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CONSULTATION RESPONSE

30 January 2007

Green Paper: Care Matters

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SCIE consultation response 1

Introduction

SCIE welcomes the opportunity to comment on the proposals set out in Care Matters.

We are in no doubt that there are a number of areas that require significant

improvement in the way we provide services for looked after children. We support the

premise for the proposals that our goals for children in care should be the same as our

goals for our own children.

However, we are concerned that the case for reform is made partly on the basis that

children in care are over represented in vulnerable groups such as young offenders,

drug users and prostitutes. We would emphasise the heterogeneity of the 60,000

children and young people in care at any one time who are from different backgrounds,

are at different life stages and who follow different care pathways. We are alarmed at

the implied causal link between short term-care and adult outcomes and between later

care careers and adult outcomes. To make a link between a week spent in care as a

baby and ending up in prison as an adult is a gross distortion which stigmatises and

devalues young people who live in care and the people who care for them.

Nonetheless, to its credit, the Green Paper has highlighted a range of problems in the

current planning and practice of child care social work and outlined some innovative

proposals to deal with them. In the body of our response we have evaluated many of

those proposals and the basis on which they are formulated. Our views are informed by

our extensive and relevant work in this field and we would be delighted to share more

detailed learning and practice points with the DfES as they finalise their proposals for

change.

In our response, we have also drawn on the views of delegates from our ‘Care Matters

expert seminar’, which was held in January 2007. The seminar was attended by over

40 delegates including policy makers and practitioners and representatives from

national youth organisations, schools and research institutions. We would like to

express our sincere thanks to all who attended and especially to those delegates who

contributed presentations and stimulated such lively and informed debate about the

issues raised in the Green Paper.

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Chapter 1

1. Are the elements we suggest for our pledge the right ones?

We welcome a systematic approach to gathering children’s views and using these to

inform the pledge. SCIE is reassured to see in appendix A that the Green Paper has

taken account of a range of resources about what children want from care. The latest

‘Children’s Views’ report from the Children’s Rights Director, Roger Morgan, which

addresses adoption, was published after the commencement of the Care Matters

consultation period so we would recommend this for consideration by the DfES

consultation team.

We would also alert the team to the work of A National Voice, an organisation run by

and for care experienced young people. Their recent report, ‘There’s no place like

home’ presents findings from their survey of 300 care leavers and a further 300

professionals. The report centres on respondent’s views about Care Leaver’s

accommodation and support. As the pledge must address issues around transition, we

strongly recommend that these views be incorporated in the final version.

In terms of the specific elements of the pledge, at this stage, they still seem fairly

random. However, we are pleased to see the focus on physical health, particularly the

dental checks, because we share the concern that the continuing health care needs of

looked after children may be overlooked. Our Fostering Practice Guide (2004)i points

out that when they are in foster care, children nearly always receive treatment for acute

health needs but chronic health problems and dental care may be neglected. We would

therefore strongly endorse health assessments and dental checks for all looked after

children.

We also lend strong support to the part of the pledge which promotes the rights of

looked after children to have their voices heard and to influence the work of the local

authority. SCIE firmly believes that children and young people should play a

fundamental role in the planning and delivery of services that affect them. To this end

we have published practice guidanceii offering a framework for systematically

developing the effective and meaningful participation of children and young people in

the design, delivery and review of their services. This guidance is especially critical in

supporting organisations to involve looked after children because as a group, they are

often marginalised, facing particular barriers to having their voices heard. The guidance

promotes a whole systems approach to participation providing specific guidance for

organisations on; developing a culture; a structure for participation and effective practice

for participation as well as effective systems for participation.

Although we are supportive of certain elements of the pledge, we are concerned that

looked after children are being treated as a group apart and that there seems to be

some discrimination in resource allocation. We would question why many elements of

the pledge shouldn’t be made for all children and young people, particularly those on

the edge of care.

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2. Are there other key barriers to attainment which we should address

in order to transform outcomes?

SCIE strongly supports the emphasis on outcomes although we believe there needs to

be a clearer, shared understanding of exactly what is meant by “outcome”, particularly

in this context. Our knowledge review on the research literature in foster careiii defines

an outcome as the ‘desired end result and intended improvement after a specific period

in the well-being of children and/or families’. It ‘relates to the impact, effect or

consequence of a particular service intervention.

The review makes a helpful distinction between:

• Final outcomes, which are generally agreed to be of value (or deleterious) in their own

right. They may occur after foster care, for example, ‘settling down in adult life and

having satisfactory relationships’. However, they may also be in a sense part of foster

care and occur at the time – for example, whether or not a child is unhappy while

fostered, or does well at school.

• Intermediate outcomes, which are not seen themselves as intrinsically valuable, but

are ‘steps on the way’ to others. For example, it might be argued that an unstable care

career is not in itself a ‘bad thing’. It is, however, undesirable because, among other

things, it affects educational progress.

• Process outcomes, which are concerned with the way foster care is provided. They

would include, for example, the degree to which the child was consulted over what

happened to her or him. They may be valued because of their effect on final outcomes

or for other reasons – for example, because they are seen as rights, or because they

are valued by children.

These distinctions will help to clarify what kind of outcome is looked for in what context

and focus on the range of barriers preventing attainment of all three types of outcome.

Although we recognise the worrying, relatively low educational attainment of looked

after children, we think that the green paper focuses disproportionately on this aspect of

children’s lives. We would point out that children and young people’s experiences of

growing up include but are about more than educational attainment. Growing up is also

about, being able to develop fully, about keeping safe and, in some cases, staying alive.

For looked after children, these will be especially pertinent.

We do not think there is sufficient emphasis on strategies to improve outcomes. One of

these is focusing on the strengths of young people, which research shows as crucial to

future outcomes.iv ‘Resilience’ refers to the qualities that cushion a vulnerable child

from the worst effects of adversity and that may help a “child or young person to cope,

survive and even thrive in the face of great hurt and disadvantage.”v While it may not

always be possible to protect a child from further adversity, finding ways to boost a

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child’s resilience should enhance the likelihood of better long-term outcomes. SCIE

thinks that the green paper should give more attention to approaches which boost

children and young people’s resilience. Local authorities should pay attention to

resilience-enhancing factors because they are the sorts of things in a child’s or young

person’s life that help them to cope in unfavourable circumstances or times of difficulty.

