own particular ethos and approach based on evidence of the most appropriate way to meet the child’s needs.
Children Act 1989 Statutory Guidance and Regulations set out the functions and responsibilities of local authorities and partner agencies under Part 3 of the Children Act 1989. In particular the following volumes describe how local authorities should carry out their responsibilities to children in care and in children’s homes: o Volume 2: Care planning, placement and case review o Volume 5: Children’s Homes 2011 – Statutory guidance on the Children’s Homes Regulations 2001 (amended) o The guidance is issued under section 7 of the Local Authority Social Services Act 1970 and is addressed to local authorities but is also relevant to providers of children’s homes.
The Inspection of Children’s Homes Framework 2013 sets out the framework and guidance for the inspection of children’s homes. 2.2 National policy The Government sees rresidential care as an important placement option for looked after children, stating that ‘children’s homes need to offer young people in their care a positive, warm and caring environment so that they can flourish and achieve their potential’. In September 2010, alongside the revised regulations detailed above, it established a programme of work to support the residential care sector and encourage continuing improvements in the quality of residential care for children.
This included induction standards for those working in children’s homes and revised qualification and workforce development measures.
More recently, in response to the Report of the Office of the Children's Commissioner's inquiry into child sexual exploitation in gangs and groups, and the All Party Parliamentary Group joint inquiry report on children who go missing from care, the Government has consulted on changes to the Regulations. These changes aim to increase accountability for and oversight of decisions to place children in homes at a distance from their responsible authority and to strengthen the inspection framework for children’s homes.
In September 2013, the department for education published its second data pack on children’s homes.
Current research supports Bristol’s strategy to have local responses to children in care in so far as is reasonably practicable, including the
7 provision of sufficient children’s homes places for those whose needs cannot be met in a family placement. 2.3 Local policy and strategic objectives The council’s Children’s and Young Peoples Services is undergoing a series of changes to respond to two major challenges: reductions in Government funding, and the rapidly growing number of children in Bristol, more of whom are disabled and / or have special educational needs. These change activities are combined with the “Children First” programme and are focused on helping children and young people to be safe and achieve their potential.
We are working alongside our partners to make the changes.2 Our commissioning priorities are set out in the Children’s Specialist Commissioning Plan 2012-20153 . These priorities are: (i) Support children to remain safely with their families Securing sufficient accommodation requires a whole-system approach that includes early intervention and prevention services to support children in their families. We must be effective by focusing our work on those families most at risk of requiring increasing levels of service provision, including care.
(ii) Improve outcomes for children in care and care leavers Children do better in well-matched stable placements. We will build upon our trusted and confident relationship with the market to deliver an increased choice of quality placements that are able to meet the needs of our children locally. (iii) Achieve value for money and reduce spend through effective cost management We will listen to what children and families tell us is effective, and work with our partners and the market to deliver more with fewer resources. We will work both locally and regionally, on a strategic and operational level to ensure that the placements we commission deliver more effectively.
Expenditure will be controlled and monitored against delivery of outcomes. 2 Information about the Children First programme is available on the council’s website http://www.bristol.gov.uk/page/children-and-young-people/changes-children-a nd-young-peoples-services- children-first 3 https://www.bristol.gov.uk/sites/default/files/documents/children_and_young _people/about_bristol_child_ and_young_people_service/Children%27s%20Specialist%20Commissioning%20Plan%2 02012-15_0.pdf
8 3. Commissioning principles and process 3.1 Enabling commissioning framework Strategic commissioning is the process by which the council identifies strategic outcomes and priorities in relation to people’s assessed needs and designs and secures appropriate services to deliver these outcomes. Services can be provided in-house or by external providers. In order to guide and standardise strategic commissioning practice, the council has developed the Enabling Commissioning Framework. This includes a comprehensive set of guidance, templates and checklists for use in all commissioning processes which will support public, private and voluntary, community and social enterprise (VCSE) organisations to better engage in commissioning processes and secure contracts.
The Enabling Commissioning Framework is based on four key elements: Analyse – understanding the service priorities, values and purpose, the needs they must address and the environment in which they operate. Plan – identifying the gaps between what is needed and what is available, and planning how these gaps will be addressed within available resources. Do – ensuring that the services needed are delivered as planned, to efficiently and effectively deliver the priorities, values and purpose set out in the commissioning plan.
Review – reviewing the delivery of services and assessing the extent to which they have achieved the purpose intended.
More information about the Enabling Commissioning Framework is available on the council’s website: http://www.bristol.gov.uk/page/enabling-commissioning 3.2 Outcomes based approach An outcomes based approach is not overly prescriptive in the specification about the services to be provided. Instead the procurement process will specify the outcomes being sought and the service users who will be eligible for services. This approach aims to support innovation but, in such a highly regulated area, there will inevitably be areas that must be subject to detailed specification and agreement about how services will be delivered.
Any procurement processes will include an assessment of whether the proposed service is likely to address the needs of relevant young people and enable them to achieve any outcomes identified (see p.2 above). The assessment will be based on evidence provided about the specific approach and its
9 appropriateness for the relevant young people. The strength of evidence base will be critical to the chance of success. Throughout the contract period, commissioners will work together with providers positively and constructively to achieve outcomes for young people using the services. The quality of services and achievement of outcomes will be evidenced through reporting processes and regular monitoring. Proposed outcomes are set out in this document. 3.3 Value for money The general duty of best value requires the council to “make arrangements to secure continuous improvement in the way in which its functions are exercised, having regard to a combination of economy, efficiency and effectiveness.”4 This means that we must consider overall value, including economic, environmental and social value, when reviewing service provision.
The aim of commissioning is therefore to achieve value for money, i.e. services that deliver the best balance between economy (cost), efficiency (degree of output) and effectiveness (outcomes and results). 3.4 Equalities This commissioning plan aims to tackle discrimination and promote equality for all groups. We have done an initial equality impact assessment that we will consult on during the consultation period (see Appendix 5). Providers will be required to demonstrate their commitment to providing an inclusive environment that is equally effective in meeting the needs of all protected characteristics.
Providers will also be required to comply with the s.149 Equality Act 2010 public sector duty to have due regard to equality objectives. Contract monitoring will include comparing outcomes for children and young people in different equality groups. We will expect providers to take action to address any significant differences for particular groups.
4 Section 3(2) Local Government Act 1999
10 4. Current services 4.1 Overview In the period April 2012 and August 2013, we had between 43 and 56 of our looked after children living a residential care each month. These included children and young people placed in children’s homes, residential schools and secure units. We looked closely into the cases of those young people living in children’s homes during the period October 2012 and April 2013, a total of 41 young people. Of these, 35 were placed in one of our council-run homes. The other six young people were placed in six different independent children’s homes.
We carried out a review of our in-house children’s homes as well as the independent homes we use regularly. The findings of those reviews are set out below. We also considered how successful we are at finding suitable, local placements for our looked after children, compared to other local authorities as well as the price we pay for placements, compared to national averages.
We concluded that our in-house services provide good value for money and give us a level of control over local services that is very important. This control means that we are able to find local children’s homes places for nearly all young people who need them. However, two of our in-house children’s homes have “adequate” Ofsted judgments and require improvement. This plan sets out other improvements we want from our in-house homes. 4.2 National data comparisons Bristol is performing well, compared to other local authorities, both in terms of placing looked after children within our local authority boundary and in the price we pay for children’s homes placements.5 See section 5 for cost comparisons.
At 31.3.12, Bristol had placed 5% of its looked after children in children’s homes compared to 7% nationally. Of those children, Bristol managed to place a higher proportion of children within its border than any other local authority in the country: 97% compared to 54% nationally. We are also successful in making best use of the homes located within our boundary -- 73% of the children living in children’s homes in our local authority area were in the care of Bristol, compared to 55% nationally. This is likely to be a reflection of the fact that a high proportion of the homes in our area are run by the council.
