Joint strategic needs assessment

Children in Care and Care Leavers (2024)

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Topic title	Children in Care and Care Leavers (2024)
Topic owner	Nottinghamshire Looked After Children and Care Leavers Board
Topic author(s)	Briony Jones, Caroline Panto, Adie Wright
Topic quality reviewed	June 2024
Topic endorsed by	Nottinghamshire Looked After Children and Care Leavers Board, May 2024
Topic approved by	Health and Wellbeing Board, September 2024
Linked JSNA topics	Child Poverty (2016) Emotional Mental Health and Wellbeing of Children and Young People (2021) Substance Misuse: Young people and adults (2022) Suicide Prevention (2023) Special Educational Needs and Disability (2023) Food Insecurity (2024) Fuel Poverty (2024) Children Known to the Youth Justice Service (2024)

Executive summary

Introduction

This chapter considers the needs of children and young people who are in care or have left care in Nottinghamshire, often referred to as Looked After children and Care Leavers. A child who has been in the care of their local authority for more than 24 hours is known as a child in care, with the local authority acting as their Corporate Parent. There are 4 main ways children and young people enter care under The Children Act:

children who are accommodated under a voluntary agreement with their parents or at the request of the young person if aged 16 – 17 years old, this can include children with respite care (section 20, The Children Act 1989);
children who are subject to a compulsory care order, interim care order or supervision order staying with birth family or other legal orders (section 21, The Children Act 1989);
children who are the subject of emergency orders for the protection of the child (section 44, The Children Act 1989);
children who are compulsorily accommodated which includes children remanded to the local authority or subject to a Youth Rehabilitation Order with a residence requirement (section 21, The Children Act 1989).

If not before, when a young person turns 18 years, they will leave the care of the local authority. This chapter will consider the needs of care leavers up to the age of 25 in alignment with Nottinghamshire’s Joint Local Offer for Care Leavers. This offer acknowledges the support needed for a care experienced person does not end at the age of 18 and that local health and care partners have a collective responsibility to support young people that has been through the care system.

Alongside universal services, there is a range of specialist and statutory services providing support to children in care. This Joint Strategic Needs Assessment chapter has reviewed national and local evidence to assess the needs of care experienced children and young people in relation to their health and wellbeing, education and employment, placement and housing, youth justice and transition to adulthood. It identifies challenges and unmet need, outlines policy guidelines, and concludes with key recommendations for how local health, social care and community partners can support care experienced young people in Nottinghamshire to live happy, healthy, and thriving lives within their local community.

Summary of Need

It is known that children in care can have worse outcomes and suffer greater health inequality than the general population. They are more likely to have mental ill health, poor educational attainment, worse physical health and adverse childhood experiences that impact their development and emotional wellbeing throughout their lives. Therefore it is important that their needs are met in a timely manner to ensure they are supported to be safe, healthy and prepared to transition to young adults. Key findings of this needs assessment include:

56% of children in Nottinghamshire enter care due to abuse and neglect. There is a small increase in children entering care due to absent parenting (21% of all children in care in 2023).
58% of children in care in Nottinghamshire are placed in foster care, this has been decreasing in recent years.
97% of children and young people in care had their annual health checks complete and 98% received their vaccinations. There are delays with children receiving timely health assessments while in care.
60% of children in care have seen a dentist in the last twelve months, which is below the average for England and the East Midlands for children in care. Diet and nutrition, emotional wellbeing and oral health are the most common interventions needed for children in care.
Children in care are more likely to have experienced Adverse Childhood Experiences (ACEs), which cause damage to a person’s health and long term outcomes. There are services available, but some have a wait list for support.
Children in care in Nottinghamshire seem more likely to have a substance use disorder than other children and not all of these children receive an intervention. Cannabis is the most commonly recorded substance in referrals to substance use service.
12.4% of children in care locally achieved ‘good’ GCSEs in English and Mathematics (grade 5 or above) compared to 49.8% in the overall population. Children in care are more likely to have special education needs.
41% of 19-21 year old care leavers in Nottinghamshire are not in education, employment or training compared to 11% of other young people of the same age.
40% of children known to Youth Justice in Nottinghamshire were a child in need, and 12% of children were or had been a child in care. There were 11 first time entrants who were in care last year and no child in care on remand.

