Care options for young people

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On behalf of the WM ADCS network, Research in Practice recently presented Care options for young people evidence to inform commissioning 2013 and you may also like to have a look at the related DfE report “Implementing evidence-based programmes in children’s services

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  • research in practice www.rip.org.uk 10/01/13
  • research in practice www.rip.org.uk 10/01/13
  • Children are being returned to homes where they have already been harmed, and where they face significant further risk, without sufficient assessment and preparation. 61% remained with a suspected abuser, 16% remained at home even after confirmed abuse or neglect. Despite these difficulties, reunification remains a largely invisible area of practice . Existing guidance on looked after children and leaving care focuses almost exclusively on the transition to adulthood, with little emphasis on children returning home and the risks they may face (nspcc 2012: 7) While elements of good practice exist in different local authorities, support for children and young people remains variable across the country as a whole (nspcc 2012: 7) Jim Wade slide from research in practice, 22Feb2012 Conference. Study: Wade et al (2011) Caring for abused and neglected children: making the right decisions for reunification or long-term care. Method of study Study took place in 7 geographically spread local authorities and had 3 main components: Census study (n=3,872)  Administrative data used to investigate patterns of stay, return and re-entry and to compare pathways to those for other LAC children Surveys (n=149) – Home group (n=68), Care group (n=81)  Case file audit to understand how stay/return decision reached; how decision supported over next 6 months  Surveys of children’s social workers and teachers to assess outcomes up to 3 years later Interviews with 11 children and 9 birth parents  To understand how and why events took the course they did; how they related to social work interventions research in practice www.rip.org.uk 10/01/13
  • Jim Wade slide from research in practice, 22Feb2012 Conference. Study: Wade et al (2011) Caring for abused and neglected children: making the right decisions for reunification or long-term care Method of study Study took place in 7 geographically spread local authorities and had 3 main components: Census study (n=3,872)  Administrative data used to investigate patterns of stay, return and re-entry and to compare pathways to those for other LAC children Surveys (n=149) – Home group (n=68), Care group (n=81)  Case file audit to understand how stay/return decision reached; how decision supported over next 6 months  Surveys of children’s social workers and teachers to assess outcomes up to 3 years later Interviews with 11 children and 9 birth parents  To understand how and why events took the course they did; how they related to social work interventions research in practice www.rip.org.uk 10/01/13
  • Jim Wade slide from research in practice, 22Feb2012 Conference. Study: Wade et al (2011) Caring for abused and neglected children: making the right decisions for reunification or long-term care Reunification more likely to be lasting Children had gone home slowly : Children who return early to the same parent are unlikely to do as well as those who return after sufficient time has elapsed for the problems that led to the original admission to have been addressed Reunification less likely to be lasting Children had gone home on a care order: Maltreated children were less likely than children looked after for other reasons to leave the care system within the study timeframe. Placing children at home whilst the subject of a care order was an important avenue for attempting their reunification, although breakdowns were higher for this group. Parents had continuing problems with substance misuse: 81% of children who are reunited with parents who are still misusing drugs subsequently re-enter care or accommodation Emotional abuse and neglect : Look after children who have experienced chronic and serious emotional abuse and neglect do significantly worse than others if they return home – plans for reunification should be considered with caution. There should be strong evidence of sufficient change in parenting capacity and appropriate long-term service availability All but one of the 16 (37%) parents who made significant changes to provide good enough care did so before the baby was six months old (Ward et al) The long-term well being of over half of the children who were permanently separated had been doubly jeopardized – by late separation from an abusive birth family followed by the disruption of a close attachment with an interim carer on entering a permanent placement. There is no evidence that any child was unnecessarily separated (Ward et al). Careful assessment of risks, evidence of parenting change, slow and well-managed returns and provisions of services to support them were associated with home placements that endured. Significant harm of infants study: parents who succeed in making sufficient changes appear to be less likely to have experienced abuse (particularly sexual abuse in childhood); to have come to terms with the removal from home of older children and to have developed insight to acknowledge that their behaviour may have played a part in such decisions; and to make use of the support that both social work and more specialist services can provide. Some groups of maltreated children may do better if they (a) return to different parent or (b) to families where key adult figure has left (no evidence for serious neglect) Engaging families (Brown) – slide information from research in practice, 22Feb2012 