Judy Hutchings and Tracey Bywater report on a new initiative to help looked after children in Wales
Looked After Children have often had a difficult start in life and they bring their challenges into their care placements. It has become clear that a ‘Care’ placement does not always address children’s emotional and behavioural difficulties and can result in failed placements, poor social adjustment and escalating challenging and antisocial behaviour.
Many looked after children come from deprived and disadvantaged backgrounds and their problems are often compounded by neglect, maltreatment and the experience of domestic violence. In Wales, 59 per cent of the children who came into the care system in 2010, came because of abuse or neglect of the social, emotional and physical needs. Looked After Children in the UK are four times more likely to exhibit psychological and behavioural problems than children in the general population. As adults, they represent 27 per cent of the prison population, half of all prostitutes and 80 per cent of all Big Issue sellers. Whilst still children they are two and a half times more likely to be cautioned or convicted of an offence than other children.
In 2010 there were 5,162 looked after children in Wales, an increase of 10% from the previous year and of 44 per cent over the last decade. In both Wales and the UK generally there has been a shift away from residential care to foster care. Criticism of the quality of residential care and abuse scandals such as that exposed in the North Wales Child Abuse inquiry (Lost in Care, the Ronald Waterhouse Report, 2000) have led to the closure of many residential care homes and those that are left are increasingly used as a last resort placement for the more challenging children.
Thirty years ago only 35 per cent of children in care in Wales were placed with foster carers but by 2010 this had risen to 78 per cent. Given the significant increase in numbers of children in care, and the proportion placed with foster carers, this represents a big increase in the demand for foster carers and at the same time the changing nature of children’s difficulties has meant a change in the role of foster carers. Historically carers provided a safe and secure home without the expectation that they would provide therapeutic support. However, they are increasingly being asked to look after children with significant emotional and behavioural problems and for some, with relatively little training.
Challenging child behaviours and carers’ lack of skill in dealing with them are the two most common reasons for placement breakdown. In Wales 529 (that is, 10.2 per cent) of looked after children had three or more placements during 2009-10. Placement moves tend to exacerbate the child’s problems, as attachments and school experiences are again disrupted. The more challenging the child’s behaviour, the more placements they are likely to experience. North East Wales Foster Care Services, an independent fostering agency, reports that over the last two years they have placed 15 children, aged 9 to 15, who had between them 150 previous care placements, an average of 8.66. The most challenged children end up in residential care placements, often after the breakdown of multiple foster placements.
Children in care do less well in terms of education and employment. Only 9 per cent of the over 16s leaving care in 2009-10 had gained five or more GCSEs at grade A* to C, compared with the 57 per cent of all children in Wales. In the same year, 38 per cent of 19 year olds who had been in care were in full time education training or employment, an increase of 1 per cent from the previous year but still well below the 78 per cent reported for 19 to 24 year olds in Wales.
In other European countries such as Germany and Denmark looked after children seem to do better than in the UK. In Denmark 60 per cent of children in care go on to higher education, while it is only 6 per cent in the UK. However, their system of supporting children in care is very different. Over half of their children in care are in residential care where education and child-care is provided by pedagogues who are qualified to degree level in social pedagogy that is currently and widely taught in Denmark. Social pedagogy encompasses the care and education of children (in fact it views these two as going hand in hand) and emphasises the importance of having a good trusting relationship with the child and also the importance of the child’s natural family and the need to include them in decisions regarding the child’s future.
Unlike in the UK, residential homes in Denmark are perceived as places where children can have their lives turned round and staff are viewed as professionals doing an important and highly prized job. Residents are considerably more likely to go on to training or employment and are much less likely to have a teenage pregnancy or in criminal activity than their UK counterparts.
By age 28, the average cost of publicly resourced specialist services for those with conduct disorder at aged 10, is ten times higher (£70,019) than for those without behaviour problems. Given the high levels of conduct problems among looked after children and the added cost to families, society and services, there is a pressing need to support foster carers in the care of these children and to improve their outcomes.
