Public Sector Thought Leadership

 

Social care commentary: children's homes

Eleanor Schooling writes that it is possible for homes to support ‘hard-to-place’ children and still achieve a good or better inspection outcome

Today, I want to talk about the children living in children’s homes. While the majority of children looked after live in foster placements, around one in 12 children live in children’s homes. Too often, children’s homes do not get the recognition they deserve for the significant role they play in some children’s lives. For some children, residential care is a positive option and it should be seen as such. Did you know that our latest statistics show that 82% of children’s homes are good or outstanding? It might not grab the headlines, but it is a real achievement by the sector.

Each child has a unique set of circumstances, so there is no one-size-fits-all approach to caring for them. Some of these children will struggle to communicate easily with others, understand their own feelings or needs, or manage relationships and situations well. For some children, this will be due to a disability or living with autism. Others will have suffered trauma or abuse, often for many years, and may be angry, confused or withdrawn. I realise how challenging this can be for the adults caring for them. I am under no illusion that this is easy work but I equally know how rewarding it can be. All children need a sense of belonging and someone who is ‘in their corner’.

For some children, sadly, the very issues that make them vulnerable and most in need of our help and support can prove to be a barrier to finding a placement. All directors of children’s services will have at times seen, as I have, social workers wringing their hands as they struggle to find a home that will take on a ‘hard-to-place’ child.

I’ve also heard that for some homes, fear of a negative Ofsted judgement can be a factor in their reluctance to take on these children. I’m sure this is a minority, but this misplaced fear should never determine whether or not a placement is offered. Homes can care effectively for children – however complex their needs – and at the same time be rated good or outstanding by Ofsted. Indeed, the proportion of children’s homes we have judged to be good or better is at a 5-year high. These homes do exceptional work with some of the most vulnerable children.

I don’t want to focus on the role of local authorities in securing suitable placements here, although clearly how they approach commissioning placements is an important part of the picture. In this commentary, I want to discuss what the very best children’s homes are doing to help and support these children and share the excellent practice we have found. These are homes that have staff with the knowledge, skills and determination in place to help these children. And their Ofsted judgements reflect that.

I will also identify some of the issues that homes typically find most challenging and how they best deal with them. This includes:

• supporting children with their behaviour
• child sexual exploitation
• children who go missing
• supporting children with autism and disabilities

Responding to the challenges

Children placed in residential care are sometimes frightened and angry. They could have had several unsuccessful placements previously, or be hurt and upset at being made to live away from family and friends. They may have other problems associated with trauma that they need help and support to address.

We know that even in the best homes, residential staff have to deal with incredibly difficult and challenging situations at times. They could be subject to physical violence, verbal abuse or have to step in to prevent self-harm, assaults, or serious damage to property. Usually, police involvement is a last resort. We rarely see homes inappropriately calling the police. When we do, we take action if we need to. Involving the police is prompted by the most serious behaviour, such as fire setting or use of weapons, and only after staff have been unable to de-escalate a situation themselves.

For staff, finding ways to help children manage their emotions in a constructive way is one of the many challenges of the job. All of our behaviour is a form of communication and children are no different. Their behaviour may be a result of what other adults have done to them or because they have a disability that means they find it hard to communicate their feelings.

For many children, testing adults or boundaries or doing risky things can be as a result of low self-esteem or because the children don’t care what happens to them. The best children’s homes:

• recognise why children are doing what they are doing
• respond with empathy
• support children to regulate their own behaviour, so physical interventions are rare

Having effective matching processes for referrals and planned moves into the home is vital. Homes that do this well make sure that:

• placements are suited from the get-go and have the best chance of succeeding. This secures the ongoing stability of the home for the other children living there
• staff use clear and simple risk assessments and regularly review care and behaviour management plans. This means that they know their children really well and understand their particular needs

As I said in my June 2016 commentary, the importance of good leadership in children’s social care can’t be overstated. Children’s homes are no exception. In the very best homes, we see inspirational leaders who set high standards. In turn, their staff are dedicated professionals whose skill, enthusiasm and understanding make them excellent role models for children. These staff:

• provide consistent care and measured approaches
• demonstrate tolerance and respect for everyone
• importantly, stick with children when they try to push them away

As we saw in one home in Yorkshire, children learn from the positive example staff set. Children then make good progress in tempering and managing how they react and respond to life. There is genuine affection between staff and children in this home, which is pleasing to see. I believe that the best staff build meaningful relationships with children and that this is the key to their success.