Conference. Sample Sample of 43 babies were traced from birth (or pre-birth) until they were three years old. All babies were identified as suffering, or likely to suffer, significant harm before their first birthday. Engaging parents Parents’ misunderstood what actions they needed to take in order to protect their child Parents continually breached written agreements – few consequences Written agreements were often ambivalent Where positive changes occurred parents valued a gradual reduction of intervention. Cases were often closed too soon. ‘ Straight talking’ social workers valued most by parents Parents who overcame difficulties all did so within 6 months . Parents who were able to overcome difficulties not likely to approach children’s social care if circumstances deteriorated. They did however approach their health visitor. research in practice www.rip.org.uk 10/01/13
  • Jim Wade slide from research in practice, 22Feb2012 Conference. Study: Wade et al (2011) Caring for abused and neglected children: making the right decisions for reunification or long-term care Study used a global measure of well-being Method of study Study took place in 7 geographically spread local authorities and had 3 main components: Census study (n=3,872)  Administrative data used to investigate patterns of stay, return and re-entry and to compare pathways to those for other LAC children Surveys (n=149) – Home group (n=68), Care group (n=81)  Case file audit to understand how stay/return decision reached; how decision supported over next 6 months  Surveys of children’s social workers and teachers to assess outcomes up to 3 years later Interviews with 11 children and 9 birth parents  To understand how and why events took the course they did; how they related to social work interventions research in practice www.rip.org.uk 10/01/13
  • NSPCC interviews found one of the greatest difficulties in making choices about a child’s permanent placement is actually taking the final decision about whether a child should return home. It requires a significant amount of confidence, and in many cases experience, to make a decision. In the worst cases this means that support for a return home continues despite strong evidence against reunification now, or in the future. Historical understanding: case file information should be used routinely to identify where families have been in repeated contact with children’s services, where support arrangements have failed and succeeded, and where previous attempts at reunification have been made Existing case file information should be used more routinely to identify where families have been in repeated contact with children’s services, where support arrangements have failed and succeeded, and where previous attempts at reunification have been made. • Validated assessment tools need to be better embedded into practice, to ensure that social workers know which tools to use when, and how. ‘ The evidence shows that the use of ‘standardized’ assessments produces more accurate classification of risk of harm, compared with clinical judgment, which is only just better than guessing at 65% (for a summary White and Walsh 2006) (Barlow 2012: 20) • Supervision should focus on improving the evidence used in assessments and enabling learning. While generally judged to be good, examples of poor supervision were identified research in practice www.rip.org.uk 10/01/13
  • (adapted) Brown and Ward slide from research in practice, 22Feb2012 Conference Link to previous slides – i.e. reunification is a difficult specialist area, where a number of factors have to be considered. This makes decision-making difficult, and time can elapse before a permanent decision/outcome is made (see example of study on slide above; details below). However, child-focused timescales have to be considered, and the research messages regarding key timescales and ages. (i.e. parental concerns/changes at 6months; and child focused timescales re 6years of age)) TO THINK THROUGH DECISION MAKING WE’LL LOOK AT THIS STUDY WHICH FOLLOWED: A Sample of 43 babies were traced from birth (or pre-birth) until they were three years old. • All babies were identified as suffering, or likely to suffer, significant harm before their first birthday. • Trace the decisions that were made about their care and the impact these had on their subsequent experiences. The families • Many difficulties in obtaining a sample – only about 4% recruited. • Children at high risk – higher risk than other children in similar circumstances • Parents had many difficulties • Twenty mothers had already been permanently separated from at least one older child. • Majority from families already known to children’s social care through involvement with older siblings • 65% identified before birth; almost all before they were six months old. Core assessments (mostly all conducted either pre-birth or before child was 6months old) 31 children remained at home 12 separated (3 permanently) Almost all decisions were temporary – on average it took 14months for a definitive decision resulting in a viable permanence plan (6months more for this to be completed. Longer for adoption). At age three • Neglect and emotional abuse most common form of maltreatment; often compounded by exposure to intimate partner violence. • No evidence that 20 (47%) children experienced maltreatment by the time they were three. At age 3 - How many children were displaying emotional and behavioural difficulties? • At least four were so aggressive as to be a risk to other children. • One child was self-harming. • Delayed speech was common • Developmental/behavioural problems more evident amongst children who were maltreated, often while professionals waited fruitlessly for parents to change. Age 3 Emotional and behavioural difficulties displayed 12 