Child Protection for the Autistic Child - A Resource
EDGE OF CARE
Adolescent service change and the edge of care, Children’s Social Care Innovation Programme Thematic Report no 2 Rees Centre, University of Oxford. http://springconsortium.com/wp-content/uploads/2017/10/Thematic-Report-2017-AdolescentServiceChange_EdgeOfCare-1.pdf
What does the phrase ‘Edge of Care’ mean? I use it a lot because I never realised when our son went into crisis in adolescence, that it fitted him, until after he had entered Care. In his case this was because of our inability to understand and meet his needs without help. From that experience I would like all professionals to see their work to support families and children with SEN-D in this context so depending on how successfully they can support a child for example within a school or GP surgery, it is likely to have an impact, no matter how small, on whether the child may need to enter care or not, possibly years later. That may sound extreme but the stakes really are very high for a lot of our children with SEN-D particularly as they get older.
I know this is not a commonly held view - most professionals come from a different perspective seeing 'child protection' and 'working with children with disabilities' as two separate and distinct specialisms. Families too, do not wanted to be 'tainted' by contact with professionals trained in child protection only and there is overwhelming stigma associated with needing social work intervention of any kind in your family.
A recent evaluative report on a number of projects with a common aim and different methodologies unsnappily titled - Edge of Care Interventions’ Children’s Social Care Innovation Programme, Thematic Report no 2 - addresses what it is to be ‘on the edge of care’ from a ‘child protection’ perspective. I think it identifies many of the issues that may apply children with SEN-D if they and we, their parents, are not supported when they reach adolescence.
I’ve extracted quotes from the report and ‘mashed them together’. There is a danger that this has created a distortion because the study is of a number of different projects. I recommend you read the report to get the full picture.
This is the Contents page:-
Executive summary Recommendations Introduction Evaluation of the Children’s Social Care Innovation Programme Adolescent service change and the edge of care Individual Projects Where is the ‘edge of care’? What were the needs of the young people defined as edge of care? Figure 1: Points at which projects intervened in the stages in the adolescent’s journey into and through care Table 1: Eligibility criteria for the Sefton Community Adolescent Service (CAS) Case study – Sefton’s screening tool How did the projects meet these needs? Relationships with children and families ‘Short-term’ residential responses to need Case-holding, management, and planning Professional development Leadership and partnership Multi-professional working Value for Money Evaluation in the adolescent service change projects Nature of the evaluations Facilitators of, and limits to, evaluation Embedded researchers Sharing of data Conclusions and recommendations Appendix 1 – Aims of individual projects Appendix 2 – Audit of adolescent services
Quotes from the report:-
A common definition Edge of care tends to refer to that group of families where entry into care is being actively considered as a likely option to meet that young person’s needs. Children and young people on the edge of care are often described as the most challenging, or those with the most complex needs, though this is rarely explicitly defined.
It was suggested that children and young people are on the edge of care who:
· a senior social worker believes will need to enter care within days or weeks as current levels of support are insufficient to safeguard them, while needs are escalating and/or family relationships or other issues are worsening.
· are in the early stages of court proceedings, and where social workers are having to make decisions on whether sufficient change is possible to allow the child to safely remain at home.
· a senior social care manager has agreed should be accommodated if an alternative intervention or support package is not swiftly put in place including those provided with respite care, or those who have been accommodated in an emergency but where the aim is for them to be reunited with their family quickly with appropriate support.
· cease to be looked after and return to their parents or wider family network, but require further support to ensure they are safeguarded and do not re-enter care.
A screening tool (Table 1) lists many of the vulnerabilities professionals would recognise as significant contributory risk factors in the journey towards care, as well as ‘edge of care/risk of accommodation’ criterion.
Table 1: Group A vulnerabilities ·Sexual exploitation (risk of, or involved in police investigation), Missing (risk identified), young person, homeless 16 & 17 years old, Gun and gang – youth at risk, Edge of care/Risk of local authority accommodation
Group B vulnerabilities NEET, Domestic Violence (DV), Neglect, Persistent absence from education, Substance misuse, Self-harm by the young person, Significant contact/referral history, Crime and ASB, Parental mental health, Young person mental health.
Relationships with/between children and parents, families By age 14, only 42% of entries to care are due to abuse or neglect, while 45% are accounted for by a mixture of acute family stress, family dysfunction and socially unacceptable behaviour.
Alongside this, many young people face challenges with their mental and emotional health (64%), special educational needs (38%) and substance misuse (32%)
The acute family stress identified above as a driver towards care is often attributable to the young person putting themselves at risk of criminal activity, substance misuse, CSE and homelessness.
