Looked-after Children Research Articles

Enhancing service provision for looked after children and young people in Doncaster.

The 0-19 looked after children (LAC) team in Doncaster, England, is a well-established service that has developed over time to identify and address the health needs of looked after children and young people and care leavers. Its aims are to improve outcomes for these children and young people by offering a holistic approach to assessing their health and well-being. The principle of having a dedicated nurse specialist for LAC following each child or young person throughout their care journey enables a trusting relationship to be established and the voice of the child or young person to be heard. This article reports on several developments in the Doncaster LAC team, including a local pilot of joint nurse and GP initial health assessments and participation in a national pilot of mental health assessments.

The impact of the COVID-19 pandemic on children and adolescent mental health in-patient service use in England: interrupted time-series analysis of national patient records.

During the initial phases of the COVID-19 pandemic, children and young people (CYP) faced significant restrictions. The virus and mitigation approaches significantly impacted how health services could function and be safely delivered. To investigate the impact of COVID-19 lockdowns on CYP psychiatric admission trends during lockdown 1 (started 23 Mar 2020) and lockdown 2 (started 5 Nov 2020) of the COVID-19 pandemic in England. Routinely collected, retrospective English administrative data regarding psychiatric hospital admissions, length of stay and patient demographic factors were analysed using an interrupted time series analysis (ITSA) to estimate the impact of COVID-19 lockdowns 1 and 2 on service use trends. We analysed data of 6250 CYP (up to 18 years of age) using ordinary least squares (OLS) regression analysis with Newey-West standard errors to handle autocorrelation and heteroscedasticity. Psychiatric hospital admissions for CYP significantly fell during lockdown 1, and then fell even further during lockdown 2. A greater proportion of admissions during lockdown were out of area or to independent sector units. During lockdown, the average age of CYP admitted was higher, and a greater proportion were female. There was also a significant increase in the proportion of looked-after children and CYP from the most socioeconomically deprived areas admitted during lockdown 2. During both lockdowns, fewer CYP had psychiatric admissions. The subsequent rise in admissions for more socioeconomically deprived CYP and looked-after children suggests that these CYP may have been disproportionately affected by the pandemic, or overlooked during earlier phases.

Enhancing Care Planning Training for Children’s Services Social Workers in a Health & Social Care Trust in Northern Ireland—a Mixed Methods Study

ABSTRACT Care planning for Looked After Children (LAC) is accepted as being critical in ensuring good outcomes for LAC, however, the available evidence base highlights that despite the introduction of key legislation across the UK, that care planning for LAC remains inconsistent. There is limited Northern Ireland (NI) specific research available that relates to care planning for LAC; with the care planning experience of LAC being referenced in the recent review of Children’s services in NI, (Jones, R. (2023). The report of the independent review of Northern Ireland’s children’s social care services. https://www.cscsreviewni.net/files/cscsreviewni/2023-06/The%20NI%20Review%20of%20Children%27s%20Social%20Care%20Services.pdf.) which highlighted the variance in policies and procedures across the five Health and Social Care Trusts in Northern Ireland (NI), resulting in continued disparity in service delivery for children and families. The current, restricted evidence base for social work decision making in care planning, highlights practitioner’s overreliance on practice wisdom rather than evidenced-based research, theory and/or service user knowledge. This mixed methods study focussed on increasing knowledge around decision making in care planning. A training package was developed and delivered to practitioners across children’s services in one Trust area. A pre and post survey was completed with 74 practitioners in addition to 20 post training semi-structured interviews. The significant response rates and sample size offer validity and strength to the findings which correlate with previous studies completed across the UK that also conclude that research, theory and service user knowledge is not prominent in social worker’s understanding of what informs their decision making in care planning for LAC. This information is valuable for practitioners and managers attached to social work in children’s services. Recommendations include further embedding of a culture of learning and reflection to support the development of practitioner knowledge, skills and confidence; and to assist in the development of governance processes to audit the impact of practitioner training.

The significance of love in relation to looked-after children and child sexual exploitation

Drawing on the knowledge that looked-after children are disproportionately involved in child sexual exploitation, this critical systematic literature review considers the significance of ‘love’, using bell hooks’ ‘love ethic’. This literature review applies a systematic approach to retrieving literature and includes ten peer-reviewed journal articles containing primary research from individuals with lived experience of being a looked-after child and child sexual exploitation, or professionals within the field. Thematic analysis is used to identify the themes of risk, agency and relational practice. Together, these explore how dominant discourses of neoliberalism, patriarchy and capitalism shape modern social work, increase the risk of child sexual exploitation for looked-after children and maintain conditions needed for child sexual exploitation to function. bell hooks’ conceptualisation of the ‘love ethic’ is discussed as a possible framework in meeting the unmet emotional and economic needs of looked-after children through using ‘love as action’. ‘Love’, critical thinking and critical reflection are then recommended for social work.