Important factors include having at least one interested and committed adult in the

child’s life.

Another is being happy and doing well at school and every effort should be made to

ensure that their experiences are positive, including encouraging them to take part in

school activities that they enjoy to help build their self-esteem.

A sense of direction is also very important to young people in troubled circumstances

because it can provide stability and control. This involves working with young people to

build up a picture of what the future may hold: to develop goals and plans for reaching

them.

Some of the things we mention here, including involvement in school activities, are

included in chapter 2 as means in themselves of achieving positive outcomes for looked

after children. However, we also highlight their importance as resilience enhancing

factors. Local authorities should concentrate on boosting children and young people’s

resilience, thereby equipping them to cope with the difficulties and barriers they face.

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Chapter 2

3. What more can be done to reassert the responsibility of parents and

help them to fulfil those responsibilities?

SCIE has carried out detailed work on the difficulties parents face and the kinds of help

that are effective. So far we have focused on parents with learning disabilitiesvi, parents

with physical or sensory impairmentsvii, parents with mental health, drug or alcohol

problemsviii ix and on families with a parent in prison (work in progress), so this is the

evidence we draw on. SCIE is also currently undertaking further work to develop the

NICE guidance on parenting programmes for a children’s services contextx.

We strongly consider that the parenting responsibilities and role of disabled parents

need to be recognised, and policies developed across community care services to

support this role. Our work with both groups identified potential barriers to the

development and maintenance of specialised and/or multi-agency services for disabled

parents which included limited funding, a lack of skills among professionals for

assessing the needs of disabled parents, and entrenched attitudes about the respective

services’ responsibilities towards children and adults. Furthermore, for parents with

learning disabilities, we identified negative attitudes among professionals about their

parenting potential.

The parents covered by SCIE’s work on physical disabilities are those with conditions

such as arthritis, asthma, cystic fibrosis, cerebral palsy, multiple sclerosis, end stage

renal disease, neuromuscular diseases, spinal cord injury, and also those with various

degrees of deafness and blindness. These parents do not constitute a clearly

homogenous group, but their parenting has particular common themes, such as a

potential need for assistance with looking after children, domestic tasks and

transportation.

The research reports that parents with physical or sensory impairments can experience

great difficulty in performing a range of domestic and child care tasks. However, parents

do develop coping strategies, and there are environmental and physical means of

supporting these parents in their roles. Direct payments are also valued by parents

because they can arrange help to suit their own needs, rather than having to accept the

less flexible support provided by other services.

Some solutions to supporting parents with physical or sensory impairments are outlined

below although we would point to the references in our research briefing for further

detailed information.

Physiotherapists and occupational therapists have identified several solutions to enable

parents with arthritis to fulfil their parenting role more in accordance with their own

expectations. These include techniques to avoid pressure on joints, alternative methods

of lifting and handling children, and advice on changes in and to the home, such as

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adapting furniture. The provision of appropriate, adapted equipment to help parents in

their parenting, especially of young children, is a constant theme of the research. The

research has also found, however, that there is a lack of appropriate products to support

certain aspects of parenting, for example, pushing a pram or buggy, or carrying a baby

when the mother is in a wheelchair.

The research has consistently found that modifying the home, to make it more

accessible to the parent, makes parenting easier, especially in the performance of

domestic household tasks, which mothers consider to be an important part of being a

parent. However, parents may be prevented from implementing such modifications by

financial or practical restrictions. In such cases, a possible solution is to provide

mothers with some form of home help. The research has also emphasised that parents

need to be encouraged to seek support from statutory and voluntary services. Medical

solutions, such as the provision of effective drug information and management, are

important for parents with debilitating physical conditions, such as arthritis and asthma:

parents who receive appropriate treatment are more able to perform their parental role

than those whose condition is managed less well.

Although question 3 asks us to consider ways of supporting parents in fulfilling their

parental responsibility, SCIE believes it is critical to highlight some of the barriers to

being able to do so. Solutions such as the ones highlighted above and detailed in our

research briefing will have limited effect if the current policy and practice contexts are

not also addressed.

One of the principal barriers to the provision of support to parents with physical or

sensory impairments is the blurring of responsibilities between adults’ and children’s

services. Children’s services tend to focus exclusively on assessing children’s needs

and welfare, including child protection issues; adult services tend to focus only on the

provision of personal services to disabled adults. The needs of disabled parents

therefore often fall between these two services, but “professional agendas can be

divergent and sometimes contradictory, and knowledge about the work of other

professionals is often limited”xi.

Generally, SCIE advocates a “whole-family” approach, which seeks to address the

needs of the parent and child together rather than separately. The potential barriers to

the development and maintenance of specialised and/or multi-agency services for

disabled parents have been identified as limited funding, lack of skills among

professionals for assessing the parenting needs of disabled people, and entrenched

attitudes about the respective services’ responsibilities towards children and adults. Our

research briefing concluded that multi-agency working needs to be very carefully

structured and co-ordinated in order to promote consistency and continuity of

information and services between the many professionals involved.

As noted above, when we consider the experience of parents with learning disabilities,

there is a particular additional problem which is other people’s perceptions. Parents

with learning disabilities often need to overcome preconceived ideas among other

people about their ability to parent. For example, there may be a willingness to attribute

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potential difficulties they may have parenting to their impairment rather than to disabling

barriers or to other factors that affect the parenting of all parents. This has been

described as the “presumption of incompetence”:

However, parents with learning disabilities face more than an image problem. Several

factors have been demonstrated to have an adverse effect on all parenting: these

include low socio-economic status; unemployment; and social isolation or exclusion. All

of these factors make parenting difficult, and parents with intellectual or learning

disabilities are at greater risk of experiencing one or more of these disadvantages than

other groups.

SCIE’s research briefing highlighted interventions which have been found to be effective

in supporting the parenting role of people with learning disabilities and overcoming

some of the barriers they face. However, we would also point out that the research has

limitations which are discussed in our briefing and which should be considered as a

background to the findings.

Relevant interventions (whether formal or informal) are described below under three

main headings; parent training programmes, teaching and social support networks.

