Meeting the health and wellbeing needs of looked after children in Devon is important. National data suggest that a large number of looked after children have emotional and mental health problems and a high proportion experience poor health, educational and social outcomes after leaving care.
A Health Needs Assessment concerning Children in Care in Devon was published in June 2016 and is available here: www.devonhealthandwellbeing.org.uk/library/needs-assessments and the main findings are summarised below.
The main reason why children are taken into care in Devon (58% in 2013-14) and across England (56% of cases) is because of abuse and neglect. Research has identified a number of risk factors associated with children being taken into care including parental learning disability, parental mental illness, parental substance misuse, housing issues and financial difficulties. These risk factors are not specific; for example the majority of children in families facing financial difficulties do not enter care. Research also suggests that there are protective factors that may reduce the likelihood of significant harm to a child. These include the presence of a non-abusive partner, a supportive extended family and parents’ willingness to engage with services.
A total of 1028 individual children were in care in Devon in 2014/15, with 699 children in care on 31 March 2015. Whilst Devon has lower rates of looked after children compared with England (49 vs. 60 per 10,000 children aged under 18 years), rates have remained static – both locally and nationally – for a number of years. Looked after children in Devon are older than the national profile with a larger percentage aged 10-15 years and 16 years and over with a larger proportion of boys (58%) than girls (42%). The health and wellbeing needs of children and young people vary with age and gender and the services in place need to reflect this age and gender profile. In relation to placement stability, 105 looked after children in Devon (15%) are known to have experienced three or more separate placements during 2014/15. Comparable data for England for 2014/15 are not available but the current Devon figure is above the national average of 11% recorded in 2013/14. Of the 870 looked after children known to be living within the county, 290 (34%) were placed within Devon by another local authority. These children and young people are not included in our Devon County Council Looked After Children’s Performance Scorecard (2014/15) or annual return to the Department for Education and we have no routine data to confirm whether their health and wellbeing needs are being met.
The data suggest that a just over one in 10 children and young people (11%) are not receiving an initial health assessment and that a substantial number of initial assessments (43%) are not completed within 20 working days of the young person entering into care. There have been recent improvements and NEW Devon CCG report that since late 2015 they have generally been able to undertake initial health assessments within 20 working days. There have been improvements in the percentage of children receiving appropriate review health assessments over recent years (82.7% in 2014/15 rising to 84.8% in 2015/16) but the percentage remains below the national average (89.7% in 2014/5 and figure unpublished for 2015/6).
Ofsted and CQC reports have highlighted that there is a need to improve the quality of some of the assessments to ensure that children and young people’s health needs are understood and can therefore be met. There was recognition in these reports that the quality of the review health assessments undertaken by the children in care nurses was very good and a significant improvement. There is a need to have greater assurance that this work leads to improved health and wellbeing outcomes for children and young people.
The data that are routinely collected to describe the physical health of looked after children are limited (to what is required for the Department of Education annual return) and are only collected for a subset of children and young people who have been in care continuously for at least 12 months on 31 March each year. No data are routinely collected on key physical health measures such as obesity/under-weight, smoking, asthma or sexual health. The latter is of particular concern in Devon, where a higher percentage of looked after children, than observed nationally, are aged 16 and older.
A lower percentage of children in Devon, than observed nationally, are receiving the dental assessments and development assessments that they are entitled to. In 2014/15, 81.3% of looked after children in Devon received a dental check-up compared with 85.8% nationally whilst 63% of Devon children aged under five were up-to-date with child health surveillance/health promotion checks compared with 89% nationally. For those children missing out on their dental checks and developmental assessments their needs are not being adequately assessed and opportunities for early intervention may be being missed.
There has been a decline in the percentage of looked after children in Devon who are up to date with their immunisations from 90.4% (2013/14) to 70.8% (2014/15). The figures in Devon for 2014/15 are also lower than seen nationally (87.8%) and the South West average (86.9%). This is putting looked after children at increased risk of illness and death from preventable infectious disease.