This gives us a high degree of control over local provision enabling us to make sure that local homes take our children, even where they may have challenging behaviour(s) or complex needs.
5 National data taken from DfE Children’s Homes Data Pack 13 September 2013
11 At 31.3.12 there were ten children’s homes in the Bristol local authority area of which six were local authority homes and four were private or voluntary homes. The majority of Bristol young people (85%) were placed in Bristol City Council children’s homes. Nationally only 28% of children’s homes places are in local authority run children’s homes. Of Bristol’s five in-house children’s homes, the latest full Ofsted reports for each home as at August 2013 show that August 2013 three (60%) were rated “good” by Ofsted and two (40%) were rated “adequate.” None were rated “outstanding” or “inadequate.” Nationally 15% of children’s homes were rated “outstanding”, 57% “good”, 24% “adequate” and 4% “inadequate.” Bristol children’s homes, with five places each, are slightly smaller than the national average for local authority children’s homes (5.8 places), but larger than the national average for private and voluntary children’s homes (4 places).
Nationally there were 101 (6%) homes registered for just one place and 239 (14%) for two places. 4.3 In-house residential Bristol City Council has five children’s homes each with five beds. One is designated as an independence training unit and tends to house older teenagers preparing to leave care and live more independently. However, older teenagers also live and prepare for greater independence in the other homes too. In April 2013 the council closed Capgrave Crescent, which was a children’s home for 11–14 year olds with the intention children and young people in the 11-13 age group should live in foster placements, not children’s homes.
Location and facilities The remaining homes are located across the city: MAP REMOVED FOR PUBLICATION The council’s children’s homes are well-maintained and generally unobtrusive in their neighbourhood. The homes have a similar range of internal spaces: including large kitchens combined with dining areas, lounges, computer/games rooms and so on. Each home has a minimum of one staff office where confidential records are kept. The young people’s bedrooms are standard single sized rooms and, with the exception of one home where each bedroom is en-suite, have shared bathroom and toilet facilities.
The focus of activity is usually the kitchen area or lounge areas. Repair and maintenance of the internal areas of the homes is both planned and responsive. The homes tend to be repaired as and when needed.
12 Below, the total spends for repairs and maintenance (both planned and responsive, including grounds), is summarised. 12/13 Spend G £12,229 H £18,425 J £12,434 K £30,029 L £17,927 TOTAL £91,044 Staffing Each house is staffed as follows: Bristol Grade Job Title FTE Posts BG12 Unit Manager 1 BG10 Ass Unit Manager 2 BG8 Residential Worker 8 BG7 Admin 1 BG1 Domestic 1 There are more female than male staff: Home % of Male Staff % of Female Staff G 29 71 H 23 77 J 31 69 K 46 54 L 23 77 Average 30.4 69.6 Quality Home Ofsted judgment (latest full report as at August 2013) Overall effectiveness comments G Good Provides good standard of care to young people.
The care each young person receives focuses on their individual needs and abilities. Young people form sound relationships with the experienced and stable staff team and the
13 Registered Manager. H Adequate The home is managed by an experienced manager and staff group. Young people form positive relationships with their staff team and the Registered Manager. Young people say they are satisfied with the quality of care that they receive and say that they feel safe and are looked after well. The improvements required relate to safety precautions in case of fire, smoking, storage of medication, checking visitors, monitoring visits, supervision of staff and improvements to the physical conditions of the home. J Good Young people receive a good quality standard of individualised care from an experienced enthusiastic and stable staff team.
Young people are very positive about the quality of care they receive and feel safe. Good role models and excellent relationships facilitate positive attachments between young people and the staff team.
K Good The home provides an excellent level of care and outcomes for young people are good. Young people speak very positively about the care and support they receive. Shortfall in the quota of care staff with a first aid qualification. L Adequate Lower levels of staff due to departures and unforeseen absence of permanent staff members. Still maintains stable and effective relationships with young people. Young people say they feel safe and well cared for. Several matters have been raised for improvement. They relate to recording of physical interventions and debriefing following incidents of physical restraint or challenging behaviour, staff supervision and appraisals, notifications, safe recruitment and vetting of staff, consultation with young people and providing the children’s guide in different languages.
14 Occupancy rates The table below shows averages for 2012-2013. Children’s home % beds allocated by unoccupied G 26% H 12% J 16% K 4% L 11% As part of this review, we have been thinking about children who have an allocated bed but who do not always stay. Can we meet those children’s needs in a different way and utilise our children’s homes for those who really need the service? 4.4 Independent residential homes National framework agreement As a sub-regional consortium, Bristol City Council, Bath & North East Somerset, Gloucestershire County Council, North Somerset Council, Wiltshire Council and South Gloucestershire, have a sub-regional framework agreement for the placement of Children and Young People in Residential Care Homes.
There are 37 providers on this agreement and children are placed using the national children’s homes contract. We spot purchase placements from providers on this agreement when they are required.
The sub-regional consortium began to use the framework agreement in February 2012. The agreement expires in January 2015, with the option of a one year extension to January 2016. Children’s homes used In the last year, Bristol children have been placed in eight independent children’s homes. The information provided by each of these homes is summarised below: Home A A is a spacious home offering high-quality accommodation and care in Bristol. It is registered to provide residential care and education for children with Autistic Spectrum Disorders, physical and emotional behavioural difficulties.
It is registered for young people from the age of 8 to 18, male and female. The approach is stated
15 as holistic and child-centred with care programmes and packages tailored to each resident's specific needs. Home B B is part of a large national provider of independent children’s homes. It is a registered children’s home for boys and girls with emotional and behavioural difficulties, between the ages of 10 and 17 upon admission but may continue to provide for young people above this age if it is part of an agreed care plan. It can accommodate up to four young people for up to 52 weeks per year, however at the time fo asking, accommodation was being restricted to two young people. Home C C is also a home delivered by a large national provider.
It is a medium to long term residential home for children and young people who require accommodation for the period of time they have to live away from their families. Although the home can cater for boys it currently specialises in providing residential care to vulnerable girls who exhibit challenging and debilitating behaviour Home D D is one home in a group of homes with education, providing a residential service for the care of up to four children and young people (boys and girls) aged between 8 and 18+ years (with a maximum five year age difference) who have a care history and who may also present with emotional, psychological, behavioural, personality or social difficulties, especially attachment disorders.
Home E E provides a residential service for two young people aged 8 years to 18 years who need to be looked after by the local authority and who require a clear and planned stable placement. As the age range implies, we acknowledge the importance of clear structured planning for young people who will eventually need to move on towards independence and the environment and supportive structures in place facilitate this effectively. E is ideally situated for those young people who require an intensively supported placement away from peer group and other adverse influences. Home F F is a residential children’s home for 11-17 year old boys and girls and provides care for five young people.
Currently, it accommodates male placements only. All young people placed exhibit social difficulties and are receiving support in addressing an underlying lack of communication skills, awareness skills or self-esteem that is contributing to these difficulties. Most of the young people at F also display forms of challenging behaviour, are very vulnerable and are placed for their own welfare. Some young people may experience other developmental delay, emotional or cognitive difficulties.
Home G G provides a specialist integrated day and residential service for children and young people between the ages of eight and 19 years who have a diagnosis of an autistic spectrum condition. Residents may attend G school or other educational provision in the locality. There are currently 22 pupils on roll, most of whom are boys. Almost all
16 pupils are in Years 8 to 13. All pupils have a diagnosis of an autistic spectrum condition and have a statement of special educational needs. Home H H is a home in Bristol that was established to provide medium to long-term care for young people who are looked after, whether on a voluntary accommodation basis or by virtue of a care order.
