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

Dedicated services to promote the mental health and emotional wellbeing of children and young people in care

Evidence suggests that early intervention to promote mental health and wellbeing can prevent the escalation of challenging behaviours and reduce the risk of placement breakdown. Flexible and accessible mental health services are needed that offer skilled interventions to looked-after children and young people and their carers. These services should have the capacity and expertise to work with black and minority ethnic children and unaccompanied asylum-seeking children and young people who may have particular needs.

Recommendation 8 Commission mental health services

Who should take action?

• Directors of children’s services.
• Commissioners of mental health services.

• What action should they take? Open

  • Jointly commission services dedicated to promoting the mental health and emotional wellbeing of children and young people who are looked after or are moving to independent living. These services should be structured as integrated teams (virtually or, ideally, co-located), and have a mix of professionals who will vary according to local circumstances (see also recommendations 9–11, 14, 16–19 and 49).
  • As a minimum, ensure these services have local authority children’s specialists, dedicated health and mental health (including CAMHS) professionals, and education specialists working with looked-after children and young people (see also recommendations 9–11, 14, 16–19, 42–43 and 49).
  • Ensure that the team includes experienced practitioners who are trained and supported to work with multi-agency networks on complex casework. Ensure that looked-after children and young people have access to these services in situations where their emotional wellbeing is at risk.
  • Ensure that child and adolescent mental health services (CAMHS) are sensitive to the needs of the groups of children and young people identified in recommendations 26–34.
  • Ensure that the commissioned team has the capacity and expertise to work sensitively with looked-after children and young people on the impact of discrimination, racism, bullying and isolation on self-esteem and personal identity (see recommendations 26–34).
  • Ensure that equal priority is given to identifying the needs of those children or young people who may not attract attention because they express emotional distress through passive, withdrawn or compliant behaviour.
  • Ensure that the services include:
    • training, support and access to specialist advisers for frontline practitioners, carers and other professionals in the multidisciplinary ‘team around the child’ (see recommendation 6)
    • specific training to prevent placement breakdown, covering early identification of those at risk of mental health problems (see 16–19, 35–38, 50–52)
    • therapeutic services for children and young people, including those in unstable, short-term and transitional placements
    • continuing with and completing a therapeutic intervention after the young person reaches the age of 18, when this is necessary.
  • Provide a responsive outreach service to carers, schools, residential homes, secure accommodation establishments and leaving-care services.
  • Include a specialist practitioner role in a dedicated multi-agency mental health service to support young people moving to independent living at age 18 or older who may not meet the threshold for onward referral to adult mental health services (see recommendation 49). The specialist role should:
    • support leaving care teams in local authorities on the mental health and emotional wellbeing needs of the young person leaving care (see recommendations 46–49)
    • provide information and advice to adult mental health services about the particular issues affecting young people’s mental health while they are in care and the emotional and mental health needs of young people leaving care (see recommendations 20–23 and as above)
    • provide specialist support services to young people aged 18 and older when this is the best option to meet their mental health needs in the short to medium term.

Recommendation 9 Ensure access to mental health services for black and minority ethnic children and young people

Whose health and wellbeing will benefit?

• Black and minority ethnic looked-after children and young people.
• Looked-after children and young people of multiple heritage.

Who should take action?

• Commissioners and providers of mental health services.

• What action should they take? Open

  • Ensure that child and adolescent mental health services (CAMHS) are sensitive to the needs of black and minority ethnic children and young people (including those with multiple heritage) and can provide appropriate interventions for emotional and mental health problems associated with racism and cultural identify.
  • Ensure service providers are alert to the possibility that children and young people may not overtly express the impact of their experience of racism on their self-esteem and cultural identity, and practitioners should ensure there are opportunities for these concerns to be discussed.

Recommendation 10 Ensure access to mental health services for unaccompanied asylum-seeking children who are looked after

Whose health and wellbeing will benefit?

• Unaccompanied asylum-seeking children and young people who are looked after.

Who should take action?

• Commissioners and providers of mental health services.

• What action should they take? Open

  Ensure that unaccompanied asylum-seeking children and young people have access to specialist psychological services (including CAMHS) with the necessary capacity, skills and expertise to address their particular and exceptional health and wellbeing needs, including:

  • post-traumatic stress
  • dislocation from country, family, culture, language and religion
  • risk of sexual exploitation
  • lack of parental support and advocacy in a foreign country
  • stress related to the immigration process
  • physical and emotional trauma from war and disruption at home such as torture, beatings, rape and death of family members
  • increased risk for suicide and mental illness.

Recommendation 11 Ensure access to specialist assessment services for young people entering secure accommodation or custody

Who should take action?

• Commissioners and providers of health services.
• Social work managers.

• What action should they take? Open

  Ensure that looked-after children and young people entering secure accommodation or custody have their physical, developmental and mental health needs assessed by a paediatrician, or suitably qualified professional with input from the dedicated multi-agency mental health service. Ensure that any recommendations from these assessments are included in the care plan or pathway plan. (See recommendations 9, 10 and 14.)