Recommendations

	Recommendation	Lead(s)
	Data collation and reporting
1.	Utilise initial and review health assessments to record need and outcomes at regular intervals while in care and inform care planning.	Health providers
2.	Explore and review considerations of care experience being treated as a protected characteristic and understand locally how partners and services can reduce discrimination and promote better outcomes for care experienced people. Review existing data records and explore if/how to record looked after status of a service user to understand if needs are being met for children and young people in care or who have left care.	NCC
3.	Utilise local data insights to assess the need and pathway for a locally commissioned sensory processing assessment and treatment service for children in care, reviewing if this would be required to meet the needs of the entire cohort, or the caseload of the CAMHS CLA and Adoption service.	ICB
4.	Develop a set of key performance indicators that can hold partners and services to account for statutory responsibilities and also demonstrate impact on outcomes for children in care for the Nottinghamshire Looked After Children and Care Leavers Partnership Board.	NCC
5.	Create functionality in social care records to monitor registration at a dentist and dental check-ups as part of case management.	NCC
	Strategic planning & governance
6.	Create a delivery plan for the Nottinghamshire Looked After Children and Care Leavers Strategy and consider how the findings of this JSNA can inform the next iteration of the strategy.	LAC Board
7.	Work with neighbouring local authorities to develop partnership agreements around the delivery of services for Nottinghamshire children placed out of area, specifically regarding mental and emotional health and inequity between access to CAMHS services and non-core commissioned services for young people placed in and out of Nottinghamshire.	NCC (D2N2) NHS England
8.	Obtain care experienced children and young people’s views on services & access and how they would like this to be delivered.	NCC, ICB, Health
9.	Establish a steering group for unaccompanied and asylum seeking children and young people within the Nottingham and Nottinghamshire Integrated Care System to address: a) Healthcare and Mental Health- § Trauma-informed health screening upon arrival. § Access to culturally and linguistically appropriate mental health services. b) Training and Awareness- § Training offer on the unique needs of UASC, including cultural competence, trauma-informed care, and legal/social contexts of asylum. § Awareness among practitioners and carers of UASC-specific issues such as health needs, safeguarding, language, culturally sensitive care, and the risk of going missing. c) Collaborative Care- § Involvement of multi-disciplinary teams (healthcare professionals, social workers, educators, legal advisors) to tackle UASC complexities. d) Community Engagement- § Promotion and adaptation of community resources, awareness and engagement to support UASC social integration and reduce stigma and discrimination.	ICS
	Service Delivery
Health & Wellbeing
10.	Develop a minimum service specification for Therapeutic Residential providers within Nottinghamshire, and working with providers create a list of providers that meet this service specification that can be used for triage.	ICB, NCC
11.	Evaluate the effectiveness of the Barnardo’s service in supporting emotional wellbeing and mental health needs when a care leaver is not accessing adult mental health services.	ICB, NCC
12.	Work with both children’s and adults’ mental health services to examine age cut offs and investigate if more flexible and effective transition arrangements can be put in place to enable dovetailing of services and explore whether leaving care could be considered a priority group in adult mental health services (e.g. lower thresholds, prioritised of waiting lists, higher tolerance for missed appointments).	ICB, NCC
13.	Review current dental service specifications and commissioning arrangements to improve access for children and young people in care and leaving care who require a dental review or who require an urgent assessment due to pain/discomfort and cannot access a dentist.	ICB
14.	Review current commissioning arrangements for Initial and Review Health Assessments to ensure sufficient capacity to meet the increase in the number of children in care and reduce evidenced delays and improve statutory compliance.	ICB, NCC
15.	Ensure, and consider training, that all practitioners working with children and young people in care are aware of the impact of trauma (including developmental trauma) and attachment difficulties and appropriate responses to these.	ICB, NCC
Substance Use
16.	Develop a cascade process from substance use services to social workers about any current substance alerts that may be a threat to children in care and care leavers. Hold regular CPD sessions with social workers locally to support with training around the identification of substance use and the treatment offer available.	NCC, PH
17.	Review how Independent Review Officer record substance use to ensure consistency in the threshold of the definition of substance use and maximise data quality and the understanding of substance use need within children and young people in care.	NCC, PH
Education
18.	Work to secure a regional agreement on the prioritisation of children in care regarding the assessment of special educational needs (SEN), initiation of SEN support and additional support needs to all schools (both mainstream and special schools). This agreement should include agreed standardised and local funding arrangements in line with the High needs funding operational guide to avoid delay in the delivery of services due to differing processes.	NCC

Key contacts

Briony Jones

Public Health Commissioning Manager, Childrens Integrated Commissioning Hub, Nottinghamshire County Council & NHS Nottingham and Nottinghamshire Integrated Care Board

briony.jones@nottscc.gov.uk