It provides child centred residential care for young people, enabling them to achieve their potential in a safe and stable environment. Based in the South West of England and Wales, We offer professional support to young people who often experienced neglect resulting in behavioural and emotional difficulties option.
Geographical spread of out of authority providers used: MAP REMOVED FOR PUBLICATION Quality Home Ofsted judgment (latest full report as at August 2013) Overall effectiveness comments A Good The standard of care provided at the home is strong with good robust recording systems in place. Good personalised care ensures young people feel valued and are treated as individuals. Staff are valued and demonstrate a good understanding of safe working practices. Young people confirm they feel safe and happy at the home and bullying is not an issue. B Good Young people make good progress in relation to their starting point on admission to the home in all aspects of their care, well-being and education Young People have a committed, effective, stable staff team who are appropriately trained and proactive at meeting the needs of the young people.
Young people are happy at the home and support the staff Leadership at the home is strong and the manager is aware and understands the areas which require further development C Good The service has a positive impact on developing
17 young people’s personal development, physical and emotional health. Each young person is valued, treated fairly and is supported to reach their full potential. Approach to behaviour management has helped develop young people’s personal control and anger management; this results in good relationships and decreasing incidents of risk- taking behaviour.
The home is well organised and managed, and strengthened with an experienced and competent care team. D Good This home provides an excellent quality of care to young people, who are at the centre of all that the home does. Care is delivered in a highly personalised way which meets young people's needs and enables them to make good progress and stay safe. This totally child-centred approach is led by the very hands-on manager, and determines everyday living in the home. There are some shortfalls in relation to monitoring, training, supervision and appraisal. These are particularly relevant as the home is poised to admit new young people and recruit new staff.
E Good Good - Young people progress well at this home because they receive personalised and well- planned care.
Young people, staff and a social worker were very complimentary about the standards of care in the home. Young people say they feel safe and secure in the home. Leaders and managers understand the strengths and areas for development of the home and have plans in place. F Good Taken from School Inspection (ESTYN, Wales), as no residential inspection found (CSSIW also do not ‘grade’ on first inspections, which this would have been). Behaviour is managed well; and proprietor ensures that C&YP have access to a wide range of appropriate specialist support services. G Adequate Adequate - In July 2012, the full inspection of the home judged its overall effectiveness to be good and did not identify any problems.
This interim inspection found that the home has made satisfactory progress since then, because it has maintained the quality of care and outcomes for young people.
Since the homes last full inspection Ofsted
18 agreed to a minor variation to its categories of registration to reflect that it is currently a home for children with learning disabilities as well as emotional or behavioural difficulties. H Good Good - Young people living in this home benefit greatly from enthusiastic, committed and experienced staff. Outcomes for young people are outstanding because staff are persevering and energetically supportive. Young people confirm that their views are genuinely sought and acted upon. Educational needs are very well met with young people making extraordinary progress.
5. Costs and benchmarking Costs of children’s home placements The average gross weekly unit costs set out below are the total cost of the placement including SEN and NHS contributions. The net costs to social care exclude those SEN and NHS contributions.
The average price Bristol pays for children’s homes placements is relatively low compared to the national average6 . We pay £2,361 per week for a place in one of our local authority children’s homes, whereas the national average cost of a local authority placement is £4,135. For independent children’s homes placements, BCC pays an average of £3,271, whereas the average nationally for independent homes is £3,800. The weekly net cost we pay in Bristol for a council children’s home place (£2,361 excluding management costs and costs of buildings repairs and maintenance) is broadly similar to that of the “care only” cost we pay for an independent children’s home placement (£2,473).
Placement type Average gross weekly unit cost Average net cost to social care BCC children’s home £2,361 £2,3617 BCC placements with independent children’s home (with no SEN funding)8 £3,131 £3,131 BCC placements with independent children’s home (with lower level of SEN £2,865 £2,352 6 The Bristol OOA calculations exclude two very costly placements of over £6,000 per week. 7 Unit cost calculated for 2011-12. There are also repairs and maintenance costs of c.£58/week and management costs of c.£45/week – these should be added to provide a true total cost per unit. 8 Averages calculated from payments made in February 2013
19 funding, £1,058 of less)9 BCC placements – average of all independent children’s home placements10 £3,271 £2,473 Local authority children’s home - national11 £4,135 NA Private / voluntary children’s home - national12 £3,800 NA BCC foster care (excluding kinship)13 £403 £403 BCC placements with independent foster agencies (IFAs)14 £756 £756 6. Needs analysis 6.1 Profile of children and young people placed in children’s homes We considered the information we held about all young people we had placed in children’s homes as at October 2012, to get a snapshot. At this time there were 41 young people placed in children’s homes (including in-house and out of authority placements, but excluding those placed in residential special schools).
We have compared the local data with national data contained in the Children’s Home Data Pack published on 13 September 2013 by the Department for Education. Demographics All the young people we had placed in children’s homes were aged 13 or more. The ages of the children are set out in the graph below. The mode (the age that appears most often) is 15 years, which is the same as the mode nationally for children living in children’s homes.
Overall, 54% of the young people were boys and 46% girls. Nationally, 63% of children’s homes residents are male. The majority, 71%, of the young people were of 9 As above 10 As above 11 Source: Children’s Homes Data Pack, DfE 13 th September 2013 12 As above 13 Unit cost calculated for 2011-2012 14 Unit cost for April-July 2013 taken from A30 IFA analysis CHIPS report
20 White British descent and 29% were non-white British. This broadly reflects the proportions in the Bristol child population. Race No. of young people Any Other Black Background 1 Black - Sudanese 1 Black African 1 Black/Black British/Somali 1 Caribbean 2 Other - Afghan 1 Other - Iranian 1 White & Black African 1 White and Black Caribbean 3 White British 29 Total 41 90% of the young people in residential care spoke English as their first language.
First language No. of young people Arabic 1 English 37 Farsi 1 Pashto 1 Somali 1 Total 41 Disabilities and SEN 24% of the young people in residential care had a diagnosed disability as follows: Disability No. of young people Autism/Asperger’s 2 Behaviour difficulties 2 Hearing impairment 1 Learning difficulties 4 Unspecified disability 1 Total 10 39% of the young people had a Statement of Special Educational Need (SEN) or a Statutory Assessment for SEN underway. The vast majority of the young people’s SEN category was Behavioural, Emotional and Social Difficulties (BESD).
21 6.2 Placement pathways and histories Reason for entry into care The majority (56%) of young people placed in children’s homes entered care as a result of abuse or neglect. Entry into Care Code Description No. of young people N1 Abuse or Neglect 23 N2 Child's Disability 0 N3 Parental Illness or Disability 1 N4 Family in Acute Stress 2 N5 Family Dysfunction 8 N6 Socially Unacceptable Behaviour 4 N7 Low Income 0 N8 Absent Parenting 3 None Unknown 0 Age at entry into care Analysis of all children in care at 31.10.12 shows that of young people living in Bristol children’s homes and semi-independent supported accommodation, over three quarters were aged 11 or over when they first came into care: Age in years % of young people 0-5 6% 6-10 17% 11-15 42% 16 and over 35%
22 Previous placement Over one third of the young people in children’s homes previous placement was another children’s home. Over one quarter were previously placed with foster carers. Slightly less than a quarter moved from their family home to a children’s home. Code Previous Placement Type No. of young people % of young people FP Relative or friend in LA boundary 1 2.4% From Home 9 21.9% H5 Residential Accommodation 1 2.4% K1 Secure Unit 1 2.4% K2 Children’s Homes & Hostels 15 36.6% P1 Placed with own Parents 1 2.4% Q2 Placement with Foster Carer 11 26.8% R1 Residential Care Home 1 2.4% R5 Young Offenders Institution or Prison 1 2.4% TOTAL 41 Placement stability The table below shows the number of placements for each young person as at October 2012.
