strengthening foster placements for looked after children: development of an evidence- based tool...
TRANSCRIPT
Strengthening foster placements for looked after children: Development of an evidence- based tool for assessment and
care planning
Steve Rock & Stacey ThomsonCAMHS Research UnitInstitute of Psychiatry
Background
• Instability related to elevated risks
• Placement breakdown has been highlighted in recent national practice guidelines (DCSF, 2009; NICE, 2008)
• Work completed for an inner London Fostering and Adoption Service funded by CLAMHS
Project overview
Systematic reviewCare plan audit
Focus group Tool development
Stakeholder consultation Piloting tool
CLAMHS consultation
Vignette - GregBackground:
Greg is a 14 year-old boy who was first placed in foster care aged 3 following the death of his mother and his father’s inability to assume care as a consequence of mental health problems and substance abuse. While his father’s condition has improved for periods and he has been able to look after Greg and his 11 year-old sister, Greg has been placed in 14 different foster homes over the past 11 years, 4 of which have broken down prematurely. Greg is bright teenager but he has generally underachieved at school and has been described by teachers as a disruptive influence. While he does not have any diagnosed mental health problems, his tendency to have aggressive outbursts has at times been problematic for his foster carers.
Vignette - GregImmediate circumstances:
Two weeks ago Greg was moved to a new placement directly from another foster placement where he was placed with his sister for 3 months. Greg had smashed a window in the carer’s home following an argument with his girlfriend, which led the carers to end the placement. Greg’s sister has remained in the previous placement as it was not possible to find a new placement at short notice that could accommodate them both. His new placement is in the same area as the previous one so he has not had to move school and can see his friends and sister easily.
His new carers are in their late forties, are married and have a son of their own who is 12 years old. They have been fostering for 5 years and social worker’s describe them as carers with excellent parenting skills who have high expectations of children in their care in terms of their behaviour and academic achievement. They know that Greg has experienced a high number of previous foster placements but they are unaware of his behavioural problems and do not have a detailed knowledge of his history. In the first two weeks of the placement Greg has been rather withdrawn but has not presented with any challenging behaviour.
Vignette - Greg
• In your opinion, what factors presented here are salient to the risk of placement breakdown? (Background/Immediate)
• Are there any protective factors?
• What else would you want to know?
Systematic review
Systematic review
• Why? provided foundation of the project, evidence upon which everything else is based.
• Research using either placement moves/placement breakdowns as an outcome measure.
Systematic review – including qualitative evidence
Synthesis of qualitative and quantitative evidence Provides better understanding of processes
Example:
Quant: previous breakdowns/ placement moves predicts future instability
Qual: Children have described a sense of detachment following a placement breakdown
Systematic review
Results
• Over 100 stability factors identified.
• Synthesis of data led to grouping of factors according to several themes
Child factors
- Age (older)- Gender (male)- History of abuse- Care History- History of mental health problems- History of behavioural problems
Birth Parent factors
- Receiving benefits- Death of mother- Substance abuse- Criminal activity- Mother evaluated negatively by social worker
HISTORICAL/BACKGROUND FACTORS (RISK)
Child Factors
- First placement was Kinship care- Health conditions/
Learning difficulties
Social worker factors
- Trained in issues around separation
Carer factors
- Age (older)- Long/stable marriage- Good parenting skills/experience
HISTORICAL/BACKGROUND FACTORS (PROTECTIVE)
Child factors
- Behavioural problems at placement- Carer concerned about threat to family/destruction of property*- Recent PBD*- Unexpected behavioural problems*
Placement factors
- Presence of other children- Separated from siblings- Court-ordered placement- Out of area placement/change in school- Carer not provided with info on child*- Carer’s children loss of freedom*
Carer factors
- Wants company for own child- Experience of stressful events- Unrealistic/unmet expectations of child*
Social worker factors
- Change in social worker
Relationship factors
- Child-carer relationship problems- Birth parent hostility towards SW- Birth parent-child contact difficulties- Contact issues stressful for carers*- Birth parent-carer conflict is a stressor for carers*- Poor Carer-SW reason for PBD*
Placement factors
- Kinship care (vs. foster care)- Presence of other children - Placed with siblings- Voluntary placement- Opportunities for child to develop- Carer has good knowledge of child’s history
Carer factors
- Good social/family support network- Saliency of resources/support impacts on carer commitment*
Relationship factors