children were reunified with parents: 3 remaining with parents with low risks 5 remaining with parents with medium/high or severe risks 4 reunified and then subsequently permanently separated There was no evidence to support criticisms that decisions made by professionals are arbitrary or taken without careful thought. Many final decisions were in line with the recommendations from an independent specialist parenting assessment. However it took time to reach a definitive decision, and during that period some children were exposed to on-going abuse, with long term consequences for their life chances. A definitive decision had yet to be made for some of those children living with birth parents who had not addressed their problems. At three years old, their chances of achieving a permanent placement outside the home were diminishing. research in practice www.rip.org.uk 10/01/13
  • These stats were based on 2001 Census data Formal kinship foster care can be a positive permanency option for many children as it can enhance their sense of belonging through continuity of family identity and knowledge, and caregivers are likely to be familiar through pre-existing relationships with the child. Research evidence points to the high level of commitment of kinship carers to children in their care (Farmer, 2010) and the higher level of stability for children in kinship care compared with unrelated carers (Cuddeback, 2004). There is evidence, however, that although there are positive outcomes for children, kinship carers are often under considerable pressure. Informal kinship carers, the majority of whom are living in extreme poverty, generally receive no financial or other support from children’s social services, and formal fostering kinship carers tend to receive reduced income and support compared to their non kin counterparts. The pivotal role played by grandparents in supporting these children and the low likelihood of such placements disrupting is undermined by the lack of recognition and support for this group, especially concerning issues of contact with birth parents which can prove particularly problematic for this group. Research shows that social workers were much less likely to supervise contact with birth parents in the case of kinship care compared to unrelated carers (Farmer and Moyers, 2008). research in practice www.rip.org.uk 10/01/13
  • Recognition of the high rates of poverty experienced by kinship carers, especially informal kinship carers; and the lack of or reduced supports received by this group concerning especially birth parent contact. Improved advice given by social workers to informal kinship carers regarding access to certain benefits, such as child benefit, tax credits and other welfare benefits. Understanding that, although permanency outcomes for children in kinship care are often positive in terms of their stability and belonging, some can experience isolation and stigma which may affect their happiness. It is important to think of ways to provide opportunities for children to be able to build positive wider networks and relationships. Taking care in the use of special guardianship orders to ensure that kinship carers do not become further isolated and penalised through their use. research in practice www.rip.org.uk 10/01/13
  • A major caveat, however, with long-term foster care surrounds the lack of stability for the majority of those living in such placements. Whilst some moves may be beneficial, such as into an adoption placement or successful reunification, others can be highly damaging, and are caused by factors such as failed attempts to reunify children with their birth parents. Such children can re-enter care and be placed with new foster carers confronted by a lack of placement choice. Sinclair (2005) reported that in 50 per cent of foster care cases, social workers stated that they had no choice of foster carer, resulting in poor matching, over-stretching of existing carers and children being placed outside of their geographical area with obvious permanency consequences (see also Holland et al, 2005). A further important issue regarding stability is the highly complex needs of many children living in long-term foster care. Children in long-term foster care are often older when they enter care and many have emotional and behavioural difficulties. Despite this, research shows that there is a lack of mental health and therapeutic services for looked after children (Selwyn et al, 2006; Hannon et al, 2010). Selwyn et al’s 2006 study found that only seven per cent of their sample received on-going support from CAMHS whilst they were looked after despite the need being much greater. Other studies have also reported on the lack of support for children and foster carers to cope with the highly complex needs of these children (Held, 2005; Munro and Hardy, 2006). research in practice www.rip.org.uk 10/01/13
  • research in practice www.rip.org.uk 10/01/13
  • research in practice www.rip.org.uk 10/01/13
  • Everyone should be familiar with NICE’s role in the clinical field. - Aim of reducing variation in the availability and quality of NHS treatments and care – by assessing available evidence on specific treatments and recommending its use or not. Its reputation for evidence based recommendations are recognised nationally and internationally. Non-departmental public body (no minister which gives some independence from government – sponsor is DH). A big component of NICE recommendations are assessments of value for money – QUALY etc But since 2013 it has a new role that is very relevant to the sector – renamed to National Institute for Health and Care Excellence
  • Other topics to be decided. Consultation on possible topics has closed recently
