Introduction
This summary aims to tell us what works in improving the emotional and behavioural
health of looked after children and young people (LACYP), on the basis of a systematic
review of the research review literature and analysis of key data.
As recommended in the scoping study on which this review builds, we focus on the
interventions for which the evidence base is most developed and relevant to the
review subject. These interventions are enhanced foster care, multi-systemic therapy
and mentoring. The review aims to provide evidence that will help service providers
to improve services, and ultimately outcomes for children and young people (CYP)
and their families.
The review was carried out by the Institute of Education on behalf of the Centre
for Excellence and Outcomes in Children and Young People’s Services (C4EO). The
data analysis was conducted by the National Foundation for Educational Research
(NFER).
Key messages
- Children and young people say that their emotional wellbeing and self-esteem is
supported when they are cared for in an environment where they feel they belong.
- Make interventions and support for children and young people accessible, so that
CYP experience placement stability. Children and young people need continuity of
support from their social worker and other professionals.
- Foster carers want better peer support networks, ongoing training to deal with emotional
needs and more information on access to services, in particular mental health services.
- Enhanced Foster Care may be effective in reducing offending behaviour and the number
of care placement moves. The training and support of foster carers is key to the
young person receiving the required support from all services.
- There is some evidence that using multi-systemic therapy (MST) can result in improved
emotional health, educational outcomes and family relations and decreased offending
behaviour.
- The small amount of research on mentoring suggests that mentoring can have a modest
impact on children and young people. The research suggests that Mentoring is most
successful when the mentor has come from a helping background or profession (such
as teaching) and has ongoing support and training.
- Overall, there is a lack of research on interventions which specifically aim to
improve the emotional and behavioural health of LACYP. Although there is some positive
evidence for the effectiveness of all three interventions considered, the initial
results reported in the international literature suggest that they may not necessarily
be more effective than other interventions. Research in progress may clarify some
of these issues.
Who are the key people with important knowledge and views working to improve services?
Looked after children and young people (LACYP)
Looked after children and young people (LACYP) experience the services and interventions
that are offered but there is a lack of research on the views of LACYP with emotional
and behavioural disorders that have used the services on offer, especially those
that have had less successful outcomes following therapeutic interventions.
As users of the services, LACYP will have insights into their own needs that may
be different from the perceptions of others. Many LACYP arrive into the care system
with a high level of emotional and behavioural needs and how these needs are handled
has a large effect on both their present and future lives. LACYP with a history
of greater placement disruption who are not involved in education are most likely
to drop out of intervention programmes and so steps must be taken to identify those
likely to need additional support to continue.
It is important that access to educational support and psychological services is
improved for children and young people and that their foster carers are also made
more aware of the support that is on offer.
Foster Carers
Foster Carers are responsible for providing the LACYP with a caring and inclusive
environment that provides them with a sense of belonging and should be able to offer
emotional and practical support. Allowing time for foster carers to build relationships
with children and young people and maintaining good relationships with social workers
is important so that they can make an impact on the quality of children and young
people (CYP)’s lives which in turn can improve the emotional and behavioural health
of children and young people.
Carers are keen to take part in training to help them support CYP with their emotional
and behavioural needs and appreciate greater communication with other foster carers.
Foster carers want to be seen as professionals and paid adequately and fairly particularly
when working with challenging LACYP with complex emotional and psychological problems.
Birth family
Birth family contact is an important and emotionally difficult issue for LACYP.
In some instances it can have a positive emotional and behavioural health impact
for LACYP, as it supports their self-identity. However, because of the complex issues
involved with how LACYP entered care, contact with birth families needs to be sensitively
negotiated.
For some LACYP contact with birth families is not desirable because of the emotional
behavioural consequences that contact can have on LACYP and in other cases LACYP
wish to pursue contact despite these difficulties.
Social workers
Social workers need to be reliable and accessible so that young people can gain
access to the services they require. Good communication with young people is crucial
so that CYP feel that their social worker is accessible.
Despite the minimum visiting requirements for looked after children in foster care
to be visited by social workers, there is some evidence that children and young
people without regular contact because there are no obvious problems feel unable
to raise issues with their social worker because of the drop in contact during these
times.
School based professionals
School based professionals have an important role to play. Placements with foster
carers and school places and or other forms of educational support need to be co-ordinated
by professionals working together across agencies. Educational professionals can
provide pastoral as well as educational support through the designated teacher responsible
for looked after children in schools and other staff.
Health professionals
Health professionals provide emotional help and support particularly through Children
and Mental Health Services (CAMHS). Key people are mental health workers and psychiatrists.
Speedy and easy referral and access to these services are crucial to improving the
wellbeing of LACYP.
Is there specific data available to inform the way forward?
Current data on the emotional and behavioural of individuals is relatively limited.
No comprehensive source of existing national data on the emotional and/or behavioural
health of children and young people who are looked after has been identified, although
data to be collected by local authorities using the Strengths and Difficulties Questionnaire
(the SDQ, completed by children’s carers with the consent of the child) should,
in the future, provide a more general picture than the single (though detailed)
ONS survey of just over 1000 children age five to 17 can afford.
The evidence base
A total of 104 items were assessed as relevant to the review questions. These were
divided fairly equally between the three areas. Key gaps in the evidence base related
to improving the emotional and behavioural health of LACYP include:
- evaluated pilots of broader support packages for foster carers that go beyond training
- studies of the contribution made by attitudes, skills and abilities of birth parents
to the emotional and behavioural health of LACYP and how to support this contribution
- studies of the contribution made by attitudes, skills and abilities of residential
workers to the emotional and behavioural health of LACYP and how to support this
contribution
- incorporation of the views of LACYP into effectiveness studies of interventions
to address emotional and behavioural disorders
- studies of the views of LACYP with direct experience of emotional and behavioural
disorders and related services, particularly younger children and those with unsuccessful
outcomes of therapeutic interventions.
Review methods
Research literature was identified by systematic searching of key health and social
care databases, including PsychInfo, Medline and Social Care Online. The review
team used a ‘best evidence’ approach to systematically select the most relevant
and high quality reviews to include in the review.
This approach attempts to eliminate bias in the selection of literature, to ensure
that the research findings are objective. Reviews and meta-analyses on LACYP and
CYP with EBH, aged 0 to 25, published since 2000 and in English were included in
the review.