Homes have the most success when they provide clear and consistent boundaries combined with incentives and rewards for children’s progress and achievements. In these homes:

• children are helped to understand and regulate their emotions
• negative incidents are reduced and those that do occur are managed well, respecting the child and their rights
• children are involved in their own care planning and, as inspectors saw in some homes, allowed to determine the rewards used. This helps children to feel invested in the home. But it also encourages continued positive behaviour as well as promoting confidence and self-esteem

In one of the homes we saw, children described the response of adults to unwanted behaviour as ‘honest and fair’. One child told inspectors, ‘I have a positive box and I can choose treats from it. I am doing really well here. I feel settled.’

It would be too much to expect children to live together in harmony all the time. But when disagreements and arguments inevitably occur, the best homes use a restorative approach to help children understand how they impact on each other. This:

• teaches them the benefits of treating one another with warmth and respect
• allows them to explore the reasons behind their behaviour
• helps repair relationships

Staff in good or better homes are specifically trained in understanding cycles of behaviour. This helps them to act effectively when young people don’t respond well to life in the home. In one East Midlands home, a member of staff commented on this process, stating ‘it is good to be able to reflect’. I don’t think you can underestimate how important it is for the adults working with children to have time to think about their practice. When you combine good quality training with supervision and other support structures, staff are better able to meet the needs of young people. Some homes also use the skills and expertise of other professionals such as clinical psychologists, psychiatrists and speech and language therapists to guide practice and support both children and staff to good effect.

Children at risk of child sexual exploitation

So high profile is the issue of child sexual exploitation that many homes are now well aware of the issues, are alert to the risks and have strong protocols and procedures in place to deal with and prevent it. However, as Ofsted has said before in the thematic report about the sexual exploitation of children, this in itself is not enough to protect children vulnerable from the threat of exploitation.

Homes that really excel in this area take a holistic approach to protecting children. Multi-agency working is pivotal. Leaders and staff work proactively with local police and safeguarding agencies, as well as other homes in the area, so they are fully aware of potential risks to young people in the community. This approach means there is a cohesive and uniform response to local risks.

The best places know how to balance risk with their responsibility to encourage safe growth. One home in the West Midlands exemplifies this. Here:

• comprehensive, bespoke risk assessments provide safeguards, while allowing children to take some managed risks
• staff understand children’s specific vulnerabilities and how these impact on their daily lives, while also being responsive to their changing needs

Children tell us they value this kind of individual planning and the sense of stability and clear boundaries it provides. This is enhanced when children are given genuine involvement in their own care: a common factor across all good and outstanding homes.

Effective education is vital. In the best homes, staff explore young people’s understanding about appropriate relationships, sexual health and online safety. Inspectors have been impressed by the inventive and creative approaches used. For example, a home that we saw in the North East used a variety of different media, such as videos, quizzes, computer animations and other visual aids to enhance young people’s understanding of the risks.

Staff in the best places are highly trained both to support young people and to recognise the warning signs. In the East Midlands, one home used support and training from external specialist organisations to enable staff to deliver this work to a high standard.

Children who go missing

Not all children who live in children’s homes go missing. This is another misconception about residential care. But children who frequently do go missing pose one of the biggest challenges to homes. For the child, an episode may stem from the most understandable of circumstances, like wanting desperately to be with friends or family. For adolescents especially, testing boundaries and yearning for greater freedoms and new experiences are natural. And while anyone could empathise with what are normal teenage feelings, children in care are of course more vulnerable and at greater risk of coming to harm. For staff, getting their response right is no easy task.

In the best homes, we see:

• staff focusing their time and energy on finding the missing child
• a good understanding of the children and their individual needs, so they are usually able to locate them quickly
• agreed strategies in place to deal with missing episodes
• close work and coordination with families, police and other agencies

And then, importantly, staff work proactively with children to support them and ensure that they understand the risks of repeatedly going missing. Effective education, again, is vital. Some homes use innovative ways of engaging with young people to help keep them safe. We saw an excellent example of effective, bespoke education from one home in the North West. They used a documentary on gang affiliation to help children understand dangers that are particularly relevant to them.

A staff member told us: ‘I speak to [the children] as grown-ups and I try to help them through the transition from boys to men. I want to give them a good platform in life.’ This level of passion and compassion ensures that the young people living at the home feel valued and receive the appropriate guidance.

What makes the difference in these places is that that staff are genuinely interested in understanding why children have gone missing and thinking about what they can do to make children want to return to the home. Again, this is why building trusting relationships is so important.

