Coronavirus (COVID-19): children, young people and families - evidence and intelligence report

D. Impact on service delivery

i) Health Services

Home visiting continued where it was essential, based on professional judgement and assessment of need. Universal health services for pregnant women, new mothers and those with pre-school children during the lockdown period, ensured that all families continued to be contacted either through essential face- to- face visits or through virtual means such as NHS Near Me. Practitioners had to adapt quickly to new ways of working and overcome challenges to access the right equipment and platforms to communicate well. Adaptations in the way these contacts were delivered to more blended model, have, in the main, been well received. Services have shared that engagement levels were high, in most cases, and near normal service levels were achieved. The School Nursing service also continued to deliver to school-aged children and young people in their care, despite the closure of school facilities, through face-to-face and virtual means. The role of these services, collectively supporting women and children to identify and respond to need has been crucial as part of ongoing GIRFEC planning.

Data from Public Health Scotland^[27] shows that coverage rates for the Health Visitor first visit remained high during the pandemic. For children who were due their review in March and early April, coverage continued to exceed 90%. Data on the 6-8 week review, 13-15 month review and 27-30 month review was published on 8^th July and although rates remained relatively high for the younger age group, the data from later reviews is much lower. There are reasons for this, associated with the data collection process, and trends will continue to be monitored to see how this can be improved as lockdown measures are eased. Uptake rates for immunisation have also remained high during the pandemic, with uptake continuing to exceed 90% for children aged 8 weeks of age who were due their first dose of the 6-in-1 vaccine in March and early April.

The data also shows that attendance at A&E for all children has been very low, around 45% less than this time last year, and is not coming back to normal levels at the same rate as adult A&E. This could be partially explained by lack of outdoor activity and other related factors.

Advice and support for parents has also been made available on the ParentClub website^[r], including free access to the Solihull Online parenting resource from the antenatal period up to age 18.

ii) Local Partnership Services

Local partnerships have reported a positive, flexible and creative response from services to the challenge of continuing to deliver high quality, timely support across a range of services during the lockdown period and as lockdown started to ease. There is much new work happening that, in many cases, has been put in place quickly and in difficult circumstances in response to fast changing and emerging local needs. The key themes identified from the feedback provided by local partnerships are summarised below, and examples of adaptation by services provided by some local partnerships are detailed in Annex B.

• Contact: Services reported that regular contact had been maintained with vulnerable families already known to them; including children and young people on the child protection register, looked after children, those in aftercare and those with a multi-agency plan. In certain cases, this contact was face-to-face and home visiting continued to take place where essential for those at higher risk. In other cases, practitioners were maintaining weekly, fortnightly or monthly contact via text, calls, video calls or social media contact. Increasingly, face-to-face contact is reported to be possible and is being used more as lockdown restrictions ease with appropriate use of PPE and physical distancing and as families' fear of virus transmission has decreased.
• Concerns during lockdown: There were reported concerns about families where family members are shielding and may have less support available. There were also concerns about some children either not engaging or engaging minimally with education. There was a sense that the lack of structure and routine may lead to an increase in concern. Some services reported concern about the potential impact of a reduced service from educational hubs over the summer on vulnerable children and families – especially those with additional support needs. Some areas reported that they are working closely with Third Sector partners to address that need during the summer holidays.
• Positive developments: Some families, whose children present with anxiety, Obsessive Compulsive Disorder, or challenging behaviour or where children were being bullied at school, have reported to services that their children (and family life) are more settled during lockdown. There is a recognition that these families may need increased support as school returns. Across a number of local areas, services reported that the pandemic has enabled the greater development of trusting reciprocal relationships and creative ways of working. Some staff are working beyond their usual roles and in different ways with partners and with children and families themselves. Some children, young people and families are also engaging more or better with services than they were pre-COVID. For example, youth justice workers have reported improved relationships and engagement with young people due to the use of technology, having more time to engage and more regular contact enabling young people to feel more comfortable to discuss issues openly. Another example is that, with children's plan reviews, LAC reviews and reviews of child protection case conferences taking place virtually, there has been an increase in the number of young people actively participating in their own meetings in some areas. These positive developments may present opportunities for further positive change in the future assuming they can be maintained.
• Care placements: Services have worked hard to adapt processes to maintain and support fostering, adoption and kinship care during lockdown. For example, through direct support and supervision, support materials and short break arrangements where necessary. Even so, in some local areas, there is high pressure on care placements and services are reported to be at capacity and links are being made with the Care Inspectorate regarding the potential need for emergency provision.
• Anticipated increase in referrals: Services report that it is likely there has been suppressed demand for some services during lockdown and that a range of difficulties are likely to be have been experienced, but not necessarily reported (including, domestic abuse, parental alcohol and substance misuse, emotional abuse and neglect, teenage anxiety, self-harm and suicidal thoughts). Many report that, as lockdown eases and more issues come to light, there is the potential for child protection concerns to rise. Services also anticipate that, at the same time, there were will be increasing levels of financial difficulty and poverty as the impact of furlough and redundancies take effect. Services reported that they are planning for the next steps to be able to manage the anticipated increase in referrals to ensure children and their families are referred appropriately and receive appropriate and timely support.