Parent training programmes

Parent training programmes are often developed for parents with learning disabilities,

and evaluation of their effectiveness is a common subject of the research. Most parent

training programmes tend to focus on child care, child safety, and mother-child

interaction. However, the results of research into parent training programmes aimed at

parents with learning disabilities are inconclusive. The research points out that the

generalisable nature of what is being taught to parents is very important, in other words,

that the parent can take what they have learned and apply it to real world situations and

to instances beyond the examples used in training. We found the most effective and

potentially generalisable type of parent training for parents with learning disabilities is

education undertaken in the home. Home-based programmes do demonstrate some

success and are known to be preferred over “centre-based” programmes as a form of

education, but many such interventions may not be particularly effective. For example,

the home environment may offer too many distractions; and parents with learning

disabilities who live with their own parents or other family members may not have

sufficient personal control over their domestic environment and the parenting of their

children to apply what they have learned.

Teaching

Teaching which is delivered only verbally, or based on observation or hypothetical

situations can prove inaccessible to parents with learning disabilities. Information and

training has been found to be most effective when it is tailored to the abilities of

individual parents. The most effective forms of education are interactive, practical,

involve repetition or “reinforcement”, and use pictorial materials. However, parents with

learning disabilities can find too much repetition both boring and condescending. SelfTRANSFORMING

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learning manuals are also effective for teaching child care and child safety skills to

parents with learning disabilities; they offer a “minimal involvement”, low-cost, homebased

alternative to the more systematic, professionally-led parenting programmes.

This enables the parents to retain a sense of control and self-help in the learning

process. Services and training programmes should be developed in conjunction with

parents and their advocates and training and support should be as non-intrusive as

possible and allow parents to retain a sense of self-help and control.

Social support systems

The research has found a strong association between supportive social networks and

the positive psychological well-being of parents with learning disabilities. We found that

some parents with learning disabilities have said that they like support groups because

they give them confidence, improve their self-esteem and assertiveness, and enhance

feelings of control. Such groups can act as a social support network, which is often

missing from the lives of parents with learning disabilities. It has been argued that the

improved confidence and sense of well-being engendered by an increased sense of

self-worth among these parents may positively affect parenting. Social support

networks may also be important because families and others can provide practical help,

such as child care and taking children out: parenting therefore is not carried out in

isolation. Social support networks may also have an indirect effect on parenting

experience because parents have a greater network of people with whom to share

experiences, concerns and solutions; this has been described as “informal social

learning”. Such social support is often lacking for parents with learning disabilities.

Measures to develop social skills and expand social networks can therefore be an

important part of a “family-centred” approach to supporting parents with intellectual or

learning disabilities. However, we would point out that there is currently little direct or

indirect evidence to demonstrate that increased self-esteem, confidence or more

extensive social networks have a positive effect on the parenting of parents with

learning disabilities; specific research has yet to be done on this topic.

Just as we did for parents with physical and sensory impairments, we believe it is

crucial to highlight some of the barriers to being able to support people with learning

disabilities in their parenting roles. Many of the problems are the same and indeed

relate to difficulties in supporting all parents in their parenting roles. The main culprits

are the operational structures of health, social and children’s services.

Although research into parents with learning disabilities found that parents with learning

disabilities require specialist support services, as stated above, it is questionable

whether health and social services are always in a position to provide this support.

There is currently little specialist provision to parents with learning disabilities. One

barrier to the provision of effective parent training is the division and blurring of

responsibilities between adults’ and children’s services. Children’s services tend to

focus exclusively on assessing children’s needs and welfare, including child protection

issues; adult services tend to focus only on the provision of personal services to adults

with learning disabilities. The needs of parents with learning disabilities therefore often

fall between these two services, but “professional agendas can be divergent and

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sometimes contradictory, and knowledge about the work of other professionals is often

limited” (Woodhouse et al, 2001).

4a. Do you agree that there is a need for a more systematic approach

to sharing effective practice in children’s services?

SCIE unreservedly agrees that with this proposition. SCIE’s own role is to develop and

promote knowledge about good practice in social care and we do this systematically by

identifying useful information, research and examples of good practice. Using this

information, we produce resources which evaluate practice in a particular area of social

care, draw out key messages for good practice and identify areas where more research

is needed to inform good practice.

We feel it is critical to make the distinction between information sharing and sharing

effective practice. SCIE shares effective practice through its practice guides which are

free online resources bringing together information, research and current good practice

about particular areas of social care, including children’s services. The guides give

front-line practitioners, their managers and the whole organisation the opportunity to

develop knowledge about what works well and apply it effectively in day-to-day work.

Practice guides are developed on the basis of the results of ‘Knowledge reviews’ which

pull together knowledge from service users, research and practice.

More broadly, dissemination and promotion of good practice material is not on its own

sufficient to achieve and sustain practice change and improvement. Ensuring maximum

impact requires a strategic approach to coordinating education and training,

commissioning contracts with outcome targets, registration and inspection standards,

performance indicators, and the other carrots and sticks available to strengthen

incentives for continuous improvement.

4b. If so, how can we ensure maximum impact in supporting evidence

informed commissioning and practice?

Carrying out knowledge reviews and developing practice guidance is of limited use if the

resources do not make an impact on commissioning and practice. When SCIE

published its fostering practice guide we also undertook the ‘fostering collaboratives

project’ to help front-line staff make use of the Fostering Guide in their own daily

practice. The practice groups focused on contact arrangements for Looked After

children. We found that, once practitioners were applying the evidence base to

practice, this then required a review of how the organisation commissioned contact

services.

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5. What more can be done to support links between adults and

children’s services, particularly in relation to drug abuse and mental

health support?

SCIE agrees unreservedly with the message in chapter 2 of Care Matters which

suggests a need for greater joint working between children’s and adult’s services. SCIE

also agrees that families experiencing drug abuse and mental health problems require

particular attention. However, there are also significant issues for disabled children and

their families when making the transition from children’s to adults’ social care, education

and health services, reflecting different standards, criteria, resource levels and

expectations of adult services which can cause considerable disruption at a vulnerable

point in young people’s lives.

Parents with mental health problems are one of the four groups of adults with mental

health problems least likely to access core services for themselves and their children.

In their report on mental health and social exclusion, the Social Exclusion Unit (SEU)

highlighted that this group face barriers to getting their health and social care needs

metxii. The SEU also made recommendations for supporting these families.