The young person with 6+ placements had a total of seven placements, three in secure units, two in residential care homes, one in a children’s home and one with the NHS. National data suggest that Bristol placing a young person in a children’s home is used more as a last resort compared to the national picture. This is consistent with our policy of placing children and young people in a family setting wherever possible.
Number of Placements % of BCC young people % Nationally 1 14.6% 29% 2 19.5% 25% 3 12.2% 15% 4-5 24.4% 16% 6+ 29.3% 15% Placement duration Of those placed in Bristol children’s homes, 51% of placements lasted longer than one year. The following pie chart shows the duration of the placements within Bristol
23 Children’s Homes up to June 2013. As at this date, the majority of children and young people (32.5%) had been in a children’s home placement for 0-6 months. Duration % of young people 0-6 months 32.5% 6-12 months 22.5% 12-18 months 12.5% 18-24 months 20% 2-3 years 5% < 3 years 7.5% Move on placements The pie chart that follows shows where young people moved on to from their children’s home placement.
24 The highest percentage (35%) of young people moved on to independent living with formalised support (i.e. supported accommodation with Youth Projects or 1625 Independent People). Four young people moved on to a foster placement with a relative or friend, but no young people moved on to unrelated foster care. 6.3 Needs of young people in children’s homes Range of needs and presenting behaviours The case files of young people in Bristol children’s homes identifies that they have a range of needs and behaviours including: Possible sexual exploitation Drug and alcohol use Offending Running away and sleeping rough Violence, anger and verbal abuse directed at others Victim of violence (parental and from others) Witness of violence including domestic violence Possible sexual assault Potential to harm younger children Poor mental health, anxiety, emotional instability Obsessive tendencies, including a fascination with blades Experience emotional, physical and/or sexual abuse Low self confidence Vulnerable Personality disorder Feeling unsafe and overwhelmed Findings from research See Appendices 2 and 3 for more details.
Our research review indicates that generally young people in children’s homes in the UK are getting older, with 14-15 years old now being the typical age. Local authorities report that there has recently been a growth in complex needs, and that more young people now need specialist support. The young people in children’s homes tend to have more severe attachment issues following multiple breakdowns of previous placements and significant emotional, social and behavioural difficulties. They were six times more likely to have mental health problems compared to other looked after children, and three quarters were reported to have been violent or aggressive in the past six months, with the same proportion reported to have put
25 themselves at risk. Children in children’s homes were also more likely to have low levels of educational attainment compared to their peers. Some young people preferred to live in a children’s home and actively rejected foster care. There may be a number of reasons for this, most often related to attachment difficulties of some sort but also a desire to display loyalty to their own parents or previous negative experiences of being fostered. 6.4 Demand and forecasting Population projections by broad age band The Bristol population of children aged 0-5 years increased significantly between 2000 and 2012 as shown in the graph below.
Projections indicate that numbers in the 5-11 year age band will continue to increase significantly. However, the numbers in the 12-18 age band are not projected to increase until around 2018 (see graph below). As this is the age group that tends to be placed in children’s homes, we do not expect an increase in demand for children’s homes places to result from population increases in the next five years. However, we will continue to monitor this and revise our forecast projections as appropriate.
26 General children in care population The past year has seen the number of children in care in Bristol rise from 685 to 720, an increase of 5% compared to a 2% increase nationally.
Bristol’s child in care population has grown more rapidly in recent years, catching up with the national average in terms of rate of increase. It is helpful to look at the rate per 10,000 as detailed in the table below which shows that Bristol’s rate has not changed significantly over the past five years whereas the national rate has increased by 9% and by 6% amongst statistical neighbours. It is worth noting that Bristol’s rate is still relatively high and when compared to the Core Cities the rate per 10,000 has grown in the face of a reducing average. Children in care per 10,000 at 31st March15 2009 2010 2011 2012 2013 % change Bristol number of children in care 650 645 680 685 720 +11% Bristol rate per 10,000 of the under 18 population 82 80 84 78 82 0% 15 Taken from DfE Statistical First Release data in September 2011 for years 2009-2011; in September 2012 for 2012 and in September 2013 for 2013.
27 Statistical neighbours average rate per 10,000 72 77 79 77 76 +6% Core cities average rate per 10,000 92 97 96 88 88 -4% England average rate per 10,000 55 58 59 59 60 +9% The table below shows how Bristol is ranked in comparison to the rate per 10,000 of both Core Cities and Statistical neighbours. In addition to the demographics of the city, a number of factors have influenced this changing pattern including changes to the statutory framework, case law decisions, the outcome of recent Serious Case Reviews and potentially the impact of welfare reform, given that there is a close correlation between deprivation and referrals to social care, including children entering care.
6.5 Child in care overall trends (March 2013) Length of care: The number of children looked after for more than 12 months increased slightly from 484 in 2012 to 495 – a rise of 2%. Entry and exit: In 2012/13, 299 children entered care during the year and 269 left care (a net gain of 30). This is a 10% increase in the number of children entering care, compared to 2011/12. Adoptions and SGOs: In 2012/13, 9.3% of the population exited care with either an adoption order (23 children) or Special Guardianship Order (31 children). As this is a new indicator, we are unable to report on the trend compared to the previous year.
Age: The composition of the children in care population by age has not changed significantly over the past year. It is the oldest age group of 16 and 17 year olds that Year Bristol Number of children in care Bristol rate per 10,000 National Average Rate per 10,000 Ranked against Statistical Neighbours (rank 1 to 11) Ranked against Core Cities (rank 1 to 8) 2009 650 82 55 2nd 7th 2010 645 80 59 4th 6th 2011 680 84 59 4th 6th 2012 685 78 59 5th 6th 2013 720 82 60 3rd 6th
28 has seen the greatest change over a longer period but has not changed significantly with the 2011/12 figure. The proportion of children in care aged under twelve months has fallen slightly, while the proportion of children in care aged 5 – 9 has increased slightly. It is the oldest age group (16 and 17 year olds) which has seen the greatest change, with a one-third increase between 2009 and 2013. Bristol has a higher percentage of Looked After Children aged 10-17 than the England average. Gender: At 31 March 2013 the ratio of girls to boys in the children in care population was 49.5% to 50.5% respectively, very similar to the ratio in 2012.
This compares with the national average in 2012 of 56% boys and 44% girls. There has been a steady increase since 2009 in the number of girls looked after in the age bands 10- 15 and 16-17.
Legal status: 64% of children in care are subject to either an interim or full Care Order, slightly higher than the national average of 59% and above the average of 52% for local authorities in the South West. A lower percentage of children are accommodated on a voluntarily basis under Section 20 of the Children Act 1989. Ethnicity: The pattern of ethnicity of the Bristol children in care population is largely unchanged over the past year. In comparison with the Bristol Schools Census of January 2013, children in care at 31 March 2013 were slightly more likely to be white and slightly less likely to be Asian.
Placement types: The percentage of children living with Bristol foster carers (including kinship) has increased from 53% in 2012 to 59% in 2013, and the percentage of children living in fostering agency placements reduced from 25% to 22%. This is in line with Bristol’s stated placement strategy. Similarly to 2012, 10% of children in 2013 lived children’s homes or residential special schools.