CELCIS reports that there is evidence of significant innovation and efforts to maintain carer assessment and care planning with local areas using telephone, teleconferencing and virtual technologies. More rural and remote areas who had technical systems already in place pre-COVID have been better placed to work in this way. Care planning reviews are reported to be continuing in all local authority areas; and that where possible children and parents have been included using a range of methods (e.g. online questionnaires to children, telephone calls to parents and support from advocacy services (where available) for both children and parents).

CELCIS have also found that there have been some positive reports across residential settings that there is increased stability and predictability for young people with less shift changes, less visitors and the pressure of attending school taken away. For care leavers, however, they note that social and physical distancing restrictions have exacerbated social isolation and loneliness, which for many has had a detrimental impact on their mental health and emotional wellbeing. However, CELCIS report that Throughcare teams have often been going above and beyond to provide individual support (whilst maintain physical distancing or providing online support). CELCIS note that local authorities are not always permitted to utilise consistent user-friendly social media platforms, meaning that young people, and local area staff, are not always able to maintain digital contact.

iii) Childminding services

During lockdown, an average of 700 childminding settings (15%) across Scotland remained open weekly, prioritising service provision for key workers and vulnerable children. The Scottish Childminding Association (SCMA) state there were anecdotal reports from members that the education hubs were not always in locations accessible to vulnerable children and families, and that this may have had an impact on uptake. In response, SCMA secured a grant from the Wellbeing Fund to provide approximately 100 childminding placements for vulnerable children, taking direct referrals from other national or local Third Sector organisations who have been unable to provide physical family support during lockdown and who may continue to have reduced capacity^[s]. As of 3 June 2020, all childminding settings were allowed to re-open during Phase 1^[t] of the 'route map'. Priority will continue to be given to providing critical childcare for key workers and vulnerable children. Capacity restrictions are expected to be reviewed and lifted during Phase 3, when the wider Early Learning and Childcare sector are allowed to re-open.

iv) The Children's Hearings System^[u]

The Scottish Children's Reporters Administration (SCRA) report that there have been 1,397 'virtual', video enabled children's hearings between 4th May and 29^th June. This figure represents around 30% of normal capacity. This virtual approach has been a key part of ensuring that those children who urgently need legal protections have access to them. At the same time, there has been a decrease in referrals to the Reporter of 29% (-2430) since lockdown commenced. Referrals continue to be received weekly, mainly from Police Scotland and continue to be assessed by Reporters alongside Local Authority Social Workers and other relevant professionals and prioritised on the basis of need for compulsory measures. Panel Members, children, young people and family members/ relevant persons, social workers, Reporters and, where necessary, safeguarders, legal representatives and advocates have been able to use virtual hearings to ensure as many of the core elements of a children's hearing can be retained in reaching decisions on the best interests of each child or young person.

A national virtual hearings team has been put in place to support all potential participants to make the most of the virtual experience – including testing devices, advice/training and providing financial support for data for families. A large amount of targeted information about virtual hearings has also been provided to hearing participants across various social media platforms^[v]. Experience and ongoing evaluation conducted by Children's Hearings Scotland (CHS) and SCRA of virtual hearings at this stage continues to be relatively mixed. SCRA reports that when all of the key ingredients work together they can work really well however, key issues around consistent connectivity and access to appropriate devices continue to be at times problematic. Work is ongoing with the Scottish Court and Tribunal Service to ensure efficient prioritisation and expediting of proof hearings and appeals against Hearing decisions. However, the necessary limitations on court time has led to some delays in establishing grounds and ongoing prioritisation will continue in this regard.

Children's Hearings can vary widely in terms of the number of participants involved. They are by their very nature designed to be inclusive and discursive. Because of this, the actual number of hearings which will be able to take place in some adapted physical form is currently uncertain as is their overall contribution to recovery of the hearings workload. Significant adaptation of Hearing rooms has been required to allow for physical distancing to be ensured. Face to face hearings recommenced in the week of 13 July and will gradually increase across the country over the next few weeks. Given the limitations in the size of hearing rooms across Scotland there will be a need to considerably change the physical hearing model and adopt a 'mixed methods' approach. SCRA has produced an update on preparation for face to face hearings^[w] and CHS and SCRA will continue to work over time to optimise the approach and delivery of hearings and will continue to develop virtual hearings alongside that of the developing physical hearing model.