There is clear evidence that the cross generational impacts of not intervening

successfully in and out of crisis leads to serious public health issues. Indeed, the

following extract from ‘Crossing Bridges’xiii highlights the potential impact of mental

health on parenting, on the child, over time and across generations:

Between one in four and one in five adults with experience a mental illness during their

lifetime. At the time of their illness, at least a quarter to a half of these will be parents.

Their children have an increased rate of mental health problems, indicating a strong link

between adult and child mental health. Parental mental illness has an adverse effect on

child mental health and development, while child psychological and psychiatric

disorders and the stress of parenting impinge on adult mental health. Furthermore, the

mental health of children is a strong predictor of their mental health in adulthood.

(Falkov, A 1998:1)

The needs of the whole family should be viewed individually but also together in the

ways that the different needs and behaviours of different family members interrelate and

impact on each other, for example parent and child, parent to parent and cross

generational. This should also include the measurement of longer term impacts if the

individual or family do not meet the criteria for service.

At present, specialisation in health and social care services mean that families are not

treated as a whole and their interrelatedness is not recognised. This separation has led

to a situation where staff in adult mental health services focus on the adult with

insufficient attention paid to the adult as a parent with responsibilities and aspirations for

their dependent children. Staff in children’s services put insufficient emphasis on the

mental health needs of parents and the potential adverse impact on children.

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Increased specialisation has emphasised the importance of ensuring effective

communication and collaborative working. Recommendations from both adult

homicide inquiries and child death reviews are remarkably similar – improving

communication, coordination and collaboration within and between all services and

agencies to better support mentally ill parents who a re struggling to meet the needs of

their children including their safety (Falkov, A 1996, Woodley 1995).

However the problems are perpetuated by current national strategies and operational

frameworks of which there are an increasing number aligned to core specialist areas. A

national based approach to raising standards and improving outcomes for all family

members does not exist. As a result, local managers and practitioners are faced with

the challenge of searching for these, then translating them into cohesive family-based

policy locally. Often, the search is to support individual decisions and is not translated

by organisations into strategy and policy, this means practitioners and managers have

repeatedly to argue decisions on a case by case basis

As families do not divide in the way that services and professionals do, sorting

through the muddle can lead to fragmented and diluted service responses with

practice guidance that does not have a ‘must do’ element or which is not recognised as

authoritative across the various groupings that make up children’s services.

Now with the responsibility for children’s services moved to the Department for

Education and Skills (DfES) and mental health services remaining with the Department

of Health, there is even more impetus to support ‘joined up thinking’ and ‘working

together’ at a national level to create guidance and standards that cross health and

social care and mental health and children’s services.

We would also point out that universal services need to include staff and community

education programmes to raise awareness and to encourage staff and the public to

consider the impact of multiple stressors in the family on the individual and the family as

a whole. Standard one of the National Service Framework for Mental Healthxiv

recognises this need as it points out that mental health problems can result from a

range of adverse factors including; unemployment, drug and alcohol problems,

domestic abuse and homelessness. Children from a very early age have access to

social education and awareness and age appropriate understanding of these issues can

act as a ‘protective’ factor encouraging children and their families to seek help at an

early stage1.

SCIE has clear views about tackling the problems outlined above so that links between

adult and children’s services are strengthened and crucially, the need for care is

prevented.

1 We will be addressing this issue in the Parental Mental Health and Child Welfare

systematic review and guideline development programme and would be delighted to

share our emerging findings throughout 2007 with our finalised guidance due to be

published in January 2008.

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Early identification of the potential ‘at risk’ population is essential. Education is a key

issue here for professionals, the public and service users. SCIE’s Parental Mental

Health (PMH) systematic review will be reviewing qualifying and post-qualifying training

and occupational standards and requirements for health and social care professionals

working with PMH families. The problem of the specialisation of services highlighted

above is relevant here because staff in neither adult mental health teams nor children’s

services are detecting the problems of other family members soon enough. SCIE’s

commissioned review of professional education will address these issues from the

perspective of how qualifying and post qualifying education and professional standards

and frameworks address the knowledge, skills and attitudes needed by professionals to

work effectively with parents with mental health problems and their children and to work

effectively as part of a multi-disciplinary team or multi-agency service.

Standard one of the national service framework for mental health should also ensure

earlier intervention with the recognition that mental health problems can result from a

wide range of factors. Standard 6 is also relevant to addressing problems before they

become acute as it is concerned with assessing the care, physical and mental health

needs of individuals caring for a person on a CPA. This would be particularly welcomed

by families where one or both parents have mental health problems. Currently, children

and young people caring for a parent with mental health problems are the group of

carers most likely not to be offered a ‘carers’ assessment of their needs from either

mental health or children and family services (Dearden et al, 2004).

However, even more could be done and earlier. Care Programme Approach (CPA)

forms and formats and the new Children’s Assessment Framework (CAF) and forms

should include specific reference to identifying which adults with mental health problems

have children. This factor should be referenced for consideration throughout

assessment and review frameworks.

The CPA is the core assessment and care planning framework for adults with Severe

and enduring Mental Illness (SMI) and therefore inclusion of the needs of adults as

parents into this programme would go a very long way into introducing the concept that

adults with mental illness may be parents and that this needs to be taken account of

during assessment and care planning and identifying whether the children are also in

need. This should include need of protection due to the direct or indirect impact of the

parental mental illness.

To date there has been a glaring omission in the CPA in its attention to the needs of the

adult as a parent and his or her dependent children. SCIE feels strongly that the fact

that an adult is also a parent should be addressed at every stage of the assessment,

care planning and review process as should the needs of the wider family e.g. well

parent, children and so on. With the Children’s Assessment Framework being piloted

and the CPA being reviewed, now is a critical time for this call for evidence to influence

change in this extremely important area.

SCIE is also commissioning research reviews on prevalence, detection and

interventions in parental mental health and child welfare, the results of which will also be

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relevant to this issue. The first review, which has two parts, seeks to uncover what we

know about the prevalence and types of Parental Mental Health Problems (PMHPs) in

the United Kingdom (UK) for the whole populations of parents and children; and for

population sub-groups. The second part will describe what range of systems, tools and

opportunities are in place for detecting PMHPs during child care screening and mental

health screening, including cross agency referral and multi agency systems. The

second review focuses on the accessibility, acceptability and effectiveness of

interventions used in the UK and overseas that support children, whole families,

parenting and/or couple relationships in families with children, where a parent already

has a mental health problem. The findings from these reviews will be finalised in July

2007 and SCIE would be delighted to share the emerging results of both reviews.