Social workers currently provide the most immediate and easily accessible advice and support for foster carers and most authorities provide initial training but the support needs of foster carers are ongoing and include the need for ongoing structured support to deal with the challenges presented by individual children that otherwise result in placement breakdown.
One small step to support foster carers has already been taken in Wales by trialling the Incredible Years group-based parent programme with carers. This evidence-based programme was designed to help and support parents in learning ways to promote a positive relationship with their child and to manage problem behaviour. The programme is already being delivered and researched extensively in Wales. Since 2006 there has been support from the Welsh Government with funding of training for staff across Wales. Research findings from Wales have added to the international evidence of it’s effectiveness as both a clinical and early preventive intervention.
In 2006-07, a one-year pilot trial of the Basic Incredible Years parent programme with Welsh foster carers in three authorities in Wales (Flintshire, Wrexham and Powys) was funded by the Wales Office for Research in Health and Social Care and conducted by the authors. It was thought that the programme would be particularly relevant to foster carers because it is attachment-based. With its focus on play and other activities the programme establishes a more positive and trusting adult-child relationship. This sets the foundation for later success with strategies for managing problem behaviour.
The trial outcomes were positive, showing a substantial reduction in behaviour problems. Participants reported that they valued the fact that the programme was run specifically for them and they felt able to share their experiences and difficulties in a confidential and understanding environment. A number of issues were raised during supervision of group leaders that helped to identify and discuss some of the specific difficulties experienced.
It became clear that the ‘rules’ set by social services were not always clear and not necessarily thought through in terms of supporting effective management strategies. The issues that arose during the trial, and the ways in which the programme was adapted to address these problems are discussed in a recent paper by the authors.
The problem of drift into long-term foster care is well established. The goal for children in care is, wherever possible, for them to return home to their birth parents. However, as a study in the United States made clear, this requires planning, resources and interventions with the birth family as well as the carer to enable effective decisions to be made. It is important that birth parents are given appropriate support to enable the right decision to be made about the possibility of their child’s return. We now have good evidence from across Wales that the Incredible Years parent programme can play an important part in developing effective parenting skills among the birth parents of cared for children. This can also contribute to the decision to return children that can be made with confidence.
The parenting skills needed by carers and birth parents are similar but research suggests that parenting support seldom reaches biological parents of children placed in foster homes. In a recent pilot study in New York, Linares and colleagues offered joint parent training for the carers and birth parents of children in foster care. They found significant increase in birth parents’ and carers’ practice of positive discipline strategies at the end of the intervention and again at the three-month follow-up, a very encouraging outcome considering the low levels of positive discipline normally associated with abusive and neglectful parenting.
Gains were also made in collaborative parenting and problem solving, although these were not maintained through the follow-up. They suggest that there may be a need for more sustained support and opportunities for collaboration between birth and foster parents but have clearly demonstrated the benefits of delivering the programme to carers and birth parents. The Linares study further reinforces the Incredible Years feedback within Wales that has shown the programme to be acceptable and effective with both birth parents and carers but takes the process one step further.
The challenges facing Wales in supporting children in the care system are similar to those in the rest of the UK. However, with the ongoing Welsh Government support for local authorities across Wales to deliver the Incredible Years programme, we are one step ahead. The infrastructure is there to train staff to provide specific support to carers with access to the Incredible Years parent programme that has proved to be both valued and effective in supporting foster carers and children in care.
Its success with differing population groups is due to its ability to address their needs without affecting programme fidelity. We now need to establish its longer-term benefit for carers and looked after children to see whether it achieves reductions in the breakdown of their placements. So far the evidence suggests that the programme could be used as induction training, offered as an early intervention at the start of their relationship with a fostered child, when a foster child has specific treatment requirements, and when a placement is at risk of breaking down due to problematic child behaviour.
Local authorities must also ensure that birth parents seeking the return of their children also receive appropriate support. This includes opportunities to help them meet their children’s social and emotional needs and give them secure childhoods. It is clear that the Incredible Years programme also has a part to play here.