CHS and SCRA have also been engaging and consulting with hearings experienced children and young people involved in 'Our Hearings Our Voice' and the Foster Network, on what hearings need to look and feel like and how hearings should be delivered^[x]. SCRA has published a full response to the engagement and consultation^[y].

Whilst significant prioritisation on all fronts, including the most urgent hearings, will continue for some time, a sizeable backlog in hearings is emerging which will require to be carefully managed across the remainder of 2020/21. Initial mapping and mapping recovery planning and need for resource deployment will continue.

v) Youth Justice services

The aforementioned qualitative study by The Centre for Youth and Criminal Justice (CYCJ) found that overall, children and young people have had limited contact with the Police during this time and that the responses by Police have been appropriate. That said, there were reports of young people actively avoiding police contact (due to anxiety) or experiencing negative contacts (e.g. being arrested or feeling unfairly targeted by police). Some practitioners have seen a reduction in offending, whilst others have seen a change in types of offences (e.g. increases in shoplifting and COVID-19 related offences like spitting). Practitioners also highlighted a small number of concerns about wider criminalisation of children and young people.

Experiences of remote service provision are consistent with other studies: barriers include lack of technology and privacy at home, and the challenges of building new relationships. However, services were found to be using a range of creative methods including various technological platforms, to keep in touch but also to run activities and projects. This ability to provide light-hearted and fun support has been identified as particularly important for young people's morale, wellbeing and mental health. Face-to-face contact (e.g. physically distanced walks) has been important for more isolated children and children where there are concerns for their welfare and wellbeing.

The report emphasises the need to be prepared for the persistent effects of COVID-19 on mental health and wellbeing as lockdown is eased and beyond. Therefore, it was stated that it is important that practitioners maintain efforts to keep in touch with children, young people and their families and continue to provide individualised practice and emotional support; as well as enabling children and young people to stay in touch with family and friends, including the provision of devices and internet data.

vi) Support for young carers

There are an estimated 29,000 young carers in Scotland and more young people may have taken on a caring role during the pandemic. The Scottish Government Policy for Carers Team has been receiving information on young carers and the impact the pandemic has had on them from a variety of organisations including: Young Scot, Carers Trust and the Scottish Young Carers Services Alliance. This information is helping inform policy development and responses during this time.

Although most local carer services have been unable to provide face-to-face support during lockdown restrictions, most have been offering alternatives such as telephone counselling and online sessions. Scottish Government funding was provided to help local carer organisations adapt to supporting carers remotely and additional financial support has been provided alongside the existing Young Carer Grant to enable young carers to take breaks from caring responsibilities.

vii) Third sector services

A range of third sector organisations have reported intelligence about the observed impact of the crisis on CYP and families, and the ways in which their services have been responding. Undoubtedly, the third sector organisations report significant challenges that CYP and families have been dealing with, but positives have also been reported for example (as noted above) children in residential homes have welcomed the continuity of staff. The key overarching themes are summarised below and further information from specific organisations is provided in Annex C.

Key Impacts reported on CYP and families:

• Increase in child protection concerns
• Increased reporting of domestic abuse
• Increased pressure and stress, including from children being at home all the time or the pressure of home-schooling, resulting in relationship fracture or breakdown
• Mental health and emotional wellbeing concerns
• Financial problems (including need for urgent assistance)
• Digital exclusion

Third sector services report an increase in demand for additional supports for families in vulnerable circumstances, and many anticipate the level of need will continue to rise. They have adapted quickly and provided a range of help to families and CYP, including:

• Urgent financial assistance (including for utilities) and income maximisation advice
• Food packages and vouchers, and referrals to foodbanks
• Support for families affected by domestic abuse (remote or face-to- face emotional support, as well as practical e.g. with moving to new accommodation)
• Provision of digital devices, data allowances, etc.
• On-line information, support, courses and toolkits (e.g. to help with stress and support wellbeing)
• Telephone helplines and support chats
• Doorstep visits or physically distant works
• Provision of medicines
• Provision of packs to support creativity and play

On behalf of the Third Sector Interface (TSI) Network, Glasgow Council for the Voluntary Sector (GCVS) ran a national survey in May^[28] to further understand the impact of the pandemic on the third sector and the people and communities it supports^[z]. The headline findings are presented in Annex C.