29 Place type 2009 % 2010 % 2011 % 2012 % 2013 % Children's home 21 3% 28 4% 35 5% 33 5% 41 6% FC in Bristol (Agency) 25 4% 37 6% 55 8% 58 9% 62 9% FC in Bristol (LA) 180 28% 202 31% 205 30% 201 29% 239 34% FC outside Bristol (Agency) 75 12% 86 13% 83 12% 93 14% 91 13% FC outside Bristol (LA) 102 16% 99 15% 88 13% 98 14% 94 13% FC rel / friend in Bristol 74 12% 64 10% 56 8% 53 8% 62 9% FC rel / friend outside Bristol 21 3% 18 3% 17 3% 25 4% 14 2% Hostel 15 2% 7 1% 11 2% 22 3% 12 2% Independent living 5 1% 6 1% 21 3% 11 2% 8 1% Other 36 6% 25 4% 36 5% 21 3% 29 4% Parents 37 6% 23 4% 16 2% 19 3% 13 2% Placed for Adoption 28 4% 23 4% 37 5% 26 4% 28 4% Residential School 15 2% 16 2% 12 2% 18 3% 17 2% Secure unit 5 1% 8 1% 1 0% 4 1% 1 0% Total 639 642 673 682 711 Distance from home: Of children newly looked after in the twelve months up to March 2013, 95% were placed within 20 miles of their home address.
This compares to 96% in 2012 and outperforms the 2012 national average of 84%. Placement stability: Bristol’s performance in terms of placement stability, both number of moves and long-term stability has remained fairly static over the past several years and is in line with the performance of Bristol’s statistical neighbours. Given that placement stability is such a key predictor of future outcomes for children, it is an area where Bristol wants to improve its performance as a way to both
30 optimise children’s life chances and contain placement costs16 . This table shows a slight improvement in performance compared to last year’s performance. Key Indicator (definitions at end of report) Annual Target Q1 2012-13 Q4 2012-13 Q1 2013-14 Progress Q1 to Q1 Stat Neigh 2011-12 England 2011-12 OPI401 (NI62) Stability of placement of looked after children: number of moves 10.5% 10.9% 77/704 9.6% 69 / 719 9.1% 66/724 10% 11% CY263 (NI 63) Stability of placement of looked after children: length of placement 72% 68.7% 171/249 71.4% 165/231 71.7% 167/233 70% 68% 6.6 Children’s homes placements trends In the last 18 months there has been a small decrease in the rate of placements into children’s homes.
The following graph shows that the number of placements into children’s homes since April 2012 appears to have decreased slightly in 2013 and has remained at about 43 since May 2013.17 The data is not included for November 2012 to February 2013 and for April 2013 as the introduction of a new case management system lead to some inconsistencies in data recording in this period. 10 20 30 40 50 60 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Total residential placements 16 See Demos Report: In Loco Parentis. Hannon, Bazalgette and Wood, 2010 and Loughborough university’s work on the Cost Calculator for Children’s Services 17 These figures are taken from BCC CYPS social care monthly briefings and are likely to be slightly inflated because they include some placements wrongly identified as residential.
Numbers include all placements in Bristol residential and non-Bristol residential excluding those made by the Care & After Team (which are unlikely to be placements into children’s homes).
31 The table below shows the number of new placements made into children’s homes since July 2012. 18 in-house residential OOA residential total residential Jul-12 4 2 6 Aug-12 3 2 5 Sep-12 2 1 3 Oct-12 2 2 4 Nov-12 4 0 4 Dec-12 2 1 3 Jan-13 1 1 2 Feb-13 3 0 3 Mar-13 1 1 2 Apr-13 4 0 4 May-13 0 1 1 Jun-13 0 1 1 Jul-13 0 1 1 Aug-13 2 3 5 Between July 2012 and July 2013, there was a decrease in the rate of placements made into children’s homes. This may, in part, have been related to the closure of one home as placements were not made into that home in the lead up to its closure in April 2013.
In August 2013 there was an unusually high number of placements made into all placement types. We do not yet have the final data for September 2013, but it appears that the number of placements has reduced to pre-August levels. The August blip is explained by an unusually high number of placement breakdowns at a time when numbers entering care had also increased. Both are likely to be associated with the school summer holidays. Accepting that the increase in August does not represent a trend, the graph below shows a pattern of slightly decreasing numbers of placements into all children’s homes placements.
This decrease is greater for placements into in-house children’s homes.
18 Data provided by BCC Specialist Commissioning Team.
32 1 2 3 4 5 6 7 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 in-house residential OOA residential total residential The following graph shows the numbers of new placements made each month for children and young people who are new entries into care or returning to care. There has been an increase in young people aged 16 and over, but no significant change in the numbers of 10-15 year olds coming in to care. 2 4 6 8 10 12 14 16 18 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 New entries & returns to care 10-15 yrs New entries & returns to care 16+ Total Linear (New entries & returns to care 10-15 yrs) Linear (New entries & returns to care 16+) Linear (Total) Factors that may reduce demand for children’s home places We are currently re-commissioning post-16 services.
These are specialist support and accommodation services for young people with higher support needs. These
33 services are mainly for 16-17 year olds as well as some older teenagers to whom the council owes a duty, such as care leavers and unaccompanied asylum seekers. The changes to these services, in place from the beginning of 2014, could deliver alternative placements for a small number of young people who would currently be placed in children’s homes. We are also developing a treatment foster care service to support 7-11 year old looked after children who display very challenging behaviours. We will be offering this service in 2014. It will provide up to ten specialist foster care placements at a time for each child for up to 12 months.
This ‘team around the child’ care will include treatment from a clinical psychologist. The formal name for this type of service is:- "Multi-Dimensional Treatment Foster Care – Children”, or MTFC-C.19 As well as recruiting and training MTFC-C foster carers, we will be creating a clinical team consisting of various professionals.
Our intention is that the MTFC service will improve outcomes for our primary age children in care with the highest levels of need. This includes those children who have experienced significant trauma as a result of abuse within their birth family and who present with complex or severe emotional difficulties (serious conduct disorders). Such children might have already experienced multiple placements possibly including failed moves to permanency, so will they may continue to struggle to form secure attachments. They are more likely to continue to experience instability and may go on to require residential care.
There is an increased likelihood of these children offending, having continued emotional and mental health difficulties, insecure accommodation and very poor outcomes in later life. We want to break this cycle by developing an MTFC-C service for 7-11 year olds. By providing support earlier we can help reduce the numbers of children needing to go into a residential children’s home when they reach 10 to 13 year olds and beyond. And because of this we can help fulfil one of our strategic priorities of ensuring that the majority of children can grow up within a family. We anticipate, therefore, that there will be reduced demand for children’s homes placements from 2015 onward.
7. Stakeholder feedback 7.1 Views of children and young people For a full report of our engagement with young people, see Appendix 1 (APPENDIX 1 REMOVED FOR PUBLICATION) 19 The service is part of the DfE’s intensive, Evidence Based Interventions Programme for looked after children, children on the edge of care or custody and their families. Our services are conducted under License under the “Oregon model” and have already been established across a number of English Authorities. For further information go to: http://evidencebasedinterventions.org.uk/
34 We spoke to nine young people across four Bristol children’s homes and asked five questions: 1. What a good day looked like at their children’s home 2. What a bad day looked like at their children’s home 3. What is difficult about living in a children’s home? 4. What could we do to improve this? 5. What would make the biggest difference? They were then asked to rate the home on a scale of 1 to 10 (1 = sad face, 10 = happy face). On average they rated their experience of living in the children’s home 5 out of 10. The main points they made were: Listen to us and involve us in decisions We want to be more involved in decisions about where they are placed We want access to these facebook and youtube websites from home We would like decisions to be made quicker and staff to really support us to organise visits from friends.
We want to do more activities and have more choice over what we do We would like to be more included in decisions about our lives and where we live When moving into a children’s home we would like a good explanation of why we are being placed there, more information about what the home is like and to visit it before we move in We want access to information on our entitlements as a child in care and care leaver Building trust with staff is one of the most important things We like staff go out of their way for us, spend time with us and treat us as individuals, not as a group Preparing for independence can be difficult for some of us We also wanted to understand why some young people ran away or did not return to their children’s homes, or did not sleep in their beds.
