Feeling at home

The Narey review argues that the prevailing view of children's residential care as an 'anachronism' significantly underestimates its contribution. Joe Lepper asks how these views can be overturned.

Councils, media and politicians alike have for too long underestimated the valuable contribution children's homes can make to improving young lives. That was one of the central findings of Sir Martin Narey's government-ordered review of children's residential care in England, released in July.

Children's homes are now seen as "an anachronism, to be used only as a last resort" states his report, which lays out 34 recommendations to "deliver significant improvement in the care of the challenging, troubled, harmed, often damaged, yet frequently inspiring children who live in them".

In its Putting Children First policy paper, the Department for Education outlines plans to address some of his recommendations, such as piloting the Staying Close strategy, which allows care leavers from residential care to be supported near to homes until they are 21.

But with no government announcement regarding many other key recommendations - such as the creation of a Residential Care Leadership Board of commissioners, academics and independent providers to advise the government - it remains to be seen whether Narey's vision will deliver meaningful change.
The Who Cares? Trust chief executive Natasha Finlayson says one of the best legacies of Narey's review would be for social workers to move away from seeing foster care as the default option for placing children.

Too many in social care have "an inbuilt assumption that being in a nuclear family is the gold standard", leaving children's homes to be seen as merely "a dumping ground", she adds.

Instead, she hopes there is greater realisation that "living in a family may be too intense" for many children and therefore makes attempts to foster them doomed to failure.

Ofsted's annual social care report certainly indicates many children undergoing multiple placement breakdowns should have been placed in residential settings from the start. Among children with this chequered care history, half finally achieved permanence in a children's home.

Bryn Melyn chief executive Bob Yetzes suggests such a shift in thinking has already begun, with the therapeutic residential care provider fielding an increasing number of calls from commissioners wanting to place children "in the high end of the most extreme cases" as soon as they come into care.

But he adds that progress is still too slow in considering a therapeutic residential care placement straight away for those who fall below that high needs threshold but "probably won't survive in a foster care family environment".

Kevin Gallagher, chief executive of residential care provider Amberleigh Care, which specialises in supporting boys who display harmful sexual behaviour, suggests that a mistrust about residential care has developed among some commissioners who have got "their fingers burned" by providers describing themselves as "therapeutic" but failing to deliver on their claims. This points to a wider issue of professional esteem and status of the residential care workforce.

Finlayson says that sometimes "the reality doesn't match the marketing claims".

"Just looking at latest job adverts, you can see ones in children's homes that say they are looking for a senior therapeutic residential care worker with a level 3 qualification - which is the equivalent of A level - and offering between £20,000 to £22,000 a year," Finlayson says. "I would contend that someone with that level of qualification and salary could not justify calling themselves a senior therapeutic worker."

Such relatively low expectations around training and salaries can leave residential care with a poor reputation among social care staff. "Some say Tesco shelf stacker one day, residential care worker the next," adds Finlayson. She calls for children's residential care to receive "the same promotion that has been going on for the teaching profession" with a national focus on "how important and rewarding the work is".

Narey calls for tighter checks on the quality of training in his review, particularly online diploma courses. All trainee social workers should also work in homes during their course, he recommends, although he does not back a move towards a graduate-only workforce, which Scotland is set to introduce in 2018.  

Gallagher says another way recruitment can improve is to ensure homes offer staff more opportunities to reflect on their often challenging work with damaged children. "When done right these are a significant benefit to staff," he says.

Supporting staff to cope with the demands of residential care could also help address missing-from-care incidents, suggests Finlayson. "What you hear most from young people who have run away is that ‘no one would be bothered if I was gone and they didn't care when I got back'."

Missing incidents

According to Ofsted's annual social care report, 2,500 children went missing from care in 2015/16. The inspectorate points to the need for better co-operation between police and children's homes to speed up the reporting of missing incidents, as well as a greater focus on return interviews to prevent repeat occurrences.

Yetzes recommends that homes establish missing incident protocols with local police that are tailored to the vulnerability of each child. Describing Bryn Melyn's protocols with police in Shropshire and North Wales, he says: "For some, if they go missing for five minutes, because the children are so vulnerable the police will attend immediately. For some others it may be an hour. Some maybe three to four hours as they are capable of looking after themselves and not at risk."