  • Highlight analysis and critical thinking in assessment resources: Five Anchor principles were developed as a framework for thinking about assessment designed to help keep practitioners analysing throughout the assessment process Support appraisal of the quality of assessments in your team provide a framework for supervisors to use when talking to practitioners about their assessments The Anchor principles: a five-question framework for analytical thinking What is the assessment for? What is the story? What does the story mean? What needs to happen? How will we know we are making progress? What can supervision bring to the assessment process? Supervision can help to encourage analysis and critical thinking among practitioners in four key ways: Opportunity for reflection You do not necessarily need to have all of the answers, but supervision is a good way to encourage your staff to reflect upon individual cases. A key way of doing this is to use your ‘outsider’ perspective to pose questions that can help the practitioner to reflect critically on the case. This involves asking questions such as ‘How do you feel about…?’ or ‘What do you think … means?’ By doing this, you are also providing a space away from the pressures of a busy work environment to explore issues relating to an individual case. Opportunity to be challenged This is not necessarily saying that the practitioner’s original decision or judgement is wrong. However, by questioning their decisions and posing alternative ways of understanding the situation, you are inviting them to consider different ways of approaching the case. This may prompt them to rethink their decision, or simply confirm their original decision, but this process will help to give practitioners more confidence in their judgement and ensure that they can clearly articulate the reasons behind that judgement. Opportunity to test out ideas It is important that social workers are not afraid of developing creative solutions to the problems faced in a particular case. As a supervisor, you can provide a safe space for practitioners to be more experimental and to test out more innovative ideas about how the case could progress. Empowering the supervisee These discussions can provide an opportunity for you and the practitioners in your team to think together, share ideas and develop capacity for analysis. You can do this through individual supervision sessions, or you could set up group supervision sessions with your team to enable constructive sharing of ideas between practitioners. Asking open questions of the supervisee about an individual case, and encouraging them to ask these questions of themselves on a regular basis, will help them to develop their own critical thinking skills, which in turn will lead to increased professional confidence and competence. research in practice www.rip.org.uk 10/01/13
  • Care options for young people

    1. 1. Birmingham 20 September 2013 ADCS paper Care Inquiry report Nice Collaborating Centre for Social Care Care options for young people evidence to inform commissioning 2013 1
    2. 2. Care Inquiry 2013 In responding to the needs of all children in care, we must find: •ways of identifying those children who can go home, and enabling them to do so safely •ways of increasing the use of kinship care, and providing the right support •ways of increasing the use of adoption and other legal routes to permanence, and providing the right support •ways of recognising when long-term foster care can, and is, offering a permanent placement for a child •ways of ensuring that all these placements are of high quality and likely to last, and ways of ensuring that the benefits of an option for a particular child will endure beyond childhood. 2
    3. 3. making not breaking  A ‘fresh’ more flexible response is needed  Permanence: ‘security, stability, love and a strong sense of identity and belonging’  Kinship care needs… should be seen as equal to adoption in its ability to provide attachment, continuity and identity… its use should be expanded  Long term foster placements also provide a possibility for permanence – ‘foster parenting’ rather than ‘caring’ 3
    4. 4. making not breaking  Specialist residential settings: this type of provision should be able to demonstrate that there is sound evidence underpinning their practice; that staff are trained, supervised and supported well; and that expert help and advice is available for staff and for the children in their care 4 I tend to assign Sundays to be my cleaning day. I got this routine by living in the young people’s home. I took it with me when I left. Having routine gives me a sense of control. That’s something which I feel should be encouraged in young people’s lives. 20-year-old (Days after leaving care)
    5. 5. Children and young people’s views  having a perceived choice about their future is very important (Schofield et al, 2012)  if children do not want to be in a placement then it is unlikely it will be successful (Sinclair, 2005, Selwyn, 2010)  48% of the children and young people interviewed in a recent NSPCC study (2012) about reunification said that they were not consulted at all about returning home and 73% reported they were not ready to return home
    6. 6. International perspectives 6
    7. 7.  adoption will only ever be the answer for a small number of adolescents  4,600 children on the adoption waiting list  3% of those adopted aged 10-15 (adoption.org)  no children over 9 were referred to adoption register 2011/12
    8. 8. age at entry to out of home care (Thoburn 2009)
    9. 9. placements: international evidence (Thoburn 2009)
    10. 10. alternative models of provision: a continuum of care: examples  Weekday residential settings (Germany)  Respite through self referral (Denmark)  Open access emergency accommodation for runaways  Social Pedagogy in residential care 10
