Innovation for children in care

Reducing anxiety for vulnerable children
ARC HD Services, Hampshire

Almost half of children in care have a diagnosable mental health disorder, a fact acknowledged in government guidance on promoting the health of looked-after young people. With this in mind, Hampshire-based independent residential care provider ARC is carrying out innovative work with nine- to 18-year-olds with complex mental health needs, including emerging personality disorders and associated self-harm behaviour, attachment disorder, post-traumatic stress, ADHD and autistic spectrum disorder. The organisation works closely with commissioning teams, child and adolescent mental health services and local providers to tailor care packages for young people.

ARC's two rurally-located three-bed homes - Brocklands and Small Acres - are designed to be small enough for everyone to feel important and have their individual needs met, and large enough to offer a sense of community living. "We aim to offer anxiety-reducing environments in calm and spacious accommodation with high levels of staff support," says director Martin Rose. "The gardens are large and have ducks and chickens, and young people are encouraged to be involved in the development and maintenance of the site."

Each child has their own bedroom, toilet and shower room, as well as their own lounge, enabling them to choose to socialise with others or remain in their own safe spaces. The bedrooms and bathrooms are designed to prevent self-harm - magnetic curtain rails, for example, will fall down under unusual loads. This allows children to have their privacy while minimising risk. "If there is a particularly high level of risk, we increase the level of observation, but given these children have strong mood swings, we can let them have time in their room alone and know they are safe," explains Rose.

Children often come to the homes from secure units or hospital. Staff carry out a rigorous assessment process to make sure new arrivals can be matched appropriately with current young people at the home, and take care to avoid disruption to existing residents.

ARC backs up its provision of an anxiety-reducing environment with the practical application of attachment theory. "Staff are trained in aspects of mental health and attachment theory and have a ‘therapeutic approach' based on an understanding of children's individual needs," says Rose.

A consultant mental health nurse therapist offers psychosocial intervention through group work or on a one-to-one basis and the service is overseen by a consultant child and adolescent psychiatrist.

Access to therapy and education is tailored to individual needs and abilities. For example, a 17-year-old recently arrived from hospital wanted to get a job rather than complete his GCSEs. "We got him involved in management training at Tesco," says Rose. "His self-esteem has rocketed. If we had made him do his GCSEs, we would have lost him. I strongly believe in the value of education but you have to be flexible."

Relationship building is key. "Staff work hard to develop strong and meaningful relationships with each of the children. It can take time to build trust, but it is the quality of relationship that mostly determines the quality of outcome for the child," says Rose. "Often the children arrive in a state of hopelessness with low self-esteem and self-value - by the time they have left we aim to have provided them with many memorable experiences and achievements and hope they will feel valued, loved and missed."

An Ofsted inspection in November 2015 found Brocklands to be a "good" home with leadership and management that is "outstanding", while Small Acres was rated "good" earlier this year. "For us the best indicator of success is that we tend to take children who stay until they are 18 - there is no high turnover," says Rose.

ARC is currently looking for another property in which to expand. "We feel our innovation lies in the creation of an anxiety-reducing environment and specialising in children coming out of hospital placements - there is a national shortage for that kind of provision," says Rose.


Matching carer ‘attachment styles' to the needs of children
Foster Carer and Attachment Study, University of Leicester

Developing secure attachments with carers is crucial to improve outcomes for children who are fostered, but different styles of attachment can affect the way in which a child develops.

In a bid to discover whether the attachment style or profile of a foster carer is associated with specific outcomes for the children in their care, around 15 fostering agencies are taking part in a project run by the University of Leicester social work lecturer John Hoffman. The agencies hope the knowledge gleaned will help with the recruitment, selection, training and ongoing support of foster carers, and decisions to match them to particular children.

"One of the next big steps in fostering is to make better use of the foster carers we already have," says Harvey Gallagher, chief executive of the Nationwide Association of Fostering Providers. "We need to be able to match children with foster carers better than before."

As part of the project, Hoffman is using standardised measurements of attachment styles, which can be used to build an individual profile for each foster carer. Fostering agencies taking part receive a day's training on attachment styles and use of measurements.

"They are being used in a number of ways - at the beginning of the recruitment process, the initial assessment phase, to help give a sense of prospective foster carers, and as part of personal development planning of existing carers," he says. "Carers have a profile that takes in different types of attachment, and we look at what that means in terms of their own functioning."

Carole Carter, director at Affinity Fostering, an outstanding-rated agency taking part, says its carers are already trained in attachment issues. "This work allows us to better understand our carers' attachment styles and look at how they can impact positively or not on the young people we currently have in placement. It can also help us explain disruption in placements," she says.

Affinity carers have completed questionnaires with the support of social workers to start building their profile. "This will give us more information when we are matching young people to carers," says Carter. "A carer might live in the right location but their parenting style might not match what we want for that young person. For example, if a young person comes from a birth family with an ambivalent attachment style, where parents might respond to them sometimes but not other times, the young person has had to up the ante to get attention. We would look for a carer with a consistent attachment style, so that they respond to that child at all times."

Hoffman insists the profiling "is not being used to stop people from becoming carers - it's about responding in a more bespoke way to the needs of a child and a foster carer".

Carter adds: "It is quite a new concept but needs to be seen in context. There may be other issues in a placement that can still benefit young people. If a carer lived near to their school for example, it might be more beneficial for the child to go there and keep some consistency in their lives, rather than elsewhere to someone with a more appropriate attachment profile. We would then do work with the foster carer around their attachment style."


Intensive support to foster asylum-seeking children
Barnardo's Specialist Fostering Service, South East

The number of asylum-seeking children in the care of councils in England has risen 62 per cent in a year according to research by the BBC, with the largest group being boys aged 16 and 17, coming from countries such as Afghanistan or Eritrea.

Barnardo's Specialist Fostering Service, based in the South East, supports unaccompanied asylum-seeking children, as well as other children with complex needs, including young mothers and babies, children who have been trafficked, children on remand and victims of child sexual exploitation.

"We train our specialist foster carers to provide full-on support for a range of different children," says Manda Nicoll, project manager. "There are currently a lot of referrals coming through for unaccompanied asylum-seeking children because of the situation in Syria. There are also an increasing number of parent and child referrals as the courts seem to be going down that route to keep babies with their mother rather than taking them into care."

It currently has 38 foster families, some of whom are looking after groups of siblings. Specialist carers need significant amounts of training and support to care for children such as a young girl from Vietnam who was trafficked and raped, and found herself here without being able to speak English.

"We place really carefully and spend a lot of time on the recruitment process, making sure carers are well-informed about what is going to be demanded of them," says Nicoll.

"The foster carer always has the opportunity to say if they want to take a child or not. We work very closely with them; there is always a social worker on call. Severely traumatised young children can cause problems at any time of the day or night."

All training is open to all foster carers, and some choose to specialise. "One carer has worked a lot with young victims of child sexual exploitation, but is now choosing to work with parents and children as they find the idea of that quite interesting," says Nicoll.

"We have put a lot of work into youngsters who want to abscond all the time," adds Nicoll. "They are not allowed access to the internet or telephone, the house is put on police alert, and the carer starts reporting procedures if the child does take off."

The Specialist Fostering Service grew out of a service set up in 1988 to support children with special educational needs who attended Meadows School in Kent, during school holidays and at weekends. It is a self-sustaining service commissioned by local authorities and currently receives up to 80 referrals a day.