Children with autism or complex disabilities

Many homes specialise in caring for children with autistic spectrum disorder or other complex disabilities, and do so very well. This group of children has unique needs, so specialist training and expertise are essential to ensure that children achieve the very best outcomes.

Those homes doing particularly well first and foremost ensure that placements are stable. Staff in the best homes:

• have an in-depth understanding of children’s needs
• are nurturing
• show emotional warmth towards children

Children come to trust staff and have a strong sense of belonging. These placements are usually long-lasting, which can help children to make good progress across all aspects of their development.

Care plans that are bespoke, detailed and influenced by young people prove most effective. These allow for clear strategies to manage any challenging behaviours. Working closely with occupational therapists and therapeutic services, staff in the best homes are able to identify and plan each child’s unique sensory strategies. This approach helps to lessen the frustration and anxiety that young people experience. In turn, this reduces physical interventions and unwanted incidents.

Excellent multi-agency assessments ensure that children’s complex needs are understood and met. In one North West home, inspectors saw truly comprehensive multi-professional assessments that produce individual strategies to help young people regulate their emotional health. They are closely followed in practice. For example, staff use individual sensory stimuli such as weighted jackets or beanbags to act as a calming measure and to increase children’s feelings of security.

Proactive healthcare arrangements help children to access the right kind of support. Another home we saw gave each child a ‘healthcare passport’, detailing their communicative abilities and likes and dislikes. This means that health professionals can get the right information from children during appointments and offer appropriate treatment or advice in a way they understand.

Good and outstanding homes also understand the value of maintaining relationships with families. They seek to involve them in children’s care at every opportunity. Staff at the best homes facilitate regular contact with families, irrespective of the distance to travel.

Preparing children for independence and the next stage in their lives is key. The best places don’t allow disability to be a barrier to accessing opportunities and broadening experiences. A number of homes forge excellent links with the community, allowing young people to develop their social and life skills. In one home in the South East, staff make good use of local resources to meet young people’s specific needs:

• a nearby hairdresser allows extra time to cut the hair of children who are anxious
• the charity shop saves dresses for a child who likes to dress up
• the supermarket offers support for young people who are learning to shop independently

These may seem simple steps, but they make a huge and positive difference to children’s experiences.

Emergency placements

While a well-planned placement usually has the most chance of succeeding, some emergency placements will always be necessary. I know from my previous experience how we all try to avoid these emergencies, but sometimes things happen. Whether this is due to a sudden breakdown of a previous placement or other unforeseen events such as a parent being taken to hospital, staff in the best homes are well equipped to manage them.

Any child placed in an emergency will be experiencing difficult circumstances. They are likely to feel extremely vulnerable, anxious or distressed. Homes providing this kind of immediate support ensure that they offer a warm and welcoming environment right from the start. Friendly staff are skilled at engaging quickly with young people. This reassures them and helps them feel safe and settled, as well as helping staff gain their trust. Staff can then better understand the child and their particular needs.

One young person we spoke to said, ‘[Name of the member of staff] is really good at what she does. She’s supportive and a really good listener. She actually cares and can get people to listen to her because she doesn’t talk rubbish or lie to you. You get it straight.’

A calm approach from staff enables them to respond to challenges well, reducing the chance of incidents escalating and becoming more serious.

Role of inspection

The very best homes know which children they can work with, and do so. They are equally strong in saying when they are not able to help a child. But as I mentioned above, we sometimes hear of homes using Ofsted and our inspection judgements as a reason for not taking on certain children. I hope that, as with so many things, this is not the case. I suspect that homes that are sufficiently confident in what they do well do not hide behind inspection but learn from it. I do not want inspection to get in the way of children getting the best possible care. And if we are getting in the way, I want to hear about it.

My aim in this commentary is to offer some reassurance that it is possible for homes to support ‘hard-to-place’ children and still achieve a good or better inspection outcome. If inspectors see that proper support is put in place for a child, then homes have nothing to fear from Ofsted. We understand that some children will continue to go missing and be involved in risky situations, despite all best efforts. Change doesn’t happen overnight.

We do however, rightly, expect children to make progress and have positive experiences that contribute to that progress, however slight. But this process is complex, individual to each child and certainly not always linear. This is something inspectors take into account. Of course not all challenges can be overcome, but we do want to see residential homes doing all they can to make a difference and improve children’s lives. There are so many places that are doing this brilliantly. I hope others will learn from their example.