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

Placements for children and young people - residential care, foster care and care by family and friends

To meet the diverse needs of all looked-after children and young people, it is necessary to have an adequate range of suitable placements, including secure and custodial care and ensure that children are involved in decisions about placement changes. Children and young people report that they value honesty from those responsible for their care about where they can and cannot influence decisions that concern their care.

Recommendation 12 Plan and commission placements

Who should take action?

• Directors of children’s services.
• Senior staff with responsibility for commissioning health services.

• What action should they take? Open

  Develop a strategy to identify suitable placements and interventions for looked-after children and young people (see also recommendations 26–34). Such a strategy should:

  • Clearly set out how to meet the ‘sufficiency’ duty under the Children and Young Persons Act 2008 to provide suitable placements to meet the needs of looked-after children and young people with a statement of the role of various forms of care, to include:
    • foster care, residential care and care provided by family and friends (see recommendations 24, 25, 26–34, 35–38, 40)
    • use of secure accommodation (see also recommendations 11 and 20)
    • how placements will be made if unavailable within the local authority area (see also recommendation 20)
    • consideration of sibling co-placement and contact (including those placed out of area) (see recommendations 15, 20 and 24).
  • Use current statutory guidance on complex care funding10 to ensure there are pooled and aligned budgets for looked-after children and young people who are likely to require highly specialised care placements for a significant period.
  • Ensure there is a multi-agency process for placement decisions that is informed by a comprehensive assessment of the social care, health and educational needs of the child or young person.
  • Include a robust protocol for sharing payment for placements that have a healthcare component. This is especially applicable to a ‘best placement’ decision where an integrated package of care and therapeutic, psychological or psychiatric input is purchased. Monitor the services for children and young people who have been placed out of the area, including how to support care leavers (see recommendations 46–49) if they choose to remain out of the area and how these services are sourced from local providers (including CAMHS and adult mental health services).

Recommendation 13 Use current information to make decisions about placement changes

Who should take action?

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

• What action should they take? Open

  • Ensure decisions on changing placements are taken on a current assessment of the needs of the child or young person, or when their care plan clearly indicates that it is in their best interests to move, and not on the basis of poor planning and resource shortfalls.
  • Ensure that the number of emergency placements are monitored with the aims of understanding why they happen and reducing their frequency as they can lead to placement instability.
  • Ensure placement plans and contracts state whether the placement is intended to meet the child or young person’s long-term needs and further ensure that the provider has a specific and robust policy to minimise exclusions and terminations.
  • When making decisions about moving children or young people from existing placements:
    • fully take into account the wishes and feelings of a child or young person
    • record the reasons for decisions taken that are not in accord with the wishes and feelings of the child or young person
    • explain to the child or young person why these decisions were made
    • ensure children and young people are made fully aware of their right to access advocacy services when a review decision is likely to overrule their wishes and feelings
    • ensure sibling co-placement and contact are considered (including those placed out of area) (see also recommendations 15, 20 and 24).
  • Ensure the child or young person has enough notice of any planned change to arrange for an advocate to support them in their review meeting.
  • Monitor and audit the number of decisions where placement moves are made against the wishes of a child or young person, including the reasons for such moves.
  • After any placement move ensure appropriate measures are put in place for continued contact with any adults and younger people, including siblings, identified by the child or young person as important, if this is desirable and safe (see also recommendations 15 and 24).
  • Ensure that for transitional arrangements the child or young person gets to know their new carers and placement through prior visits and, wherever possible, overnight stays. Ensure also that ‘good endings’ are made with previous carers.
  • Ensure that placement decisions, including decisions about making and breaking placements, and planning for transition to leaving care:
    • take account of the health needs and developmental stage of the child or young person as well as their age
    • take into account fully all professional views about the progress and needs of the child or young person for any review, assessment and decision about changing placements
    • allow young people in residential care to remain in placement up to age 18 and beyond where it is in their best interests and appropriate to their continuing needs.
  • Ensure placement changes among family and friends are recorded, including the reasons for the moves.

Recommendation 14 Ensure looked-after children and young people in secure and custodial settings have their care plan or pathway plan reviewed

Who should take action?

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

• What action should they take? Open

  • Ensure that looked-after children or young people living in secure accommodation have a care plan or a pathway plan that is based on a comprehensive assessment of all their needs11 (see recommendations 5, 11, 20, 26–34).
  • Carry out an immediate review of the care or pathway plan when any looked-after child or young person enters or leaves secure accommodation or a custodial setting. The review should ensure that all the health needs of the child or young person, including their emotional and psychological health and wellbeing, are provided for during their time in secure accommodation or custody.
  • The pathway plans of young people who are leaving or have left care must also be reviewed when they enter or leave secure accommodation or a custodial setting.
  • Ensure that the care or pathway plan is communicated to the receiving team, including health partners, when the young person leaves the secure setting.
  • Ensure that a child or young person is not moved from a secure or custodial placement into independence or semi-independence any sooner than if they had not been in secure or custodial accommodation.