Good Practice: How a fostering scheme has improved outcomes for children with the most complex needs

Project Multidimensional Treatment Foster Care in England

Funding The programme has received £16m to cover the costs of the national implementation team and local programmes

Purpose To improve outcomes and life chances for children and young people in care with the most complex needs

Background A national drive to improve the outcomes for children and young people in the care system prompted a search for programmes with the biggest impact. An approach developed by the Oregon Social Learning Center in the US had been shown to make a real difference to some of the most vulnerable young people. The programme was the basis for the Multidimensional Treatment Foster Care in England (MTFCE) scheme, which began in 2002 with a series of pilots.

The scheme was aimed at young people in care with the most complex needs, often the victims of appalling abuse and neglect, whose experiences translated into difficult behaviour. It was clear that existing services were not meeting the needs of this vulnerable group, explains Rosemarie Roberts, director of the MTFCE national implementation team, "particularly when it came to teenagers. I think some people had a tendency to write them off and say 'there's nothing we can do'," she says.

Action Children and young people who enter the programme will usually have been through multiple placements that have broken down and even failed adoptions. A key aim is to create stability and give children the ability to settle into a family, whether that means returning to birth parents, long-term fostering or adoption. The approach involves using highly trained foster carers who are supported by a specially trained team of professionals. Each foster family works with one child at a time and collaborates with the clinical team to ensure that the child gets the support they need.

The clinical team is led by either a clinical child psychologist or an experienced social worker with clinical experience in areas such as mental health or family therapy, and includes a range of professionals such as educational psychologists, therapists, skills coaches and social workers.

There are a number of strands to the programme. It is overseen by a national implementation team staffed by personnel from the Central Manchester University Hospitals NHS Foundation Trust, the Institute of Psychiatry, and South London and Maudsley NHS Foundation Trust.

Children get intensive support as well as practical help to develop basic social skills. "Our skills coaches help children and young people to develop some of the social skills they are lacking, from how to say 'hello' to people to how to make friends and what to talk about," explains Roberts.

One of the key factors to success is support for carers, who get a daily phone call and are asked a series of simple questions about how things are going. This daily contact means they feel supported and the information gathered helps professionals quickly identify and work on problems that could put a placement at risk.

Outcome The scheme has been rigorously evaluated by the national team and the evidence suggests it can help turn things around for even the most challenging children and young people. For example, it has led to substantial reductions in "high risk behaviours" among those who "graduate" from the programme. Violent behaviour towards others reduced from 76.6 per cent on admission to 42.5 per cent. Forty-three per cent entered the programme with convictions for criminal offences but just 16 per cent received a further conviction or caution during the programme. Thirty-three per cent were self-harming, dropping to 4.5 per cent. Absconding from placements reduced from 51.6 per cent on entry to 33.3 per cent.

There were also improvements among the younger age groups and perhaps one of the most promising findings suggests the approach can help boost children's intellectual capacity, says Roberts. Results from the scheme for threeto six-year-olds show increases in IQ. The mean IQ scores when children started were 89.57 but after nine months had increased to 104.25.

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