    11. 11. Home or care: making the right decisions 11
    12. 12. reunification  10000 a year (3050 adoptions)  67% of maltreated children who return home subsequently readmitted (NSPCC 2012)  growing evidence that maltreated children who remain looked after do better (Wade et al 2010)  where there is strong evidence of serious emotional abuse or past neglect, these children did best in care  most returns = poorest outcomes
    13. 13. Children were less likely to have gone home where Had experienced neglect Had a learning disability Did not want to go home Birth parent contact was infrequent Where parental problems at admission were still subject of ‘serious concern’ Most important predictors of return Risk to child safety assessed as acceptable Problems that had led to admission considered improved For older children, wanting to return had some effect making the right decisions (Wade et al, 2011) Variation in LA practice was a bigger factor in determining whether a child was returned home than the needs of the child
    14. 14. (Wade et al 2011)
    15. 15. what helps reunions to last? These factors had continuing resonance for stability at final follow-up, on average 4 years after decision In addition, stability at 4 years less likely where: •Serious concerns existed at 6 months •Children had gone home on a care order •Parents had continuing problems with substance misuse •In cases of emotional abuse and neglect Wade et al (2011) Reunions more likely to be lasting at 6 months where: •Children had gone home slowly, over longer period of time •Planning for reunion had been purposeful and inclusive •Problems that had led to child’s admission had reduced •More social work support had been provided to the family •Parents had accessed more services to help them with their problems •Children are younger Wade et al (2011) Parents who overcame difficulties all did so before child was 6 months old (Ward et al 2010)
    16. 16. care may be the best option  Outcomes (stability and well-being) for Wade’s ‘care group’ (maltreated children who remained looked after) were better than for those who went home  Most had settled well, had good relationships, were doing quite well at school and not getting into great difficulty  Many felt safer, were relieved to be away from dangerous homes and well cared for (others more ambivalent)  well-being levels were higher that those who had remained continuously at home  Problems early in reunion predicted poor well-being at follow-up  Those who had experienced one or more breakdowns at home fared worst of all  Where there is strong evidence of serious emotional abuse or past neglect, these children did best if they remained in care (Wade et al 2011)
    17. 17. Home or care: decision making 17
    18. 18. Decision making taking the final decision about whether a child should return home Quality of the assessment can be improved in three ways: Historical understanding of cases Validated assessment tools need to be embedded into practice Structured Professional Judgement Supervision should focus on improving the evidence used in assessments and enabling learning (nspcc 2012: 10) RiP resources and NSPCC Project Unaided clinical judgment in relation to the assessment of risk of harm, is now widely recognised to be flawed Barlow 2012
    19. 19. Decision making (Brown and Ward, 2012) At identification Severe risk: Risk factors, no protective factors and no capacity for change High risk: Risk factors, protective factors and no capacity for change. Medium risk: Risk factors, protective factors, capacity for change. Low risk: No risk factors (or previous risk factors addressed, protective factors and capacity for change. Includes two outliers Age 3 Permanently separated from parents: two unsatisfactory placements, others showing signs of strain Medium, high and severe risk: living at home, on- going concerns Low risk: living at home, no on-going concerns Almost all decisions were temporary – on average it took 14months for a definitive decision resulting in a viable permanence plan (6months more for this to be completed. Longer for adoption).
    20. 20. Classifying families at risk of harm (Brown and Ward, 2012) Severe risk: Risk factors apparent and not being addressed, no protective factors apparent Parents UNABLE to demonstrate sustained capacity for change; ambivalence or opposition to return by child or parent High risk: Risk factors apparent and not being addressed. At least one protective factor Parents UNABLE to demonstrate sustained capacity for change; ambivalence or opposition to return by child or parent Medium risk: Risk factors apparent and not all being addressed. At least one protective factor Parents ABLE to demonstrate sustained capacity for actual change. Parents and child both want return home to take place Low risk: No risk factors apparent or previous risk factors fully addressed, protective factors apparent Parents ABLE to demonstrate sustained capacity for actual change. Parents and child both want return home to take place 20
    21. 21. Kinship care needs… should be seen as equal to adoption in its ability to provide attachment, continuity and identity… its use should be expanded Kinship care 21
    22. 22. Kinship care  173,200 children living in kinship care although 90 per cent not technically ‘looked after children’ (Selwyn and Nandy, 2012)  no system of registration for these children  kinshsip care can enhance sense of belonging: pre- existing relationships and high level of commitment of kinship carers (Farmer, 2010) and stability (Cuddeback, 2004)  carers under much pressure – poverty, no or little financial or other support from children’s social services especially around contact with birth parents  risk that use of SGOs divert children from welfare system and support?