We had separate conversations with three young people with a history of running away from children’s homes or not staying.
Solutions these young people identified that would have helped them to stay included: More consistent staffing - fewer staff, less changes of staff, more clarity about staff rotas More staff cars to enable them to collect us Relationships with staff are the most important thing, we need to feel cared for and supported Someone neutral to call if we feel like running away, or have run away
35 More activities (but not bowling) Need to live closer to our families 7.2 Views of practitioners We held two workshops with providers and other practitioners to gather their views and ideas.
One was held on 18th June 2013 with unit managers and assistant unit managers of Bristol children’s homes. The other, on 12th July 2013 was with a range of providers including in-house and independent children’s homes and residential special schools as well as commissioners and other professionals who work with looked after children.
Practitioner stakeholders identified a number of strengths in local provision as well as areas for improvement. The strengths of the council’s children’s homes included experienced and stable staff teams, stable placements, good working relationships with other agencies particularly youth offending, and willingness to work with challenging young people, local homes that are fit for purpose and have large gardens. The strengths of independent homes were varied, and often related to individual homes. These included reflective practice, able to keep young people safe in a rural setting out of the Bristol area, child-centred approaches as well as good staff learning and development.
The main issues and areas identified for improvement were: Placements and process Important to involve children and young people (and families) in placement decisions, give options and enable them to visit a children’s home before they move in. Too many emergency / crisis placements mean the best placements are not always identified; children and young people are not as involved in decisions as they could be and may not therefore have confidence in the placement being right for them. It’s important to ensure to ensure that a full assessment informs placement decisions.
Day-to-day decision making can be too slow, e.g.
agreement to overnight stays with friends and friends visiting the home. Shortage of local provision for children and young people with very challenging behaviour, especially those with autism. Listen to and involve young people Need to involve children and young people in all decisions that affect them. Give them feedback.
36 Staff, training and theoretical approach Staff training needs to focus more on the ethos and skills associated with a psychological (or reflexive–therapeutic) approach. Too many staff changes, need more continuity. Importance of skills and qualifications of managers and staff, particularly to deal with very challenging behaviour. Requires good, reflective supervision as well as support and training. Staff would benefit from a developed career path / progression. Buildings and location Homes could be more homely – currently have too many locks and can feel institutional.
Children and young people generally want to be placed close to friends and family.
Quality and outcomes including priorities for children and young people Importance of managing behaviour in homes through consistent application of rules. Needs of children and young people are becoming more complex and challenging. Importance of raising the aspirations of children and young people Importance of stable placements . Need for more specialist homes to meet needs of children and young people with increasingly complex needs.
Transitions to independence Preparation for independence needs to be more effective, flexible and an extended process. It can be a difficult process for some young people and needs to be done in a supportive way. Children who do not stay / run away Communication with young people is crucial. Talk to them to understand why they are not staying; give effective feedback to them in key work sessions. May help to have a neutral person, or phone line, for young people to call. Consistent application of processes, practices and procedures around children who go missing, or do not stay. This includes consistent approaches to managing young people’s behaviour as well as the implementation of missing from care procedures including child exploitation risk checklist.
Relationships with other teams, services and agencies Importance of homes having good working relationships with schools and
37 education. Role of child’s social worker needs to be clearer. External providers feel they do not have enough contact with social workers. Good information sharing – particularly at the start of a placement. Importance of clinical / therapeutic supervision –model in Bristol children’s homes with CAMHS consultation to be developed further and include support from Bristol Collaborative Service. Children and young people require input from mental health services.
Would benefit from earlier diagnoses.
Relationships and communication between staff, children young people and families Quality, stable, consistent relationships between staff and children and young people is the most important thing, especially developing trust and staff who care and go out of their way for children and young people. Children and young people need more information about why they are in care and reasons for their particular placement. Commissioning approach Current performance management of external providers to be developed to become more focussed on outcomes and quality. Quality assurance should involve talking to children and young people.
8. Research and good practice Appendix 2 sets out the key messages from research that is relevant to children’s homes and Appendix 3 contains summaries of the research reports we have considered. Key lessons from research and guidance OFSTED have found that the key/critical factors in maintaining excellence in children’s homes are: Quality of relationships that children have with staff, with each other and where possible with their families. Time spent with the children and young people individually and in groups so that they are able to develop meaningful secure relationships.
Absolute consistency in the management of behaviour so that young people understand and respect the boundaries that are set and respond positively to encouragement, rewards and meaningful sanctions.
An unwavering commitment to support children and young people to succeed, and a belief in their ability to do so, translated into active support for their
38 education both in the homes and in their partnerships with schools and other professionals i.e. ensuring each child received a good education. Working with each child or young person to build their emotional resilience and self-confidence, to prepare them for independence and enable them to withstand difficulties and set-backs in the future. Effective leadership and high morale in the staff. This requires lots of praise for staff and recognition of their good work combined with consistent management oversight through regular supervision and appraisal. There should be no surprises for staff who should constantly know how they are performing.
The homes judged to be outstanding by OFSTED are committed to all staff being qualified to at least an NVQ at level 3, although not all staff will have this qualification when they join. NVQ level 3 is typically seen as the minimum requirement although many staff, particularly those with management responsibility, also hold an NVQ at level 4 or continue studying to degree level. Research also suggests that: More effective homes tend to be small so problems in managing the group and peer dynamics do not dominate.
Staff working with children with challenging behaviour in residential care need to show a clear commitment to young people, be accepting and demonstrate a warm, caring attitude. They should develop relationships of trust and respect, listening to young people and taking their problems and views seriously. The importance of the staff-resident relationships is consistent with the ‘reflexive- therapeutic’ approach in children’s services in other European countries (Berridge et al, 2012).
It is important to understand which young people will benefit from living in the home and creating the conditions, from their first contact with the young person, which are most likely to make the placement a success.
Meticulous planning that engages young people and responds in detail to their individual needs so that their experience of care is highly personalised, combined with a commitment to never ‘give up’ on a child or young person and to do everything possible to maintain the placement.
Key requirements of approach - Nurturing positive relationships through practice Supporting heritage and identity Planning for relationships Sustaining relationships for children placed away from home Providing long-term help and support Recognising and supporting changing perspectives over time Focusing on quality
39 Commissioning and procuring placements for children should pay greater attention to issues of quality, and ways of measuring quality should include a focus on the support provided to help children develop and maintain relationships.
Importance of relationships Government policy has consistently highlighted the importance for children of ‘a sense of security, continuity, commitment and identity’ through childhood and beyond. Good practice indicates that relationships with people who care for and about children are the golden thread in children’s lives, and the quality of a child’s relationships is the lens through which ‘we should view what we do and plan to do.’ It is proposed that whatever the service approach or socio-cultural context, positive outcomes are associated with the quality and stability of the relationships that a young person in the care system is able to maintain and/or develop with key adults and with pro-social peers.
This may include birth parents, other family members, social workers, residential care workers, social pedagogues, teachers, peers and mentors.
Young people who lack a strong family and social network still often need supportive relationships and strategies to navigate their way through life. Vulnerable young people who do manage to overcome adversities generally share one important factor: the presence of a consistent person to provide continued support. This does not need to be the most important person in the young person's life; it could be a personal advisor, a lead professional or a mentor. Based on this, putting in place the structures to support and maintain such relationships should be the core focus of service development across all and any models of care provision.