The building of effective working relationships with young people and their families, and shoring up strained relationships within families is, therefore, a significant challenge to those working with adolescents.
Families were sometimes much more open to developing a relationship with someone other than a social worker as they felt less threatened by the statutory weight of the social work system. However, in the most effective projects, close working with social workers ensured that the statutory framework remained available where risks were not being managed.
Just too difficult? The screening tool successfully identified young people with a complex mix of significant needs that placed them squarely within the definitions of ‘edge of care’ as those imminently at risk of requiring accommodation. However, this needy and challenging cohort stretched the CAS beyond what had been expected and left it holding risks which were considered beyond its capacity to manage safely. This changed the cohort being referred to include less complex cases where the preventative support offered ..had a greater chance of changing behaviours while managing a more limited range and severity of risks.
Those children and young people closest to the edge of care remain the hardest to engage, so where interventions focus on them, regular monitoring of information and strong leadership and management on the ground are essential to avoid ‘mission creep’ to less complex cases.
Initial selection for an intervention proved to be largely service-led, rather than needs-led. While project theories of change had begun with needs and devised models of intervention to meet them, in practice, once the interventions and teams had been put in place, the cohorts were selected to a greater or lesser degree to match the interventions.
But what worked? Where evaluations demonstrate decreases in the numbers entering care this seems most likely due to effective earlier intervention than diversion at the point of a care decision.
It is clear that the creation of a residential provision takes longer than the creation of a multi-professional team and this should be considered by those setting them up.
Despite .. the small sample of cases .. there was evidence that some families benefitted from the experience of supported respite that mixed a range of positive activities with more focussed and intensive work to develop family relationships and resilience.
All these ‘residential’ evaluations, though, recognise the pressure to fill beds irrespective of need at a time of budget squeeze and increased demand, as unit costs are much higher when the provision is not at capacity.
Though not strictly a ‘residential’ response it is worth noting that an area of need specific to the older adolescent group was risk of, or actual, homelessness. Though homelessness is often a proxy for a range of more complex needs, shaping the interventions offered to enable swift and easy access to a tenancy or similar does seem to have had benefits to those projects that identified this need and responded. Enfield included a ‘Homelessness Team’ within its innovation and this avoided the need to accommodate some older teens through the care pathway with a consequent reduction in numbers entering care.
Workers responded well to training in common models of practice, or which supplemented existing models being implemented, such as Signs of Safety. Where training was not offered consistently across teams, there was strong feedback to suggest it should be, as there was a synergy when co-located multi-professional working was paired with a common training programme. It inducted professionals, who might not previously have worked together, into a team, but also gave them a clear set of models within which to work. Multi-agency data sharing proved much more difficult to establish than multi-professional working; the former too often limiting the impact of the latter.
Co-location was a real strength where it was adopted, as it developed greater understanding between disciplines and provided informal professional development to all. It also helped the development and adoption of a shared vocabulary across the multi- professional team that provided families with more consistent clarity.
Judgements on the value for money of interventions need a measure of the costs of ‘business as usual’, sufficient sample size for analysis, and clear outcome data. Relatively few projects have been able to provide evaluators with the data they needed for a robust cost benefit analysis. All evaluation plans included clear proposals to assess value for money. Projects that embraced economic evaluation from the start, reported on value for money (e.g. Enfield, North Yorkshire, and to a lesser extent Ealing). These projects all reported significant savings.
And what would help? It might be that if the specification of social care databases included greater capacity for longitudinal tracking of impact, then ...social care services would embark on their own longitudinal analysis of impact.
Finally I believe no adolescent with very challenging needs should be beyond help to the point that entering care or becoming homeless is an inevitability. I really worry about what happens to children if they lose the 'anchor' of a family where parents could be helped support the child at home, no matter how difficult family life is. That this may be the case for many children with SEN-D is a ‘red flag’ that something is going very wrong much earlier with their and their families support around SEN-D. I fear for these children and their families because I know how poorly equipped the Care system is to support young people who have very high levels of need.
Also see Children's Society (2018) Thinking about Adolescent Neglect https://www.childrenssociety.org.uk/sites/default/files/thinking_about_adolescent_neglect_practitioners_briefing.pdf and Children’s services making ‘stupid’ cuts because of budget demands, says new ADCS president http://www.communitycare.co.uk/2018/04/19/childrens-services-making-stupid-cuts-budget-demands-says-new-adcs-president/