SCIE/NICE recommendations on looked after children: Promoting the quality of life of looked-after children and young people

Supporting babies and young children

Evidence suggests that frequent moves and parents’ physical and mental health problems can adversely affect the ability of babies and very young children to form healthy attachments that lead to healthy emotional and physical development. To combat this disadvantage, there is a need to plan decisively for permanent placements, based on high-quality assessments carried out by skilled professionals. Comprehensive, flexible service provision can help meet this aim.

Recommendation 16 Assess the needs of babies and young children and ensure access to services

Who should take action?

Social work managers. Providers of health services (including CAMHS).

• What action should they take? Open

  • Ensure that comprehensive and sensitive assessment processes are in place to identify the needs of babies and young children as early as possible.
  • Ensure frontline practitioners support the baby or young child and carers and, if necessary, a referral is made to specialist services, following the needs assessment.
  • Ensure that equal priority is given to identifying the needs of children who may not attract attention because they express emotional distress through passive, withdrawn or very compliant behaviour.
    • Ensure assessments: are conducted by appropriately trained health professionals and frontline practitioners who work with looked-after children, such as health visitors, community and specialist paediatricians, psychologists and nurses for looked-after children and young people
    • include the views of carers, social workers and early years practitioners who have day-to-day contact with the baby or young child.
  • Ensure that interventions recommended by assessments are included in the healthcare plan. This is the responsibility of the social worker managing the case (see also recommendation 5).
  • Ensure that interventions recommended in the healthcare plan continue to be made through transitional periods if babies or young children move from a placement and when they move to permanence.

Recommendation 17 Ensure there are specialist services for babies and young children

Who should take action?

• Directors of children’s services.
• Senior staff with responsibility for commissioning and providing health services (including CAMHS).

• What action should they take? Open

  • Ensure that all frontline practitioners have access to specialist services (including dedicated CAMHS teams) to help them meet the emotional and physical wellbeing needs of looked-after babies and young children. These services should have practitioners who:
    • have a good understanding of the emotional, physical and developmental needs of babies and young children, including those with complex emotional needs
    • have a high level of understanding of attachment theory, and the impact of trauma and loss on child development and the forming of attachments
    • are skilled in observing and understanding the behaviour of babies and young children, and parent–child interactions.
  • Ensure that specialist services can provide support such as consultation and training to carers and frontline practitioners, and can work directly with the child and carer on interventions that focus on supporting secure attachments.

Recommendation 18 Ensure carers and frontline practitioners working with babies and young children receive specialist training

Whose health and wellbeing will benefit?

Looked-after babies and young children.

Who should take action?

• Directors of children’s services.
• Senior staff with responsibility for commissioning and providing health services (including CAMHS).
• Senior staff in fostering services and residential care.

• What action should they take? Open

  Ensure that all carers and practitioners who care for and work with babies and young children (including foster carers and prospective adopters) receive training from specialist training providers (including CAMHS). This should be additional to core training (see also recommendations 18, 31–38 and 50) and should include information on the:

  • development of attachment in infancy and early childhood
  • impact of broken attachments
  • early identification of attachment difficulties
  • particular needs of babies and young children who have experienced prenatal substance exposure or who have inherited or acquired learning or developmental problems.

Recommendation 19 Reduce moves and achieve permanence for babies and young children

Whose health and wellbeing will benefit?

• Looked-after babies and young children.

Who should take action?

• Social workers and social work managers.
• Independent reviewing officers.
• Placement teams.

• What action should they take? Open

  • Ensure care planning takes account of the need to minimise the experience of separation and loss for babies and young children (see also recommendations 5, 12, 13 and 30).
  • Ensure assessments of emotional welfare and the impact of loss of attachment are primary considerations in a decision to make a placement change, including a move to permanent carers.
  • Consider returning the child to a previous stable placement if an adoption placement breaks down.
  • Ensure that the history and extent of previous placement instability is taken into account before a change from the current placement is agreed.
  • Give serious consideration to a foster carer’s desire to adopt a child and ensure that an adoption assessment fully considers the capacity of foster carers to provide long-term stability and secure attachment.
  • Ensure alternative placements are available (‘twin tracking’) if assessments of birth parents or carers who are family or friends are unsatisfactory. This might include approving carers who wish to adopt as both foster carers and prospective adopters.