There are very clear messages about the advantages for children of being able to grow up in a family that reflects their own culture, and of getting support to develop their understanding of their family history. A relationship and family focus must enable the development of the child’s identity, including their ethnicity, culture, religion, language, gender and sexuality. Children, young people and adults who have been in care, or have been adopted or cared for through other routes to permanence report that they value relationships with people who: are always there for them; love, accept and respect them for who they are; are ambitious for them and help them succeed; stick with them through thick and thin: building relationships for our most vulnerable children; are willing to go the extra mile, and treat them as part of their family, or part of their life, beyond childhood and into adulthood.
40 Young people who go missing or don’t stay Repeat incidents of going missing, even for short periods of time, are strongly linked to sexual exploitation. The links between children going missing and being sexually exploited are well documented. This is relevant both for children who live at home and for those in residential children’s homes. It can be a complex issue but research indicates that children who go missing are at heightened risk of sexual exploitation and also that sexual exploitation can be one of the ‘push’ factors leading to children running away. Common characteristics and risk factors of children and young people who go missing from care and those who are at heightened risk of sexual exploitation include: o poor attachments, lack a stable home environment and may have disrupted or chaotic family backgrounds o previously suffered abuse and neglect o excluded from school o living in residential care and using drugs and alcohol, or self-harming, as a reaction to previous traumatic experiences o vulnerable children and young people transitioning into adulthood.
(CEOP, 2011; OCC, 2012; Scott and Skidmore, 2005 in Godar 2013). Looked after children say they run away for a range of reasons. It is important to understand these reasons as they present different risks and require a range of preventative measures and responses. These can be described as ‘push’ and ‘pull’ factors. Push factors include disliking the placement they are in, not getting on with carers / staff, or fear of violence. Pull factors include running to family and friends (and, in some cases, perpetrators of sexual exploitation) and wanting to feel safe.
Local authority decisions about placements and how looked after children are supported within the care system can decrease or increase the risk of children and young people running away and/or being sexually exploited. Placement moves and instability in care can leave children and young people lacking a sense of identity or agency, which they may try to re-establish through running away. Changing school at the same time as changing placement may increase feelings of instability. Courtney and Zin (2009 in Bowyer 2013) showed that looked after children and young people are most likely to run away in the very early stages of a placement when relationships are in their infancy.
Children and young people say they are more likely to go missing again if: the problems they ran away from remain and there is no one to talk to on their return or they disclose problems but no action is taken. Understanding what children and young people do and where they go when missing is critical - both in providing for any additional needs and in identifying trends that might indicate sexual exploitation. How this information is gathered, recorded and shared is important. Not all children who run away will be ready to
41 talk on their return.
Staff undertaking interviews need strong listening skills to encourage disclosure of harm while away. Research in Practice publication noted in appendix also outlines some service principles for young people who go missing and are sexually exploited. Research suggests that looked after children are more likely to engage with services for those who go missing on their return than other children and young people. Strong links to other services are needed to address underlying factors in missing episodes, including family support, provision of accommodation and re- engagement with education.
9. Challenges and potential for improvement 9.1 Rising numbers and reducing budgets At a time when the child population of Bristol is increasing, and the numbers of children coming into care are increasing, Bristol City Council faces huge budgetary pressures which makes it imperative that we ensure our children’s homes placements provide excellent value for money. This means placements that are cost effective, providing quality care and stable, local placements that enable young people to achieve long-term outcomes.
Our policy is that, where possible, all looked after children should live in a family setting.
This is not only the best option to meet the needs of most children and young people, but the cost of foster placements is significantly lower than children’s homes placements. Our aim is that no young person under the age 13 will be placed in a children’s home. Young people who are 14 and older will only be placed in children’s homes where this is clearly the best setting for them. We will always consider value for money in deciding where to place a child, but this does not mean we will make placement decisions on the basis of price alone. Placement decisions will be based on the needs of the child or young person and we will endeavour to ensure that, wherever possible, a choice is offered and that placement options are discussed with each young person (and their family where appropriate).
When considering the cost of a placement, we will consider the whole child and the total cost of the placement including for example, any home to school travel or other arrangements.
We will take a structured commissioning approach to working with both in-house children’s homes and external providers. We will a develop service level agreement with our in-house service, setting out the requirements of the service and performance targets. For both in-house and independent children’s homes, we will require that providers focus on achieving outcomes. We will encourage providers to build on best practice and improve services to deliver stable placements and to enable young people to achieve short and long-term outcomes. We will work in
42 partnership with providers and manage their performance by reference to the outcomes they have achieved for those young people they care for.
The proposed outcomes measures are set out at Appendix 4. The numbers of new placements into children’s homes has reduced slightly over the last 18 months. We will commission 22-23 places, a slight reduction from the current 25 places in our current in-house children’s homes. This will include four 5-bed homes and one 2-3 bed specialist home. We will continue to spot purchase other placements from a framework of pre-qualified providers as required. We will continue to monitor the number of placements in children’s homes and consider the impact of the MTFC foster scheme and the changes to post-16 services.
We will then determine whether it will be possible to close a further home in 2015-16.
9.2 Complexity of needs It can be difficult to find local placements for young people who have complex needs and challenge services. Often such young people present with a combination of severe and disorganised attachment and post-traumatic stress responses that can be manifest in aggressive or other anti-social, obsessive, impulsive and risk-taking behaviour. These very few young people are usually involved with a number of agencies and will have a Statement of Special Educational Needs. Typically, those agencies will be mental health services, youth justice services, social care, police and specialist services such as BASE (Barnardo’s Against Sexual Exploitation) or Be Safe (Bristol’s service for children with sexually harmful behaviour).
We will commission a smaller two or three bed unit for these more complex young people. The benefits of a smaller home for this group of young people include: Easier to provide consistent staffing able to focus on building relationships and working together to deliver a consistent package of care tailored to the individual needs of the child Easier to give a highly structured package of care Fewer children will make it easier to provide a calmer environment with less disruption Fewer opportunities to hurt others (these young people often present a risk to other young people as well as themselves) The home will be expected to work closely with mental health services and local special schools to support young people to access the therapeutic and educational support they require.
This is likely to include children’s home staff working within the young person’s school at times.
43 Ideally, and depending on the young person’s age and assessed needs, young people will live in this specialist home for 12-24 months before being ready to move on to a less intensive children’s home or foster placement. 9.3 Relationships and behaviour Psychological approach Feedback from stakeholders and our review of research indicates a need for a higher degree of clinical and/or reflective supervision in our local children’s homes. We will require providers, both in-house and external, to adopt a psychologically- informed approach. Currently there is not enough evidence to recommend any particular approach.
However, we will expect all providers to operate a psychologically-informed approach that is consistent with the Signs of Safety20 approach that the council is adopting across its children’s services. The psychological approach will need to include reflective supervision for staff. Reflective supervision enables staff to reflect on their experiences of working in a children’s home and examine their thoughts and feelings about those experiences in order to identify approaches that will best meet the needs of the young people they work with21 .
Relationships The young people we talked to stressed the importance of relationships with staff in children’s homes. They want staff that listen to them and who demonstrate that they care about them by spending time with them and taking them out; staff who do not spend their time in the office or chatting to other staff members. Likewise, research reports emphasise the importance of stable and secure relationships. We will require that providers involve the young people who live in their homes in both the recruitment and performance management of staff. We will ask all looked after children at their six monthly LAC review if they have someone to talk to about things that upset them and will measure this outcome by service provider.
We will also carry out annual checks on each children’s home which will include talking to 20 The council has recently adopted the Signs of Safety 20 methodology across all of its children’s social work services. This is a strengths-based, safety-organised approach to child protection case work. More information can be found here: http://www.signsofsafety.net/ 21 More information about reflective supervision: http://socialwork.msu.edu/ceu/docs/Reflective_Supervision_Powerpoint.pdf
44 the young people living there about a range of matters including whether staff care about them and whether they feel fairly treated. Managing challenging behaviour Children tell us that they value a consistent and positive approach to managing behaviour. This is supported by research as well as by the stakeholders we consulted. We will therefore require providers to set out their approach to managing challenging behaviour safely and to evidence their training of and support for staff as they implement the approach. Every provider will be expected to provide positive behaviour plans for each child that are based on an individual assessment of risk and observation of problematic behaviours (prevalence and severity).