Remembering the forgotten: How can we help looked-after children's social and emotional development in the early years?

The development of looked-after children (LAC) is greatly ignored in early years research, with few interventions designed specifically to tackle the issues that may arise as a result of becoming a LAC. In the final instalment of this three-part series, Emma Gillespie, early years educator, discusses the importance of understanding the factors that may contribute to poorer social and emotional development for LAC than their peers. She hopes that greater understanding will enable practitioners to provide better support to LAC where the odds have been stacked against them.

Oral Health Advice for Looked-After-Children: A pilot care pathway in Buckinghamshire, UK.

Looked-After-Children (LAC) frequently are more likely to have untreated dental caries, periodontal diseases or dental trauma (McMahon et al., 2018). The COVID-19 pandemic reduced the availability of dental appointments, including for LAC. This initiative piloted the inclusion of a dental pathway into the existing LAC care pathway in Buckinghamshire. The key principle was providing oral health messaging around maintaining good oral health and preventing disease in these children by training those involved with their care. A working group was convened, which included dental public health, clinical and training expertise. A care pathway was developed with resources drawn from existing programmes including mini Mouth Care Matters (mMCM). The care pathways were designed to identify children who needed care urgently due to pain or discomfort, signpost them to the relevant/most appropriate providers and provide oral health improvement advice for everyone. Local partners were engaged to ensure that the processes and training were appropriate. A pilot training session was then carried out for a range of staff engaged in the care of LAC within Buckinghamshire. The pilot dental pathway, launched in March 2022, initiative was welcomed by all stakeholders, including dental commissioners. The pilot training session received positive feedback from participants, with requests for more sessions. Training sessions were subsequently translated into video sessions, accessible when needed, for new staff or as refresher sessions. There are opportunities to reduce future inequalities for these children by inculcating positive behaviours early in their care journey. This will reduce their need for care. Identifying and implementing the most appropriate initiatives requires collaboration and commitment from all stakeholders.

Remembering the forgotten: Why is the gap between looked-after children and their peers not being addressed?

Remembering the forgotten: Why is the gap between looked-after children and their peers not being addressed?

Remembering the forgotten: Why we need to focus on looked-after children

A widely agreed fact is that the early years of a child’s life can be a strong predictor of their development, but an often-forgotten category of children is Looked-After Children (LAC) ( Harvard University, 2022 ). In the first article in a three part series, Emma Gillespie, early years educator, shares the research from her dissertation which looks at the impact of being a child in care on an individual’s early social and emotional development.

Depressive symptom networks in the UK general adolescent population and in those looked after by local authorities

BackgroundDespite the importance of understanding depressive symptom constellations during adolescence and specifically in looked-after children, studies often only apply sum score models to understand depression in these populations, neglecting associations...

Introducing Routine Assessment of Adverse Childhood Experiences For Looked-After Children: The Use and Properties of the Trauma and Adverse Life Events (TALE) Screening Tool

The present study aims to illustrate the process of developing, implementing, and clinically validating a new assessment measure, the Trauma and Adverse Life Events (TALE) screening tool, to assess Adverse Childhood Experiences (ACEs) among looked-after children. The TALE was developed by adapting existing ACEs measures to reflect the experiences of looked-after children. The TALE was completed by the local authority social worker for 218 children placed with Five Rivers Child Care (a UK fostering agency, residential, and educational care provider). Reliability was examined and exploratory factor analysis was conducted. Correlations between TALE scores, background variables, and psychosocial wellbeing using the carer-report Strengths and Difficulties Questionnaire (SDQ) and Child Dissociative Checklist (CDC) were also explored. The TALE was found to have acceptable reliability (α = .71). A three-factor solution was found which explained 46.24% of the variance, with factors labelled ‘Direct Experience of Abuse’, ‘Witnessing Harm’, and ‘Household Dysfunction’. Exposure score was significantly associated with total difficulties score on the SDQ (rs = .24, p < .001) and Impact score was associated with the SDQ’s impact score (rs = .33, p < .001). Exposure and Impact scores were both positively correlated with CDC scores (rs = .16, p = .021 and rs = .22, p = .002). This paper presents evidence of the importance of screening looked-after children for ACEs and demonstrates that the TALE is a valid and reliable tool for this purpose. Adverse and traumatic experiences were highly prevalent in this population and appeared to be closely related with children’s psychosocial wellbeing. Results emphasise the importance of routine assessment of past experiences within trauma-informed psychological care and intervention planning for looked-after children.

