Social Care Wales response to the Inquiry into the Emotional and Mental Health of Children and Young People

Introduction

Thank you for your letter of 17 November 2017 requesting a response from Social Care Wales to this inquiry.

Social Care Wales is a Welsh Government sponsored body.  Our vision is that every person who needs support lives the life that matters to them.  We aim to achieve this vision by working with people who use care and support and a broad range of organisations to:  

·         set standards for the care and support workforce

·         develop the workforce

·         work with others to improve services

·         set priorities for research

·         share good practice

·         provide information on care and support

Key points

·         Social Care Wales’ summary of the Welsh regional population assessments has found that more support is needed for those not reaching CAMHS thresholds and many report an increase in referrals in recent years (par. 8)

·         Across Britain, almost half of children in care have a diagnosable mental health disorder (par. 10)

·         Social Care Wales is developing scoping research that looks at innovation and improvement in children’s social care taking place in Wales, focussing on children who are looked after (par 12)

·         We are reviewing the social work degree with the aim of ensuring that newly qualified social workers are able to meet the challenging and varied needs of the children they care for (par. 20)

·         We are revising the health and social care induction framework and considering how to improve its uptake among residential child care workers and tackle high staff turnover (par. 21)

Summary of regional population assessments of children and young people’s needs

1.   Social Care Wales is preparing a summary of the regional population assessments of care and support needs, which will soon be published on our website.

2.   In April 2017, regions[1]across Wales published an assessment of the care and support needs in their area. Population assessments, as they are known, are a requirement of the Social Services and Well-being (Wales) Act 2014. The assessments are a joint exercise, undertaken by local health boards and local authorities in partnership with the third and independent sectors across each region. These assessments will form the basis for care and support planning in the future.

Emotional and mental well-being

3.   One of the key areas of focus for children and young people was around supporting emotional and mental well-being.  One in five young people in Wales report low life satisfaction and one in ten experience bullying.  All regions in Wales recognise the importance on emotional and mental well-being in children and are providing support through emotional well-being services, programmes in schools and counselling services, including online counselling. 

4.   It’s important that we continue to build our understanding of what well-being looks like for children and young people.  Some areas are tracking and responding to need, through online surveys for school pupils, enabling them to identify the extent of the issues raised and respond to need.

5.   Those who see our children and young people every day, such as education and childcare providers, are recognised by regions for the important role they play in supporting emotional well-being.  Some areas feel more needs to be done to support those working in early years to recognise and respond to signs of social and environmental risk.  It is also felt there needs to be more engagement and involvement with schools to raise awareness on mental health.

Children who are looked after

6.   Across Wales, it is also acknowledged children who are looked after are more likely to experience emotional and mental health issues, including those in the secure estate.  In particular, there is a need for specialist support for trauma and attachment issues for children who are looked after by local authorities. Some regions report delays in psychological support for those children and many are working to improve the way they support their mental health needs.  This is being met currently through specialist psychological services and training for professionals on attachment disorders. 

7.   However, some regions feel we need a better understanding of the numbers of children experiencing attachment issues.  We also need to increase awareness of the signs through training professionals, improve the support to foster carers and adoptive parents to prevent placement breakdown and increase provision of specialist counselling.

Child and adolescent mental health services

8.   With regards to children and adolescent mental health services, it is recognised by some regions that more support is needed for those not reaching CAMHS thresholds and many regions report increased referrals in recent years. However, many regions are already reviewing and responding to pressures on CAMHS services in their area.  It is also worth noting that some regions identified a specific issue around self-harm for young people.  There are many good examples of how regions are meeting needs, including self-harm pathways, crisis services and the development of a single point of access.  However, the focus remains on increasing the availability of support to address the emotional needs of children and young people to prevent escalating need or unnecessary referrals.

Role of children’s social care

9.   From our conversations with people working in the social care sector, we are aware of the pressures facing specialist child and adolescent mental health (S-CAMHS).  Social care providers play an important role in working to reduce the effects of abuse and trauma, build resilience with the effect of fewer children developing acute or chronic mental health issues, thereby reducing the pressure on S-CAMHS.

Social Care Wales’ contribution to supporting the mental health and well-being of children

Improving services for children who are looked after

10.                Children who are looked after are at high risk of developing long term mental health illnesses.  According to a recent report by Social Care Institute for Excellence (SCIE), “almost half of children in care have a diagnosable mental health disorder and two-thirds have special educational needs.[2]

11.                Social Care Wales is responsible for working with others to improve services.  Care and support for children who are looked after is one of our priority areas for improvement.