9.4 Involving children and young people As described above, where possible, commissioners will ensure that young people are involved in decisions about their placements.
We will require all children’s homes we commission to provide a leaflet, brochure and/or short film about each home including information about staff. These will be provided to children and young people and discussed with them before they move in to the home. We will expect the children’s homes we commission to be committed to listening to and involving young people. We will require providers to demonstrate how they involve young people and give evidence of the difference that involvement has made. We will talk to young people at our annual check to ask whether they feel they have a say in decisions that affect them.
Young people have told us they want to do more activities. We will monitor this by asking each looked after child at their six-monthly LAC review about their involvement in organised activities. We will then monitor this by provider. 9.5 Children who do not stay Occupancy rates in Bristol children’s homes show that sometimes there are young people who rarely stay in their bed overnight. Anecdotal evidence suggests that this may be one or two young people placed in Bristol children’s homes at any one time. The young person may well be in daily contact with the home and their whereabouts known.
The concern is that the placement is costly and yet not fully meeting the young person’s needs. Undoubtedly, young people are at greater risk by staying away from home for all the reasons previously outlined, but particularly of sexual exploitation. The high fixed cost of an unused bed in a children’s home placement is not providing value for money. We want to unlock this resource and develop a
45 service that delivers in a different way to those young people who do not stay. That service must be focussed on protective relationships and developing resilience alongside the goal of achieving safe and stable accommodation that the young person wants to return to. We will develop a new reporting system so that commissioners have accurate monthly reports on young people who do not stay in their beds. Where there is a pattern of underuse, commissioners will arrange a placement stability meeting to consider the presenting issues and build a plan based on improving outcomes by achieving stability either in that placement or, if in the young person’s interest, through a move to an alternative placement.
We will liaise with partners, carers, staff and young people to design and then develop a more coordinated approach to caring for young people who do not stay in their placements. We will consider whether to commission specialist provision for these young people. 9.6 Moving on from children’s homes Moving on to foster care Our analysis shows that very few young people move on from children’s homes to foster care. Children’s homes will be encouraged to identify those young people who are ready to step down to a foster placement. Prior to monitoring meetings with providers, we will consider each young person’s case and identify those who might benefit from a move to foster care.
Transitions to independence Across all placement types, there is evidence that looked after children in Bristol are often not well prepared for independence. Young people in Bristol children’s homes report that they would benefit from a more graduated and flexible approach than the current “independence programme”. We will require providers to set out their approach to improving young people’s readiness to move on. We will monitor how successful they are by looking at long- term outcomes for the young people they have cared for, i.e. the percentage of care leavers aged 19 who are in suitable accommodation (NI 147) and the percentage in education, employment and training (N1 148).
46 10. Commissioning recommendations 10.1 Resources / budget The budget for children’s homes for 2013/14 is £2,768,000 in-house and £3,107,210 for out of authority placements. 10.2 Commissioning recommendations We propose to block fund 23 children’s homes placements, a reduction from the 25 places we currently commission. We intend to retain all five of our in-house children’s homes in-house, operating from the buildings currently used. One of these homes will reduce from five to three beds and operate as a specialist home for young people with the most complex needs and challenging behaviour.
We will develop a service level agreement with the internal provider setting out service requirements and performance targets. We will introduce robust performance management arrangements by which commissioners will monitor the quality of the in-house service and homes. Commissioners will also check that outcomes and other performance targets are being achieved and agree changes and improvements where necessary.
We will continue to spot purchase additional placements from the children’s home framework but will seek to minimise the number of placements we spot purchase. 10.3 Options appraisal The above commissioning recommendations we developed by considering a range of options for future provision. The final short list of options was: Option 1 - Retain all current Bristol children’s homes in-house (between 20 and 25 places) Option 2 - Block contract placements from one or two external providers (between 20 and 25 places, either in our current Bristol children’s home buildings, or other buildings in the Bristol area) Provision Recommended procurement option 1 3-bed specialist unit for most complex & challenging young people In-house service in one of the current Bristol children’s homes buildings 2 Four 5-bed children’s homes Retain in house from current Bristol children’s homes buildings 3 Additional specialist placements as required Continue to spot purchase from providers on national framework agreement where there is no suitable provision from any of the services above at 1 and 2
47 Option 3 - A mixed economy, i.e. block contract for one or two homes with an external provider (between 5 and 10 places) and continue to commission the remaining places from Bristol’s in-house children’s homes (between 15 and 20 places) Option 4 - Transfer Bristol children’s homes to a staff mutual or other similar arrangement Option 5 - Spot purchase all, or a higher proportion of, children’s homes placements We carried out an extensive options appraisal in which involved two service managers for area safeguarding teams, the service manager with responsibility for children in care children in care social work teams and for commissioning placements for children in care, as well as commissioning and procurement specialists.
We also sought the views of the council’s Assistant Mayor for children, young people and education.
We considered the likely risks and benefits of each option on a number of factors under these headings: Quality and outcomes Effect on children and young people Costs Effect on the council and its ability to meet its duties Deliverability The schedule below summarises the results of this options appraisal. Option Summary of comments Option 1 – No change Retain all current Bristol children’s homes in- house Viable – preferred option. Compared to other local authorities, we are able to find local placements and our spend per placement is low. This option would enable the council to continue to have a high degree of control over local placements, ensuring that the homes take our children and work collaboratively with local services.
The other key advantage recognises that the most important factors for young people living in the homes, is stability and good relationships with staff. This option would promote continuity, would not impact on staff retention and would minimise feelings of insecurity among young people and staff. Our in- house children’s homes are relatively low cost. However feedback from young people and Ofsted judgments do suggest that the quality of the provision could improve. We would introduce a service level agreement and robust contract management to drive service improvements and ensure performance targets are met.
Option 2 - Block contract placements Viable. A competitive tender process would enable us to secure quality provision for a competitive price (likely to be
48 from one or two external providers) somewhat lower than the cost of current in-house provision and the average cost of equivalent spot purchased provision). This option may create more flexibility in the future, e.g. for an external provider to move its service from one of our 5-bed children’s homes into two smaller homes. However, there were concerns about the loss of council control over placements, in particular the risk that the provider may refuse to accept our children.
There were also concerns about the impact of the transition to a new provider on children and staff.
Option 3 – Mixed economy (retain some in-house and block contract some) Viable. Tendering one of our Bristol children’s homes, will allow us to appoint a quality provider to develop the market locally and to promote good practice. This may provide opportunities for shared learning and drive up the quality of both the council’s children’s homes and independent sector homes. The service would be delivered from one of our Bristol children’s homes buildings as this would enable us to bring the service back in-house if the service failed to deliver placements and/or improved outcomes.
Option 4 – Transfer Bristol children’s homes to staff mutual Not viable.
There is no evidence that current staff teams have the appetite to run the service independently. The risks are too great. Option 5 – Spot purchase all, or increased provision Not viable. The evidence from national data is that council’s that rely on spot purchased placements pay more and are less able to place their children locally. The current market would be unable to deliver sufficient placements in the local area.
10.4 Indicative commissioning timetable Activity Date Consult on draft commissioning plan Nov – Dec 13 Revise commissioning plan following consultation Jan 14 Final commissioning plan is approved Feb 14 Homes remaining in-house Service level agreement (SLA) developed for in-house services Feb 14 In-house service begins to operate to new SLA Jun 14 Specialist unit operational Sep 14