- Committed/ attached child/carer- Birth parent co-operative- Increase in birth parent contact- Frequent SW-child contact- Good Carer-SW rapport- stable/supportive SW-child relationship*
CIRCUMSTANTIAL/PLACEMENT FACTORS (RISK) CIRCUMSTANTIAL/PLACEMENT FACTORS (PROTECTIVE)
PLACEMENT INSTABILITY
HISTORICAL/BACKGROUND FACTORS (RISK)
Child factors
- Age (older)- Gender (male)- History of abuse- Care History- History of mental health problems- History of behavioural problems
Birth Parent factors
- Receiving benefits- Death of mother- Substance abuse- Criminal activity- Mother evaluated negatively by social worker
Child factors
- Age (older)- Gender (male)- History of abuse- Care History- History of mental health problems- History of behavioural problems
Birth Parent factors
- Receiving benefits- Death of mother- Substance abuse- Criminal activity- Mother evaluated negatively by social worker
HISTORICAL/BACKGROUND FACTORS (RISK)
Child Factors
- First placement was Kinship care- Health conditions/
Learning difficulties
Social worker factors
- Trained in issues around separation
Carer factors
- Age (older)- Long/stable marriage- Good parenting skills/experience
HISTORICAL/BACKGROUND FACTORS (PROTECTIVE)
Child factors
- Behavioural problems at placement- Carer concerned about threat to family/destruction of property*- Recent PBD*- Unexpected behavioural problems*
Placement factors
- Presence of other children- Separated from siblings- Court-ordered placement- Out of area placement/change in school- Carer not provided with info on child*- Carer’s children loss of freedom*
Carer factors
- Wants company for own child- Experience of stressful events- Unrealistic/unmet expectations of child*
Social worker factors
- Change in social worker
Relationship factors
- Child-carer relationship problems- Birth parent hostility towards SW- Birth parent-child contact difficulties- Contact issues stressful for carers*- Birth parent-carer conflict is a stressor for carers*- Poor Carer-SW reason for PBD*
Placement factors
- Kinship care (vs. foster care)- Presence of other children - Placed with siblings- Voluntary placement- Opportunities for child to develop- Carer has good knowledge of child’s history
Carer factors
- Good social/family support network- Saliency of resources/support impacts on carer commitment*
Relationship factors
- Committed/ attached child/carer- Birth parent co-operative- Increase in birth parent contact- Frequent SW-child contact- Good Carer-SW rapport- stable/supportive SW-child relationship*
CIRCUMSTANTIAL/PLACEMENT FACTORS (RISK) CIRCUMSTANTIAL/PLACEMENT FACTORS (PROTECTIVE)
PLACEMENT INSTABILITY
HISTORICAL/BACKGROUND FACTORS (PROTECTIVE)
• Child factors
• - Age (older)• - Gender (male)• - History of abuse• - Care History• - History of mental health problems• - History of behavioural problems
Child Factors
- First placement was Kinship care- Health conditions/ Learning difficulties
Social worker factors
- Trained in issues around separation
Carer factors
- Age (older)- Long/stable marriage- Good parenting skills/experience
Child factors
- Age (older)- Gender (male)- History of abuse- Care History- History of mental health problems- History of behavioural problems
Birth Parent factors
- Receiving benefits- Death of mother- Substance abuse- Criminal activity- Mother evaluated negatively by social worker
HISTORICAL/BACKGROUND FACTORS (RISK)
Child Factors
- First placement was Kinship care- Health conditions/
Learning difficulties
Social worker factors
- Trained in issues around separation
Carer factors
- Age (older)- Long/stable marriage- Good parenting skills/experience
HISTORICAL/BACKGROUND FACTORS (PROTECTIVE)
Child factors
- Behavioural problems at placement- Carer concerned about threat to family/destruction of property*- Recent PBD*- Unexpected behavioural problems*
Placement factors
- Presence of other children- Separated from siblings- Court-ordered placement- Out of area placement/change in school- Carer not provided with info on child*- Carer’s children loss of freedom*
Carer factors
- Wants company for own child- Experience of stressful events- Unrealistic/unmet expectations of child*
Social worker factors
- Change in social worker
Relationship factors
- Child-carer relationship problems- Birth parent hostility towards SW- Birth parent-child contact difficulties- Contact issues stressful for carers*- Birth parent-carer conflict is a stressor for carers*- Poor Carer-SW reason for PBD*
Placement factors
- Kinship care (vs. foster care)- Presence of other children - Placed with siblings- Voluntary placement- Opportunities for child to develop- Carer has good knowledge of child’s history
Carer factors
- Good social/family support network- Saliency of resources/support impacts on carer commitment*
Relationship factors
- Committed/ attached child/carer- Birth parent co-operative- Increase in birth parent contact- Frequent SW-child contact- Good Carer-SW rapport- stable/supportive SW-child relationship*
CIRCUMSTANTIAL/PLACEMENT FACTORS (RISK) CIRCUMSTANTIAL/PLACEMENT FACTORS (PROTECTIVE)
PLACEMENT INSTABILITY
CIRCUMSTANTIAL/PLACEMENT FACTORS (RISK)
Child factors
- Behavioural problems at placement- Carer concerned about threat to family/destruction of property*- Recent PBD*- Unexpected behavioural problems*
Placement factors