6. What more could be done to support family, friends and carers?

SCIE agrees with the proposition in chapter 2 that there is a need to see solutions within

the young person’s natural family or social network. For example we should consider

whether the child or young person could stay with relatives or family friends for a period

with the intention of keeping them out of the care system altogether. Delegates at our

Care Matters seminar representing A National Voice strongly supported this notion of

providing support within the context of families or local communities as a means of

avoiding entering the care system. As the green paper points out, securing placements

with family and friends often leads to greater stability. This approach to placing children

and young people has been described as ‘Kinship Care’ and research has highlighted

some very positive findings about it.

In 2001, for example, researchers from DeMonfort University’s Children and Families

Research Unit carried out a study in the London Borough of Wandsworth Social

Services Department exploring the experiences and views of young people in ‘kinship

care’. The study findings echo the assertion in the green paper about kinship care

placements being more stable and longer term. Furthermore, the children in kinship

care were overwhelmingly positive about their placement: they reported feeling loved,

settled and safe. The kinship carers were also broadly positive about this approach.

Almost all carers believed that the overall impact of the placement had been positive in

terms of improving the young person’s feeling of security, behaviour, educational

achievement and links with the birth family. However, around half the carers were

struggling to cope with the difficult behaviour of the young person and there were

problems concerning money, loss of freedom and overcrowding. Consequently, carers

wanted more financial and social work support. Indeed, there appeared to be a strong

argument for kinship carers getting the same level of financial support as that devoted

to foster carers.

The research also highlighted the need for Kinship Care to be recognised in a policy

framework. In policy terms it was hardly recognised and social workers pointed out that

Kinship Care scarcely featured in their training. In practice, other interventions were

prioritised so that where kinship placements did occur, responsibilities were very

unclear.

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SCIE therefore welcomes the green paper’s recognition of the potential benefits of

looking for a care alternative within the young person’s family circle. However, for any

of the DfES proposals to be effective, Kinship Care must be embedded in the policy

framework, addressed in social work training and routinely considered as a realistic care

alternative preventing vulnerable children and young people from entering local

authority care. Apart from cases where there is a safeguarding concern, this after all, is

the outcome we should be working toward. We know from listening to delegates from A

National Voice, that this is their priority.

There are of course numerous other family support services and Home Start represents

one of the largest. However it is also one which illustrates the problem of investing in

programmes which appeal to our common sense. Established over thirty years ago,

Home Start offers volunteer home visiting support to families under stress with children

under five years of age. On the face of it and because of its apparent similarity with the

notion of family group conferencing, Home Start sounds as though it would deliver the

outcomes we want from early intervention schemes for families at risk. However, using

a comparison group, the results of one studyxv did not in fact support the view that

Home-Start had made a significant difference to the mothers over the eleven-month

period of the research, relative to the experiences of the families in the comparison

group. This does not mean that Home Start and schemes like it are redundant; far from

it. Mothers who received the support of a Home-Start volunteer valued the service and

considered that it had made a positive difference to their lives. However, mothers in

both groups showed similar levels of improvement, even though there was no evidence

of any other comparable family support service being received by the comparison group

during the intervening period. The receipt of Home-Start services also pushed costs for

the study group to a higher level relative to the comparison group. Combined with the

outcome results, the evidence did not therefore point to a cost-effectiveness advantage

for Home-Start

7. Is it right for us to work towards an increase in the number of

younger children supported in families and, as a result, a small

younger care population with more complex needs?

As stated above, it is right to work towards an increase in the number of children and

younger people supported in families. The difficult judgements are in relation to children

at risk of abuse or serious neglect, and those likely to be involved in offending, where

both staying at home and entering care may have damaging consequences, and the

choice is about the lesser of two evils. Even where the best thing for the child is to

enter care, the importance to children’s identity of continuing membership of and

involvement in their own families should not be underestimated.

It is not clear that the second part of the question follows from the first. Whereas the

Green Paper seems to assume more support for families will divert more young people

from entering care, in fact adolescence is the time when parental and family influence is

diminishing, and the risks to young people are becoming more extensive. Involvement

in delinquency and violence related in many instances to drug and alcohol abuse,

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experience of bullying and adverse peer pressure. Vulnerability to sexual exploitation

and premature pregnancy, are often linked to severe neglect and chaotic lifestyles.

Some young people run away from home to escape the pressures and threats they feel

there. These young people also have “complex needs” which may not be met by

increased family support, and may require new and innovative strategies to develop

alternatives to care.

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Chapter 3

8. Do the proposals in this chapter add up to sufficient strengthening

of the corporate parenting role? If not what more should be done?

This chapter seems to be confused about the concept of the “corporate parenting role”,

and this is further reflected in the loose way it uses the terms “corporate parenting”,

“embodying the corporate parenting role”, “parental role” and “parent” more or less

interchangeably. The confusion is already apparent in the opening statements “As the

corporate parent of children in care the State has a special responsibility for their

wellbeing” and “The State takes on an immense responsibility for these children by

agreeing to undertake the parental role on a day to day basis”. The position in law,

policy and guidance is not that an impersonal “State” takes on responsibilities, but that a

designated local authority is accountable for fulfilling the role of corporate parent.

The social worker’s role, which is absolutely critical, is to exercise many of the

responsibilities a parent would exercise, on behalf of, and in conjunction with, the local

authority. Some parts of the parental role and responsibilities will in many cases go on

being performed by the child’s own parents, others by the carers with whom the child

may be placed, and others again through the local authority’s accountability

arrangements, themselves defined in some detail by central government, and taken into

consideration by the local court when deciding whether or not to make a care order.

The social worker oversees and coordinates all these elements, which will vary in detail

from child to child. It is important to grasp that the social worker herself is not the

corporate parent, and that in this context the definition of “social care practices” as

“small groups of social workers…wholly independent of local authorities” is a

contradiction in terms. Later chapters seem to be clearer about this.

With that major caveat, SCIE believes some of the proposals in the chapter have merit.