    23. 23. Kinship care: strengthening stability  recognise high rates of poverty and lack of support  Commission for family support for kinship carers  improve advice to informal kinship carers on benefits and contact with birth parents  some children experience stability but also stigma and isolation  ensure SGOs do not further penalise kinship carers
    24. 24. adolescent graduates and entrants (Stein 2007)  different issues – different approaches (p14- 15). But underlying issues may be very similar  child protection/family breakdown
    25. 25. stability  all need consistency and stability  all types of placement are challenged by adolescent developmental factors  however - 54% of moves are initiated due to delayed and precipitate entry or over- optimistic expectations of swift reunification (not relationship breakdown with carers) (Ward 2009)  3+ placements in a year down from 13% in 2007 to 11% in 2009-2010. 2012 still 11%  movement is avoidable and supporting stability is cost effective
    26. 26. stability  age: Farmer and Lutman’s ‘unstable group’ were the oldest (mean 11.5 years)  proactive case management: ‘unstable group’ characterised by passive case management  changes at home: if the child was returned to a changed household odds of stability increased by a factor of nearly 3.5  local authority performance: those not in the poorest performing LA were 10 times more likely to be in stable placement (Farmer and Lutman 2010)
    27. 27. evidence-based interventions  implementation issues – Wiggins et al checklist  need for robust evaluation in English settings 27
    28. 28. long term foster ‘parenting’ 28
    29. 29. long-term foster care  75% of looked after children are cared for in a foster placement (DfE, 2012)  stable long-term foster care can have very similar outcomes to stable adoption (Biehal et al, 2010)  offers a route to permanency for those who want to maintain a strong sense of identity and contact with their birth families (Ward et al, 2004)
    30. 30. problems associated with long-term foster care  may not ‘feel’ very permanent – always possibility of legal challenge or change of care order  Special Guardianship Orders (SGOs) introduced 2005 to enhance stability but reduction of financial and other supports is major concern for many foster carers and deterrent to their take-up (Schofield and Ward, 2008)  Some local authorities provide financial support with SGOs but this appears to be rare and is currently discretionary (Wade, 2011)  Children often have highly complex needs but despite this, lack of mental health and therapeutic services (Selwyn et al, 2006)  Leaves young people vulnerable at the time of transition to adulthood
    31. 31. strengthening stability in long-term foster care reduce unplanned placement moves through:  reduction in the use of emergency placements  improving decision making concerning reunification  more recognition and support for the complex needs of children  increasing the pool of foster carers to avoid over- stretching existing carers
    32. 32. NICE Collaborating Centre for Social Care
    33. 33. The new role of NICE  From April 2013 developing guidance and quality standards for social care in England  Topics referred by the DoH and DfE  apply an evidence-based system to decision-making in social care, similar to that provided for the NHS  guidelines and standards, based on best evidence ensuring quality and value for money for those responsible for commissioning and professionals  promote better integration between health, public health and social care services
    34. 34. Planned topics  Health and Well-being of Looked After Children and Young People (Publ. April 2013)  Transition between children’s and adults’ services (Publ. March 2016)  Abuse and neglect of children and young people (Publ. May 2016)
    35. 35. How does it fit in the sector?  Not mandatory - aspirational and examples of best practice  NICE is in discussion with OFSTED about how social care quality standards might inform and support the inspection of children’s social care services  Stakeholder consultation for each guideline  Involvement during guidance development groups: invitation for expert evidence
    36. 36. commissioning  a continuum of services  permanence as the focus  be informed by children and young people  Local needs analysis from:  care as last resort  emergency placement  repeated returns home towards:  planning for stability and wellbeing  Support to overcome consequences of earlier experiences - building therapeutic alliances  support to 18+ 36
    37. 37.  planning  support packages  therapeutic alliances  evidence-based models  step down from intensive support  transitions
    38. 38. Counting what counts  Beyond existing data collection, what else would you want to know to understand whether you are achieving improved stability/permanence?  Where might savings be made/costs avoided if placement stability / permanence was improved?
    39. 39. research in practice resources  Evidence Matters in Family Justice (Erlen and Lewis 2012)  Engaging resistant, challenging and complex families (2012)  Analysis and critical thinking in assessment (Brown et al 2012)  Children experiencing domestic violence (Stanley 2011)  Safeguarding in the 21st century (Barlow and Scott 2010)  Parental Mental Health Problems: research review (Tunnard 2004).  Signposts  Frontline briefings  Parental substance misuse (forthcoming 2013)
    40. 40. West Midlands Research in Practice Partners  Birmingham  Coventry  Dudley  Herefordshire  Sandwell  Solihull  Staffordshire  Stoke-on-Trent  Telford & Wrekin  Walsall  Wolverhampton  Worcestershire 40

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