- Presence of other children- Separated from siblings- Court-ordered placement- Out of area placement/change in school- Carer not provided with info on child*- Carer’s children loss of freedom*
Carer factors
- Wants company for own child- Experience of stressful events- Unrealistic/unmet expectations of child*
Social worker factors
- Change in social worker
Relationship factors
- Child-carer relationship problems- Birth parent hostility towards SW- Birth parent-child contact difficulties- Contact issues stressful for carers*- Birth parent-carer conflict is a stressor for carers*- Poor Carer-SW reason for PBD*
Child factors
- Age (older)- Gender (male)- History of abuse- Care History- History of mental health problems- History of behavioural problems
Birth Parent factors
- Receiving benefits- Death of mother- Substance abuse- Criminal activity- Mother evaluated negatively by social worker
HISTORICAL/BACKGROUND FACTORS (RISK)
Child Factors
- First placement was Kinship care- Health conditions/
Learning difficulties
Social worker factors
- Trained in issues around separation
Carer factors
- Age (older)- Long/stable marriage- Good parenting skills/experience
HISTORICAL/BACKGROUND FACTORS (PROTECTIVE)
Child factors
- Behavioural problems at placement- Carer concerned about threat to family/destruction of property*- Recent PBD*- Unexpected behavioural problems*
Placement factors
- Presence of other children- Separated from siblings- Court-ordered placement- Out of area placement/change in school- Carer not provided with info on child*- Carer’s children loss of freedom*
Carer factors
- Wants company for own child- Experience of stressful events- Unrealistic/unmet expectations of child*
Social worker factors
- Change in social worker
Relationship factors
- Child-carer relationship problems- Birth parent hostility towards SW- Birth parent-child contact difficulties- Contact issues stressful for carers*- Birth parent-carer conflict is a stressor for carers*- Poor Carer-SW reason for PBD*
Placement factors
- Kinship care (vs. foster care)- Presence of other children - Placed with siblings- Voluntary placement- Opportunities for child to develop- Carer has good knowledge of child’s history
Carer factors
- Good social/family support network- Saliency of resources/support impacts on carer commitment*
Relationship factors
- Committed/ attached child/carer- Birth parent co-operative- Increase in birth parent contact- Frequent SW-child contact- Good Carer-SW rapport- stable/supportive SW-child relationship*
CIRCUMSTANTIAL/PLACEMENT FACTORS (RISK) CIRCUMSTANTIAL/PLACEMENT FACTORS (PROTECTIVE)
PLACEMENT INSTABILITY
CIRCUMSTANTIAL/PLACEMENT FACTORS (PROTECTIVE)
Placement factors
- Kinship care (vs. foster care)- Presence of other children - Placed with siblings- Voluntary placement- Opportunities for child to develop- Carer has good knowledge of child’s history
Carer factors
- Good social/family support network- Saliency of resources/support impacts on carer commitment*
Relationship factors
- Committed/ attached child/carer- Birth parent co-operative- Increase in birth parent contact- Frequent SW-child contact- Good Carer-SW rapport- stable/supportive SW-child relationship*
Child factors
- Age (older)- Gender (male)- History of abuse- Care History- History of mental health problems- History of behavioural problems
Birth Parent factors
- Receiving benefits- Death of mother- Substance abuse- Criminal activity- Mother evaluated negatively by social worker
HISTORICAL/BACKGROUND FACTORS (RISK)
Child Factors
- First placement was Kinship care- Health conditions/
Learning difficulties
Social worker factors
- Trained in issues around separation
Carer factors
- Age (older)- Long/stable marriage- Good parenting skills/experience
HISTORICAL/BACKGROUND FACTORS (PROTECTIVE)
Child factors
- Behavioural problems at placement- Carer concerned about threat to family/destruction of property*- Recent PBD*- Unexpected behavioural problems*
Placement factors
- Presence of other children- Separated from siblings- Court-ordered placement- Out of area placement/change in school- Carer not provided with info on child*- Carer’s children loss of freedom*
Carer factors
- Wants company for own child- Experience of stressful events- Unrealistic/unmet expectations of child*
Social worker factors
- Change in social worker
Relationship factors
- Child-carer relationship problems- Birth parent hostility towards SW- Birth parent-child contact difficulties- Contact issues stressful for carers*- Birth parent-carer conflict is a stressor for carers*- Poor Carer-SW reason for PBD*
Placement factors
- Kinship care (vs. foster care)- Presence of other children - Placed with siblings- Voluntary placement- Opportunities for child to develop- Carer has good knowledge of child’s history
Carer factors
- Good social/family support network- Saliency of resources/support impacts on carer commitment*
Relationship factors
- Committed/ attached child/carer- Birth parent co-operative- Increase in birth parent contact- Frequent SW-child contact- Good Carer-SW rapport- stable/supportive SW-child relationship*
CIRCUMSTANTIAL/PLACEMENT FACTORS (RISK) CIRCUMSTANTIAL/PLACEMENT FACTORS (PROTECTIVE)
PLACEMENT INSTABILITY
Project overview
Systematic review
Care plan audit
Care plan audit
Care plan audit
Why?