We comment on the model of independent social care practices below. The proposals

for the social worker as lead professional to hold a budget would create scope for more

flexible and creative responses to the care needs of individual children and young

people. Care would be needed in considering the budget control and accountability

arrangements for these budgets, otherwise they may have the opposite effect to that

intended, and lead to budgetary considerations over-riding the welfare of the child.

Guidance on the creation, content, management and use of children’s care plans may

help promote consistency and good practice, but similar guidance in the past on, for

example, assessment has resulted in excessively rigid, bureaucratic procedures a long

way from the reduction in bureaucracy other proposals are seeking. Working with

experienced professionals and young people on these two proposals could be helpful in

producing flexible, user-friendly devices they can use in partnership to achieve

outcomes they have agreed.

Other chapters are also relevant to strengthening the LA’s corporate parenting role,

including those encouraging the local authority to draw on all its resources and

functions, as education and activities provider, significant local employer, and potential

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funder supporting young people’s higher education, career and housing ambitions, to

give the child in their care the best possible start.

9. Would a ‘social care practice’ help give social workers more

freedom to support children?

There was a strong feeling at our expert seminar that greater freedom to support

children in a more flexible way is desirable. Social workers employed by local

authorities feel constrained from responding creatively to the needs of looked after

children by various factors, including limited professional time and supervision,

resources insufficient and often in the wrong places, excessive caseloads of children,

young people and families with complex needs, and lack of access to specialist services

like CAMHS and remedial education. Voluntary sector schemes however, have greater

freedom to spend their voluntary investment on innovative approaches where the

statutory sector is sometimes slow to change established practice and too concerned

with the risk associated with new ways of working. We therefore see there is some

case for piloting social care practices, particularly if located in the voluntary sector.

However, there are serious problems with the Green Paper’s concept of a social care

practice which need to be addressed.

As indicated above, the blurred relationship between the practice and the local

authority offers scope for confusion, conflict, and lack of clear accountability for

safeguards and standards.

The evidence from a range of other human services settings is that it is extremely

difficult to implement effective commissioning and contract arrangements even

for standard off-the-peg services, still less for services personalised to individual

needs of highly vulnerable children and young people.

The argument that the practices could cut loose from local authority bureaucracy

ignores the fact that much of the procedural complexity stems from central

government’s requirements for safeguarding, consistent decision-making, audit

trails and protection of public funds, and these requirements would presumably

also need to be met by the practices.

Independent practices would be susceptible to exploitation by unsuitable people

seeking access to vulnerable children.

The proposal for profit-taking in this field is problematic, could create perverse

incentives, and may put members of a practice in serious conflicts of interest, as

we have seen in other private provision for children.

This said, the SCIE seminar did identify potential benefits of the green paper model for

groups with highly specialised or complex needs forming a very small proportion of a

local services’ work, for example a pan–London practice for deaf-blind children.

However there needs to be a much clearer rationale for applying it in social work with all

children in care. GP practices are predicated on large patient populations that are not

all active at one time. Again, the green paper model will stand or fall on its financial

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security. As a seminar delegate put it: ‘all children adopted, in credit; all children in

secure accommodation, bankrupt’.

We are also concerned that there is no reference to what happens to the rest of child

care social work, such as child protection and working with disabled children and

families. As one delegate at our expert seminar put it, with social care practices taking

work with children in care out of local authorities; what happens about the ‘rump’ of child

care social work left behind and how do practice expertise and standards influence the

work remaining?

Further concerns were raised at our seminar. Although delegates agreed that local

authorities had not always been good, supportive employers of social workers, they felt

the proposals for an independent social care practice jarred with what is being

attempted in Every Child Matters. They suggested there may be more mileage in

building a virtual team of different specialists around the practitioner with lead

responsibility for the child.

In light of our misgivings about the proposed social care practice model proposed, we

urge the government to consider other models for arranging child care social work. We

highlight as an example, the work of Glasgow social services.

SCIE has visited Glasgow SSD about its changes to its front-line social work service (as

referenced in the Scottish Executive 21st Century Review) and interviewed a wide range

of the department’s staff. Briefly, the department has returned its first line managers to

practice, with small practice teams comprising an experienced, expert practitioner (the

former manager); a less experienced social worker and two social care workers. The

department did this to improve their recruitment and retention and allocation difficulties

and considered that they were wasting the practice expertise of their managers and

perpetuating a dependent, over managed workforce. Although the department has

improved staffing levels, staff at all levels report a considerable decrease in ’managing

up’, more confident decision making at practice level and increased understanding,

interest and contribution to strategic planning.

We therefore welcome the green paper’s analysis of the organisational strictures on

effective practice but would suggest it is worth considering a range of models to

overcome this. We would strongly support identification and piloting such a range.

10. Should the Independent Visitor role be revitalised and renamed as

‘independent advocate’ to introduce advocacy as a key element of the

role?

In the context of discussions about this issue at SCIE’s expert seminar, there was a

concern about the level of intrusion in young people’s lives. In particular, A National

Voice pointed out that if the social worker and the LA as corporate parent were fulfilling

their role, there would generally be no need for an independent advocate. A National

Voice had support from other stakeholders in warning against having too many

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professionals in young people’s lives, and thought the arrangements proposed in Care

Matters should in part be judged against whether they ensure minimal intrusion. On this

basis, some seminar delegates saw no justification for individual advocates.

Debate around the independent advocate also stimulated discussions about the role of

the social worker as many felt that the advocacy role had been fundamental to the

traditional social work role, and tallied with the Green Paper’s emphasis on the social

worker being as active and focused on the needs, interests and wishes of the child in

care as a natural parent would be. Delegates regretted the loss over recent years of

some of the key elements in the role social workers traditionally played in relation to

children and their families, and felt that if the role could be reframed for a 21st Century

context, there would be less need for a separate independent advocate as another adult

in the child’s life.

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Chapter 4

11a. Should a ‘tiered’ approach to fostering placements be

developed?

Delegates at the SCIE seminar representing A National Voice supported a tiered

approach and suggested it might be applied beyond fostering to include residential care.

However we would want to add that a tiered approach should be balanced with children

and young people’s needs. Support services or placements should be person centred

and fitted around the needs of the individual rather than the child or young person

having to fit within a rigid tiered system. Requiring a child to move placements because

his changing needs had redesignated him to a different tier would be counter-productive

and likely to harm the child’s wellbeing.