Narey's review also addressed the issue of the size of children's homes.

Three-quarters of homes registered between 2012 and 2016 were for five children or less - and one quarter of these were only for one to two children.

But Narey says there is no strong evidence to support the assumption that outcomes are better in smaller homes and urges councils and providers to consider boosting the supply of larger settings.

Bryn Melyn is already bucking the trend for smaller homes by opening an eight-bed children's home in 2017, specifically for girls and with a strong focus on communal living as a way of preparing them for independence. The larger size will enable it to provide permanent psychology and education support, as well as training kitchens.

Narey also addresses a popular assumption that large homes lead to institutionalisation, where children are expected to fit into predetermined routines and rules. He says that poor management rather than the actual size of the home is the more likely factor behind such a situation.

Finlayson goes further than Narey in saying that smaller homes are more of a concern than larger settings. "A one or two-bed home with a high staff ratio can sometimes be far too intense for the young person and I query whether that provides value for money," she says.

Avoiding institutionalisation

She believes institutionalisation can be effectively countered by focusing on strong relationships between staff and children and "behaving in a more quasi-parental way", with staff helping with homework and questions around sexual health.

"When we speak to young people they want staff to be their champion, who they know will look out for them," she says.

Designing bedrooms of different sizes as well as giving children freedom around how they decorate them are other ways to avoid institutionalisation, says Yetzes. But he warns against trying to force children's homes to replicate a family home environment.

"Children in residential care don't want another set of parents. They already have parents in most cases - whether they like them or not is another matter."

Action for Children has developed a strategy for its children's homes, Residential Outcomes Now, that focuses on promoting strong relationships while keeping an appropriate professional distance.  

Head of policy and research Emma Smale says: "This brings a relationship-based culture at management and practitioner level. The focus is to show the importance of building relationships so that children feel supported and safe and can trust the people they are cared by."

The Narey report's recommendations, if implemented, would likely take years to filter into mainstream practice. To speed up change, there is a belief that more radical solutions are required than his own call for a DfE-run leadership board.

Bryn Melyn chief Yetzes calls for the creation of an independent body to oversee residential care with the same standing as the medical Royal Colleges. If residential care is to shed its anachronistic image in some quarters, such bolder steps may be required.

Whole-team training aids understanding

Team training is seen as a crucial ingredient to a successful children's home, according to Sir Martin Narey's residential care review.

Such group sessions help build team spirit and offer staff the chance to share the daily challenges they face and learn new strategies to tackle them.

One such example is the RESuLT training programme, developed in 2011 by the South London and Maudsley NHS Foundation Trust-based National Implementation Service.

This has benefited from £4.1m from the Department for Education's social care innovation fund and, following trials in Dudley, Greenwich and Oxfordshire, has since been used by a further eight councils for children's home staff.

The programme provides 10 weekly, half-day sessions for all members of a children's home team, including domestic staff and management, and is carried out by two facilitators, one from another home and one from child and adolescent mental health services.

Through role-playing, practical activities and analysing latest research, the course covers issues such as promoting positive behaviour and improving relationships with children.

RESuLT lead developer and systemic psychotherapist Cath Connolly says the involvement of all staff is a key element as "it gets everyone together and gets them to think about how they work as a team".

Other benefits are "giving staff a theory and language to their practice, which helps their self-esteem", says Connolly.

"This means they are able to go to looked-after children reviews and rather than sit in the corner quietly they can speak confidently using a theoretical language about the interventions they use in the home," she adds.

Melanie Dryden, manager at Maitland Road Children's Home in Dudley, one of the first to take part, says her team's confidence improved dramatically after the course.

"We also discovered more about our strengths and that some of the good practice we were already doing wasn't being done in all homes," she adds.

Ross Pearce, a senior residential childcare worker at the same home, added: "It gave us a better understanding of the children by taking us through their development from when their mother was pregnant with them."

Evaluation by the Universities of Loughborough and Bristol praise the course's blend of theory with practical advice, as well as for helping to bring staff teams together.

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