• Effective care planning is a priority for the local authority
• Placement stability is a priority nationally
• Currently no guidance on care planning around placement stability
Care plan audit
The purpose of this audit was to establish:
• The extent stability factors derived from the evidence base are identified by social workers
• The extent to which stability factors identified by social workers are reflected in action plans.
Care plan audit
Method
• Searched care plans for stability factors identified in review
• Identified/evidence of intervention planning
• N=53, aged 0-15, referred for foster care between 1st Sept ’09 and 31st Dec ’09
Care plan audit
Findings – overview
• Variability in level of information recorded.
• Overall, there was no consistent approach to planning around placement stability.
Care plan audit
Conclusions
• Inconsistency/absence of information not surprising in the context of care plan design/lack of guidance
→ Forms designed around 7 areas of developmental need
• Information recorded in other documents• Care planning around placement stability in
need of more attention
Project overview
Systematic reviewCare plan audit
Focus group
Focus group
Focus group
Purpose
• Get SW perspective on issues around care planning/ audit findings
• Use SW experience to generate ideas for improving practice
Focus group
Key themes
• Care plans are NOT a document social workers use to help them formulate around placement stability- use other documents.
• ‘always thinking about it’• Adding more ‘check boxes’ or supplementary
documents to the care plan was NOT likely to develop a more structured approach to care planning– just more paper work.
Focus group
Key themes
• Statutory visits - placement stability is at the forefront of thinking.
• The notion of a pre-statutory visit checklist explored – a good way of promoting a structured approach to thinking and planning around placement stability.
Project overview
Systematic reviewCare plan audit
Focus group Tool development
Development of assessment tool
Development of assessment tool
Based on the review findings, audit and focus group…….
1. Pre-statutory visit checklist (background/immediate/protective factors)
2. Checklist guidance notes
Using the checklist
Associated risk
Factor/problem present?
If ‘yes’ see reference for additional guidance:
Placement factors Sibling placements When siblings are separated they are more
unstable. Y/N P2.4
Using the guidance notes• P2- Immediate factors
4. SIBLING PLACEMENTSGenerally placements are more stable if siblings can be placed together. Although in some circumstances such as when one sibling poses a serious risk to the other, it is necessary to place them separately.
If a child has been separated from their sibling it may be helpful to consider:
Ensuring the child is happy with frequency and quality of contact arrangements with their sibling(s). When a child has previously played a care-giving role, separation can be particularly distressing due to anxiety about their sibling’s well-being.
Corresponding evidence
• Sibling placements – There is consistent evidence that separation of siblings predicts instability and joint placement promotes stability. Sibling separation can be particularly distressing for children who previously played a significant care-giving role in relation to their sibling.
A preventative measure
• The checklist and guidance were designed to help social workers ensuring the stability of EXISTING placements.
Project overview
Systematic reviewCare plan audit
Focus group Tool development
Final consultations and Pilot
Consultation with LFAS
Use of the tool in practice
• LFAS would like to maintain emphasis on care planning.
Pre-visit checklist/guidance notes to be used to inform care plans.
• Checklist to be used as point of reference for Independent Reviewing Officers.
Have stability factors identified in the checklist been incorporated into CPs?
Piloting the tool
Method- Informal use - not tied to documentation/ care
planning
Sample- 8 social workers
Focus Group
CLAMHS Consultation
Input from CLAMHS Psychology
- Using less psychological/formulation-orientated language
- Linking the guidance notes to relevant local services
Back to Greg……
Have a go at using the checklist and have a look at the corresponding guidance notes when you have identified a risk factor/ the absence of a protective factor.
Group exercise
• How does the tool reinforce good practice?• How does the tool add to or extend existing
practice?• What are the practical issues around integrating
the tool into practice?• How might the information be used to inform
care planning?• How else might the tool be used in practice?
Discussion points
• Does using the checklist and guidance notes help?
• How might you think about addressing these factors in care plans?
• Can you foresee any issues around using these tools?