Exploring looked-after adolescents’ reports of their dissociative experiences.

ObjectiveIn this study, the relationship between levels of dissociation, several pre-placement factors and other background variables was explored to facilitate understanding of the high prevalence of dissociation in adolescents living in care. MethodsA sample of adolescents (n = 68) between the ages of 11 and 17 in care at Five Rivers Child Care (FRCC) participated in the study. The Adolescent Dissocitive Experiences Scale (ADES), a self-administered dissociation questionnaire was compared with an established carer-report measure of dissociation, the Child Dissociative Checklist (CDC), the Strengths and Difficulties Questionnaire (SDQ) and the Trauma and Adverse Life Experiences Assessment (TALE) to explore the relationship between dissociation and other emotional, behavioural, and trauma-related difficulties in a looked-after population. ResultsThe exploration of demographic variables revealed that dissociation was more likely to be present in females than males, with the age placed in care also influencing levels of dissociation. Measures related to pre-placement risk factors were not shown to be related to dissociative experiences. As expected, regression models were not significant in explaining variance in ADES scores with minimal effects from background, pre-placement risk and psychopathology variables. Finally, a discrepancy was observed between participant self-related dissociation and carer, or residential worker observational scores of the adolescents’ dissociation. ConclusionThe study's findings corroborate previous research confirming high levels of dissociation among adolescents in a specific care population, with the ADES questionnaire demonstrating the ability to measure dissociation. Utilising the ADES can offer an opportunity to understand the presentation of dissociation in looked-after children, and for clinicians, may provide a deeper comprehension when formulating a more sophisticated support or treatment plan.

The Dental Health of Looked After Children in the UK and Dental Care Pathways: A Scoping Review.

There has been a 37% increase in the number of Looked After Children (LAC) in England over the past decade. Although LAC have more health and social problems than their peers, little is known about their dental needs, barriers to dental care, and pathways used to access it. This scoping review assessed the evidence on the dental health needs of LAC in the UK and their different dental care pathways. Embase, MedLine(R), Scopus, Web of Science, PubMed and CINAHL, grey literature databases and third-sector organisation websites were searched up to February 2022. Included studies were any study type involving UK resident LAC aged 0-18 with no limits placed on time in care/placement. Thematic analysis identified access barriers and dental care pathways. Twenty-eight articles were included (nine publications, 11 abstracts and 8 grey literature). Oral health surveys, population linkages studies and service evaluations described the poor oral health of LAC and their unmet needs. Barriers included the lack of dental care and irregular attendance; the lack of integrated working between health and social care teams, lack of self-care and oral health promotion, and psychological issues complicating dental treatment. Four dental care pathway models were identified: care navigation, facilitated access, nurse-led triage and referral, and signposting to local dentist with multi-agency information sharing. LAC are a vulnerable group with barriers to care suggesting the need for integrated working between health and social care teams, specialist services and an evaluation of pathways to identify best practice.

Looked after children: an overview for the dental team

Looked after children (LAC) are children and young people (CYP) who have been under the continuous care of the local authority for more than 24 hours. Reasons for becoming looked after include concerns about abuse or neglect, breakdown in family functioning, or absence of a suitable caregiver (for example bereavement, parental illness, or separation, such as for unaccompanied asylum-seeking children). Many LAC live with foster families, extended family, or in residential care homes, but a CYP can be legally 'looked after' and still be living with their original or birth family, or living independently with support. Regardless of the circumstances, the local authority has responsibility for meeting the needs of the CYP, including dental care, usually via a named social worker. The evidence available suggests that LAC are at higher risk of dental caries and pain. In 2021, Public Health England reported on inequalities in oral health in England and although evidence was limited, found LAC to have poorer oral health and access to care. It is important that LAC are considered for enhanced prevention and reviewed regularly to enable appropriate provision of dental care. Understanding who can consent for dental treatment is essential.

Looked after children: an overview for the dental team.