12.                We are in process of developing scoping research that looks at innovation and improvement in children’s social care taking place in Wales, focussing on children who are looked after, and children on the edge of care. 

13.                Social Care Wales is a member of the Improving Outcomes for Children Ministerial Advisory Group[3], and has active involvement in all three work streams, at all levels of the structure.  We will continue to contribute to the group’s work in the year ahead.

14.                We are commissioning research into children who need care and support in secure units for welfare reasons.  Furthermore we are involved with the Welsh Government’s Residential Child Care Task and Finish Group. 

15.                We commissioned an e-learning resource on the local authority responsibilities under the Act for children who need secure accommodation[4] and these are available on our Information and Learning Hub.

16.                We recognise the links between S-CAMHS and children’s social care, and have completed scoping research on evidence based models and their effectiveness and shared this with the sector[5].

17.                We are guiding a development by SCIE in Wales to develop a practice guide on therapeutic interventions for the emotional and mental health needs of children and young people who are looked after.  It is due for completion by spring 2018 and is based on research undertaken for the Department of Health in England, but re-framed within a Welsh context.

18.                We are also developing our work on outcomes focussed practice, again with the aim of addressing adverse childhood experiences and building children’s resilience and emotional well-being.   We are also working on an improvement hub for practitioners to enable easy access to research and evidence informed interventions.  Coupled with the scoping research, and the therapeutic intervention work, we will develop strategies to share best practice across Wales. 

Workforce

19.                In terms children’s social care, we are responsible for registering social workers and residential child care staff. 

20.                In relation to social workers, we are in process of reviewing their degree with the aim of ensuring that newly qualified social workers are able to meet the challenging and varied needs of the children they care for.  A known contribution to children building resilience is having stable relationships with adults.  Therefore this review will support the continuing development of the workforce to effectively meet children’s needs for skilled, experienced and talented workers.  We also commission the  Continued Professional Education and Learning Framework (CPEL) for qualified social workers which has a core module on ‘Mental health and Well-Being’   in the Experienced Practice in Social Work programme.  This supports students in acquiring an advanced understanding of mental health and well-being practice considerations within Welsh contexts.  

21.                According to our annual profile of the residential childcare workforce[6], the percentage of workers who hold the required qualification to work in the sector is decreasing.  The evidence suggests that the number of individuals registering on the basis of completing their induction is increasing but many are then leaving the register and employment in residential child care rather than completing the required qualification.  Reflecting this, turnover amongst residential child care on the register is high, at 20pc. 

22.                Therefore, we are also revising the health and social care induction framework and considering how to improve uptake of this in residential child care workers.  There is ongoing work, with partners, reviewing the qualifications framework for children and adult health and social care workers.  For our most traumatised and abused children these aspects of work force development are crucial in that we need to be sure that we can offer these children better care than if they remained at home.

23.                We are aware of the wider challenges in providing good quality care to children who are looked after and as such are involved with reviewing the fostering regulations and developing a national fostering framework, including post-approval training for foster carers, including kinship carers, a growing proportion of the fostering caring population. 

Summary

24.                There is clear evidence that children who are looked after require specific care and support for their emotional health and well-being

25.                Social Care Wales is supporting the children’s social care workforce to improve the care and support they provide.  This workforce is part of the wider team of people who support the emotional and mental health of children and young people in Wales.  As a new organisation, with a remit to regulate, develop and improve social care we look forward to working with the committee and other partners in the years ahead on this challenging and rewarding agenda. 



[1] In this context, regions are based on the local health board footprint as specified in part 9 of the Social Services and Well-being (Wales) Act 2014

[2] .13, Improving mental health support for our children and young people, SCIE, November 2017.  NB.  SCIE research is part funded by Social Care Wales

[3] Improving Outcomes for Children Ministerial Advisory Group, Welsh Government

[4] Assessing and meetings needs in the secure estate, Social Care Wales

[5] Known Effectiveness of Models and Frameworks for Interventions with Children and Families (PDF) , SSIA (now Social Care Wales), February 2015

[6] p3 The Profile of the Residential Child Care Managers and Workers in Wales 2016, Social Care Wales (formerly known as the Care Council for Wales)