On a related point, there was a strong feeling among experts at our seminar that social

workers who had the responsibility, in consultation with the child, family and other

colleagues, for deciding where children’s needs would be best met, should be able to

make that judgement separately from budget considerations. People felt that in the

current system, budgets paralyse decision making that is truly person centred.

11b. If so, should this be underpinned by a formal qualification

framework?

The training of foster carers has become an established part of fostering practice and

preparation training before approval as a foster carer is now universal.

After approval, nearly all agencies across the public, independent and private sectors

provide NVQ training. Some agencies have further developed their programmes and

provide specialist training in the areas that foster carers request such as:

• managing contact between foster children and their birth families

• managing children’s behaviour

• supporting education and liaising with schools.

However, SCIE’s work for the fostering guide, cited above, found that training by itself is

not sufficient to create and retain experienced carers. Also training should be integrated

into the service as a whole and not just limited to foster carers. For example, if carers

receive training in using a particular approach to children’s difficulties, social workers

must also know and use the same approach. SCIE’s collaborative work on foster care

also shows that foster carers could benefit from some of the same training as social

workers, for example, on child protection, but are they not included in this.

Although there is plenty of evidence to suggest that carers appreciate training, no clear

relationship between the level of training provided and placement success has been

demonstrated. More research in this area is required.

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Under the Fostering Service Regulations 2002 and the National Minimum Fostering

Standards the fostering service provider is already subject to statute and regulations for

training foster carers. We already know that preparation training is universal and

ongoing training is delivered by nearly all agencies across the public, independent and

private sectors. The question is whether there is any need for a formal ‘qualifications

framework’ to underpin a tiered approach to placements, as set out in the green paper.

At SCIE’s expert seminar, there was a general feeling against such a move. Delegates

accepted that foster carers require the support in their role that current training provides.

However, they felt that moves to professionalise fostering might undermine the

importance of the requisite love and compassion which characterise foster carers.

Some were concerned that this would even deter potential foster carers and considering

the reliance of the green paper proposals on an expanding workforce, this is an

alarming proposition.

12. How can we increase placement choice without increasing

financial burdens on the system?

Partnership working and joint commissioning is a developing area designed to tailor

services by creating placement choice. Many independent fostering providers and local

authorities are developing specialist schemes, partnership arrangements and service

agreements within their own agencies and with others to increase the number and

suitability of available placements.

Local authorities, independent fostering agencies and voluntary childcare organisations

are replacing spot purchasing of placements with service level and partnership

agreements. Some are extensive, involving large numbers of agencies where costs,

services and standards are agreed and monitored.

Children and young people placed in these schemes include those with particularly

challenging and difficult needs, such as young offenders, those with learning or physical

disabilities, those in sibling groups or those who require long-term foster carers

SCIE’s practice guide on fostering provides a number of useful practice examples

where local authorities worked to increase placement choice through partnership

working and innovative commissioning. They are outlined below:

DERBY CITY, DERBYSHIRE, LEICESTER CITY, LEICESTERSHIRE,

LINCOLNSHIRE, NOTTINGHAM CITY and NOTTINGHAMSHIRE commissioned

Barnardo’s to assist them in recruiting foster carers in that region. They have also

worked together to construct service level agreements with a small number of

independent fostering agencies involving agreed inspection and accreditation

arrangements to increase placement choice, quality and value for money.

SOUTHAMPTON CITY COUNCIL'S HEALTH AND SOCIAL CARE DIRECTORATE

commissioned tenders from independent fostering agencies for ten foster placements.

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They found that the previous spot purchasing arrangements were expensive,

uncoordinated and lacking in any quality assurance mechanisms.

SEDGEMOOR independent fostering provider was selected following an extensive

process of scrutiny of policy and procedures, and interview. This process was driven by

considerations of quality, cost and partnership working. Joint staff groups manage and

deliver the service and local authority staff have been seconded to the agency.

CHRYSALIS CARE, an independent fostering agency, has entered into an agreement

with one London Borough and is negotiating with another to recruit independent

fostering agency foster carers in those authorities, which will then be available to offer

local placements. This initiative was developed to avoid London children from the two

local authorities being placed long distances from home.

WALTHAM FOREST and WESTMINSTER are among those authorities which have

negotiated the pricing, and procurement, of placements outside the local authority

provision.

The Community Placement Scheme is a specialist fostering project for teenagers in

Belfast. It was established in 1997 as a joint initiative between SOUTH and EAST

BELFAST Health and Social Services Trust and Barnardo’s. It offers an alternative to

residential care for young people displaying seriously challenging or offending

behaviour. It offers intensive support to its foster carers, and its social work staff set out

to "try to make things work and grease the wheels”. The scheme sees carers as

partners in this process and treats them with respect.

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Chapter 6

18. Have we set out the right features in the comprehensive model of

health care for children in care?

The model of health care for children in care is comprehensive but also difficult and

complex to understand, requiring the young person to find their way round a fragmented

system based on multiple specialities. This makes the lead health professional the key

proposal in this section, with a remit to establish a relationship of confidence with the

child and young person, to act as navigator and advocate round the system, and to

provide reliable and stable source of personal health advice.

20. Is the approach to supporting children in care who enter youth

custody the right one?

The corporate parenting role continues when children in care enter youth custody, as it

should. This section may need strengthening. The limitations and risks of youth

custody are well known; limited access to education, training and development

activities, unmet mental and physical health needs including risks of self harm and

undiagnosed depressive and bi-polar conditions, significant levels of drug abuse and

bullying and high rates of reoffending. A good parent would be doing all in their power

to ensure their child suffered minimum damage from this process and to direct them

from further offending after discharge. The local authority and social worker need to

find ways to carry out this role for young people who are in their care who are among

those most vulnerable to these factors.

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Chapter 7

22. Should young people be allowed to remain in their foster families

up to the age of 21, including when the young person is at university?

SCIE strongly supports this proposition although we do not think the plans go far

enough. We believe that the period of support for young people should be extended

into their twenties. This reflects the real situation for the wider young adult population.