Looked after children (LAC) are children and young people (CYP) who have been under the continuous care of the local authority for more than 24 hours. Reasons for becoming looked after include concerns about abuse or neglect, breakdown in family functioning, or absence of a suitable caregiver (for example bereavement, parental illness, or separation, such as for unaccompanied asylum-seeking children). Many LAC live with foster families, extended family, or in residential care homes, but a CYP can be legally 'looked after' and still be living with their original or birth family, or living independently with support. Regardless of the circumstances, the local authority has responsibility for meeting the needs of the CYP, including dental care, usually via a named social worker.The evidence available suggests that LAC are at higher risk of dental caries and pain. In 2021, Public Health England reported on inequalities in oral health in England and although evidence was limited, found LAC to have poorer oral health and access to care. It is important that LAC are considered for enhanced prevention and reviewed regularly to enable appropriate provision of dental care. Understanding who can consent for dental treatment is essential.

A Critical Review of "Exploring the educational experiences of looked-after children and young people in Wales"

Many children in Wales who are labeled "looked-after" cannot do as well as those not in care in terms of study. Although an increasing number of studies show the educational disadvantage among children and young people in care can be a factor, some researchers intend to study the impact of being regarded as "in care" on LACYP's educational outcomes by interpreting the feelings as well as thoughts of the participants. This essay will discuss the research paradigm of this study and its several components including ontology, epistemology, methodology and methods in detail. Besides, the strengths and weaknesses around how the research was conducted will be evaluated based on the criteria of credibility, dependability, transferability and confirmability. These criteria proposed by Guba & Lincoln are considered to be suitable for evaluating truthfulness in qualitative research.

Eliciting Looked After Children’s Views and Relationships Through Card-based Participatory Research Methods

This brief report discusses the usefulness of “ranking and ratings” cards in the context of participatory research with looked-after children. Within this research, we draw upon notions of participation as outlined in the UNCRC. We undertook participatory research to elicit the voices of looked after children, aged 6 to 11 years, who were involved in a school-based creative mentoring intervention. The researchers created a “ranking and ratings” card based upon the popular game “Top Trumps” to create familiarity and facilitate an examination of mentor-mentee relationships through focused conversations. We found that children’s interactions with the cards stimulated conversations which were open and detailed. This was of particular value for conducting participatory research with marginalized children who may not otherwise necessarily engage in research with an unfamiliar adult.

Voices from the silent cradles: Life histories of Romania’s looked-after children by Mariela Neagu

<b>Voices from the silent cradles: Life histories of Romania’s looked-after children</b> by Mariela Neagu

Philosophy and the clinic: Stigma, respect and shame.

Since its foundation in 2010, the annual philosophy thematic edition of this journal has been a forum for authors from a wide range of disciplines and backgrounds, enabling contributors to raise questions of an urgent and fundamental nature regarding the most pressing problems facing the delivery and organization of healthcare. Authors have successfully exposed and challenged underlying assumptions that framed professional and policy discourse in diverse areas, generating productive and insightful dialogue regarding the relationship between evidence, value, clinical research and practice. These lively debates continue in this thematic edition, which includes a special section on stigma, shame and respect in healthcare. Authors address the problems with identifying and overcoming stigma in the clinic, interactional, structural and phenomenological accounts of stigma and the 'stigma-shame nexus'. Papers examine the lived experience of discreditation, discrimination and degradation in a range of contexts, from the labour room to mental healthcare and the treatment of 'deviancy' and 'looked-after children'. Authors raise challenging questions about the development of our uses of language in the context of care, and the relationship between stigma, disrespect and important analyses of power asymmetry and epistemic injustice. The relationship between respect, autonomy and personhood is explored with reference to contributions from an important conference series, which includes analyses of shame in the context of medically unexplained illness, humour, humiliation and obstetric violence.

The challenges that social care services face in relation to looked after children with neurodevelopmental disorders: A unique insight from a social worker perspective

Looked after children (LAC) continue to be one of the most vulnerable groups in society with numbers and rates in care increasing year-on-year. The aim of this study was to explore the unique perspectives, perceptions and opinions of experienced social workers on the little explored subject of neurodevelopmental disorders (NDDs) in this population. Using purposeful sampling, 10 social work professionals with extensive experience of working with these children were interviewed using a semi-structured interview. A thematic analysis using NVivo software was utilised to analyse, code and identify themes that contributed to the aims of the study. Four overarching themes and sub-themes emerged from the findings: perceptions of NDDs, perceptions of diagnosis, access to service provision and the impact on care settings. Attention deficit hyperactivity disorder, autism spectrum disorder, dyslexia and dyspraxia were the more prominent conditions discussed. Even though these children are embedded in service provision, the findings raise important questions for both health and social care policy. There is a pressing need for research from a nationwide context to further explore areas of prevalence, training, resources, access to relevant specialist support services and the impacts on the already vulnerable LAC with an NDD.

Outstanding innovators focus on looked-after children

Outstanding innovators focus on looked-after children