Legal Update: Keeping children in care safe

Children are generally taken into care because they are perceived to be at risk of harm or abuse. However, a number of recent reviews have laid bare the harm experienced by children already in care. These include the Hesley Review, which highlighed disabled children being abused in residential settings and the case of a child tragically murdered not long after being placed into an adoptive family.

CoramBAAF’s annual Health Conference, which gathers together a range of experts and health professionals who work with children in care and care leavers, had a sobering title this year: Safe in care or in harm’s way? Recognising and responding to risks to keep children in care safe. The answer that emerged, drawing on current research, is that children in care are not always safe in care.

Criminal gangs

So why are some children in care still in harm’s way? Anne Longfield, the former children’s commissioner for England and chair of the Commission on Young Lives, talked about the criminal gangs who identify and prey on vulnerable children and young people and the sophisticated and ruthlesss strategies they use to recruit young people for exploitative purposes, such as buying them clothes, games or food. She argued that tackling this threat would require multi-agency work and intervention at a local level as well as a national strategy.

However, when multiple agencies and professionals are involved in the care of a child, there can be a danger of everyone assuming that someone else is responsible. CoramBAAF authors Wendy Rose and Hedy Cleaver undertook a study of serious case reviews involving children living in fostering and adoptive families and they found that when a child is in care, or if a new safeguarding risk is identified, it can feel more complicated to mount an appropriate response due to confusions around responsibilities, processes and roles.

The importance of providing good mental health support to children in care was underlined by Dr Barry Coughlan, a researcher from Cambridge who gave a comprehensive update of findings from recent and ongoing research into the relationship between experiencing maltreatment and the links with subsequent mental ill health. There is a statistically increased risk of experiencing mental health difficulties in children and young people who have been maltreated. Despite this, research has shown that children in care aged 16 and 17 are referred to children’s mental health services less than their non care-experienced peers. While conference attendees made clear that there was a lack of mental health services in general, it is alarming that children and young people at higher risk should face such a gap in support.

Recognising risk

So how can we ensure that children in care do not slip under the radar? Health professionals can be very accessible to children and often hold important information about them. They may be in a position to see, hear, observe and respond to children. They can talk to children, and ask them questions, about their lives at home, in the community, at school, and importantly, in their online lives. Dr Vicki Walker, consultant paediatrician, designated doctor for looked-after children and assistant officer for child protection at the Royal College of Paediatrics and Child Health, noted that a child who is vulnerable in real life is also vulnerable online. She shared research from Internet Matters which found that teenagers with care experience are often the subject of intense cyberaggression, receiving threats of harm against themselves or family members as well as contact from people trying to persuade them into unwanted sexual activity.

Sharing concerns

Engaging children in care during their health assessment appointments emerged as an important opportunity. These appointments, which aim to identify health needs and plan and offer appropriate support, allow a child to open up more to a health professional. Medical professionals at the conference also recognised the challenges posed to them individually and collectively, asking themselves: can we listen harder to the voices of children? Can we make sure children in need of mental health support are heard and receive the right care in a timely way? How do we ensure there are no gaps in information sharing between health and social care? If we have concerns as health professionals, how do we share these concerns appropriately?

CoramBAAF is currently in the process of updating our health assessment forms. As we do this, we are considering how we can help make these opportunities more accesible for children and young people. It may be a small step but if it helps a child to open up more to a health professional, it could make a big difference.

Nationally, there still remains significant work to be done to better safeguard and support children in care from the risks that exist in our society. Children living in foster families, with adopters, and in residential care, are often safe. But the delegates concluded that we must remember that – as the reviews have shown us – this is not always the case. Unfortunately, we must “think the unthinkable” and know that safeguarding doesn’t stop when children enter care.

• www.corambaaf.org.uk