As the green paper points out, the average age for leaving home is 24 but young adults

in the general population can normally expect the support of their parents at later

stages, including when they themselves become parents. We are concerned about why

this level of support should not be extended to young people in care if it is what they

want. This will be particularly relevant for young people in care facing certain issues

such as mental health, drug problems or lone parenthood. This would clearly have

implications for social workers and the foster caring workforce which would have to be

properly worked through.

24. Are there any other ways in which we can increase the number of

children in care progressing to university?

We endorse the plans in the green paper to support more children in care progressing

to university. The high levels of debt incurred in undertaking higher education under

present arrangements will clearly deter young people from care, as they do others from

disadvantaged backgrounds. The lack of parental support in cash and practical help

(e.g. childminding) is another gap a good corporate parent should consider.

However, particularly in terms of the suggested bursary to study in higher education, we

strongly believe that the same financial incentive and other supports should be offered

to young people in care to move into further education or to undertake apprenticeship

training.

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Chapter 8

25. Should we introduce a new power for local authorities to intervene

in schools performing poorly for children in care?

We are not convinced about the need for a new power for local authorities because we

would have thought that this is something Ofsted could already be expected to pick up

on.

26. What more should we do to give children in care a greater say in

decisions which affect them?

We should be clear about the range of reasons why children in care do not have a

greater say in decisions that affect them. Most decisions are based on negotiations

between adults in their lives including natural and substitute parents and a variety of

professionals. The forums for these negotiations from case conferences to court

hearings are not designed to facilitate children and young people expressing their own

views especially when there is conflict with adults with whom they have strong,

ambivalent or fearful relationships. These structures for decision making may need

radical change driven by the views of young people to give them at least equal status to

have their say. Our rigid service structures, financing systems and procedures can also

squeeze out the views of children and their families.

27. How can Independent Reviewing Officers be made more

independent and their role strengthened?

Following our response to question 26, the role of the IRO would be strengthened if they

were accountable for ensuring the voice of the child is heard, recorded and given proper

weight in the decision making process.

28. What key outcomes should we measure to assess whether we are

being successful in transforming the lives of children and young

people in care?

The Green Paper is based on the laudable premise that our goals for children in care

should be exactly the same as our goals for our own children. As Alan Johnson points

out, these goals encompass more than educational success and therefore SCIE

maintains that measures of success should be about far more than qualification

attainment. After all, as many at our expert seminar pointed out, we want more for our

own children than simply a good education. Delegates felt therefore that exam results

should by no means be the sole indicator of success in transforming the lives of children

and young people in care. We would strongly suggest that this is approach should not

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be misinterpreted as having low educational aspirations for looked after children.

Furthermore, lots of children in care make progress which is not necessarily reflected in

exam results. There should be hard progress measures which are broader than

educational attainment and these, for example levels of physical activity, have already

been usefully coined as part of the Every Child Matters agenda.

29. General comments

SCIE is concerned that Care Matters does not give enough attention to looked after

children:

with disabilities;

who are in the youth justice

have asylum seeking or refugee status

We are also concerned that there is neither enough focus nor sufficient funds to sustain

a preventative approach to supporting children and young people at risk of entering the

care system. We would welcome a more coherent strategy of keeping children within

their own familial and social networks; we know this is what they want. However, we

realise that strengthening this approach is not simply about increasing funding; it is

about using current resources in a more imaginative way. SCIE would endorse the use

of person, or ‘family centred’ early intervention where the young person and their birth

families chose from a continuum of short term support that might include for example,

short term fostering placements or kinship care.

SCIE believes that the DfES have a responsibility to consider the proposals set out in

Care Matters within the context of the existing legal framework for supporting looked

after children. There was a widely held view among delegates at our expert seminar

that much of the green paper proposals can be implemented within the framework of

existing legislation. We would urge the DfES to examine how much we can achieve for

looked after children if only we use the powers that are already in place. If we can

improve the stability and continuity of children’s social work we can achieve much of

what Care Matters seeks to achieve.

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References

i SCIE (2004) Practice Guide 3: Fostering London: Social Institute for Excellence

i

i Wright, P., Turner, C., Clay, D. and Mills, H. (2006) The participation of children and

young people in social care London: Social Care Institute for Excellence

i

ii Wilson, K., Sinclair, I., Taylor, C., Pithouse, A., and Sellick, C. (2004) 'Fostering

success: An exploration in the research literature in foster care', Knowledge Review 5,

London: Social Care Institute for Excellence.

iv Bostock, L. (2004) Resource guide 4: promoting resilience in fostered children and

young people London: Social Care Institute for Excellence.

v

Gilligan, R. (1998) ‘Beyond permanence? The importance of resilience in child

placement and planning’, in M. Hill and M. Shaw (eds) Signposts in adoption: Policy,

practice and research issues, London: BAAF.

vi SCIE (2005) Research briefing 14: helping parents with learning disabilities in their

role as parents London: Social Care Institute for Excellence

vii SCIE (2005) Research briefing 13 (2005) Helping parents with a physical or sensory

impairment in their role as parents London: Social Care Institute for Excellence

viii Kearney, P., Levin, E. and Rosen, G. (2003) Report 2: Working with families with

alcohol, drug and mental health problems London: Social Care Institute for Excellence

ix Kearney, P., Rosen, G. and Sainsbury, M. (2003) Resource Guide 1: Families that

have alcohol and mental health problems: a template for partnership working London:

Social Care Institute for Excellence

x National Institute for Health and Clinical Excellence and Social Care Institute for

Excellence (2006) Parent-training/ education programmes in the management of

children with conduct disorders London: NICE

xi Woodhouse A., Green G., Davies S. (2001) Parents with learning disabilities: service

audit and development. British Journal of Learning Disabilities, 29 (4), 128-132.

xii Office of the Deputy Prime Minister (2004) Mental Health and Social Exclusion, Social

Exclusion Unit Report London: ODPM

xiii Falkov, A., Ed, (1998) Crossing Bridges – Training resources for working with

mentally ill parents and their children Reader London: Department of Health/ Pavillion

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xiv Department of Health (1999) National Service Framework for Mental Health London:

HMSO

xv McAuley, C., Knapp, M., Beecham, J., McCurry, N. and Sleed, M. (2004) Young

families under stress: Outcomes and costs of Home-Start support, York: Joseph

Rowntree Foundation