Looked after children are overrepresented in substance misuse services. In 2014/15, Y-Smart (Drug and Alcohol Services for under 18s) reported that 26 (19%) of the 134 children and young people they supported with a Tier 3 intervention were looked after children (nationally looked after children represent 1% of the total child population). While it should be noted that this service has high successful completion rates, the disproportionately high percentage of looked after children requiring the service suggests a possible underlying substance misuse problem within the wider cohort of looked after children.
Emotional and behavioural wellbeing
Nearly half (45%) of all looked after children in Devon for whom a completed Strengths and Difficulties Questionnaire was available had a score that suggested their emotional health and wellbeing was cause for concern. This has changed little over the last few years and is currently higher in Devon than the national average (37%). These data suggest that needs are not being met but no routine data are available to confirm this.
National research shows that disabled children are more likely to be looked after children than their non-disabled peers. Throughout 2014/15, 212 (20.6%) of the 1028 looked after children in Devon had at least one disability. This questions whether, both nationally and locally, services are successfully working at an early stage to reduce the need for disabled children to enter into the care system. National research also suggests that children with disabilities face increased barriers to returning home or achieving permanency/stability (which is known to have a profound impact on health and wellbeing). Routine data does not currently allow us to compare health and wellbeing outcomes for disabled and non-disabled looked after children. These data are important to ensure that access to health care and the wider determinants of health as well as health and wellbeing outcomes are equitable within the looked after children population.
Routine data are also not sufficient to understand the health and wellbeing needs of care leavers in Devon, in particular in the year after they leave care when health needs (e.g. substance misuse) are known to increase.
National research tells us that looked after children account for a disproportionate number of victims of child sexual exploitation and can be particularly vulnerable. An estimated 20-25% of victims are looked after children compared with 1% of the child population being in care. A local review, published in January 2015, suggests that there is currently insufficient data through which to track children at risk of child sexual exploitation in a coherent multi-agency framework which affects our ability to undertake targeted prevention work. This has significant implications for the health and wellbeing of looked after children.
|Box 4, Children in Care in Devon, Perceptions and Experiences
In October 2015, Children in Care in Devon were surveyed and asked about their views on their health and well-being, as part of a wider Health Needs Assessment published by Public Health Devon. 694 questionnaires were sent out to Children in Care and 181 were returned, a response rate of 26%.
What makes you happy? Independent of age group, all children and young people placed a high value on ‘family’, ‘friends’ and ‘hobbies & sports’ to support their happiness. Older participants (16 and over) also focused on being ‘safe and loved’ and ‘entertainment, having fun and play’. Figure 1. shows the responses to this question in a word cloud – with the most popular represented by larger size words.
“What makes you happy?”
What are your main worries? Many children said that they had no worries in their life (39.9%). However, ‘change / moving / future’ was a source of worry for secondary school aged children and particularly for children aged 16 and over. ‘Not seeing (biological) family’ was a concern, particularly for young children. Most respondents did not know what would reduce their worries, but some said ‘feeling safe’, ‘stability’, and ‘having more contact with (biological) family’ would reduce their worries. These findings echo national research which highlights the central role of close personal relationships and stable housing situations in determining well-being.
What’s good in your life? Responses from all age groups were quite similar with several themes standing out including ‘school/college’; ‘hobbies/sport’, ‘family’ ‘friends’ and ‘foster carers’.
How happy do you feel with your life now? The average score was relatively high – between 8 and 8.5 (out of a maximum total of 10). However a group of children and young people (5.5% of all responders) gave a score of 4 or below suggesting that they had feelings of low satisfaction. Data are not available to know whether this picture is different for children who are not in care. The findings from the survey do not align with the high percentage of Children in Care in Devon (45%) whose emotional and behavioural health is a cause for concern. This suggests that the responders to the survey may have been those with higher levels of wellbeing.
Whilst there are limitations, the survey results provide some interesting insight into what children and young people think about their wellbeing and suggests they are interested in talking about it.
Source: Looked After Children Health Needs Assessment, June 2016, Public Health Devon