Health Promotion Guidance: Nutritional Guidance for Children and Young People in Residential Care Settings

Section 2 Who Cares? Scotland Consultation Report: Findings from consultation with children and young people

"Children and young people tell us what matters to them"

Overview

The Who Cares? Scotland consultation report "It's no like one of those café places where you can order anything you want", which accompanies this guidance, describes the views and experiences of children and young people living in residential care. The report captures their food and food-related issues, likes and dislikes and what they suggested could lead to improvements. The information gathered has been used to inform the overall report.

It helpfully suggests steps residential establishments can take in response to the views of children and young people. Some relate to making changes in practice or process, while others may be more challenging, implying structural change or further resource investment. A common factor includes offering possible solutions to the issues children and young people raise themselves which can help enhance their health and wellbeing and improve their experience of food.

"If we were buying and cooking our own food then we'd know what we're eating, instead of having no idea what's in our food all the time. It's no wonder we put on weight." (Female, secure unit)

The Scottish Government recognises that there are residential establishments already working in ways which effectively address the concerns expressed by children and young people. However, not all do. The consultation report provides an accompaniment to the guidance and offers helpful insights and suggests areas where improvements can be made if necessary.

Listening to young people

Five key themes emerge from the consultation:

Young people seeing food as an unknown quantity - Many of the children and young people consulted expressed frustration at having little or no knowledge about where the food they eat is cooked, who cooks it, its nutritional value and the ingredients used.

"When I first came in, I didnae ken where the kitchen was but it's in a separate building. The dinner comes up...so we don't know where it's coming fae". (Male, secure unit)

Across all settings, young people were keen for more nutritional information, for example, using a " traffic light system" to help them make informed choices about what they eat. They regularly made links to appearance, weight gain after eating the food provided for a period of time and (sometimes limited) access to exercise opportunities.

Staff and establishments responding to young people as individuals - Children and young people were clear about their likes and dislikes. They were able to suggest changes (at times) and recognised restrictions associated with a group living environment. Often children and young people would have to decide what they would eat a week in advance. Although needs relating to allergies and specific dietary requirements were generally met, individual preferences and circumstances could lose out to the need to cater for the majority. For example attending after school clubs scheduled at the same time as the units normal mealtime means that a child would be faced with a reheated meal.

Some cooks and care staff were more responsive to the preferences and situation of individuals than others. A minority of young people had a very restricted diet or ate only breakfast and supper as they disliked the food on offer or how it was cooked. Opportunities to shop for food or cook themselves differed across settings and within different units in the same establishment. This inconsistency and often a lack of explanation as to why activities might not take place could be a source of frustration for children and young people.

"…we just suggest stuff and the cook usually listens…she bought peppercorns for one young person because he likes things hot." (Male, children's unit)

The importance to young people of being involved in food issues - Many stressed the importance of feeling listened to by the cook and care staff. They wanted to be more involved in issues surrounding food and nutrition. Often it was indicated they were hesitant to speak out if, in the past, they had not felt listened to or not been offered an explanation as to why their request was not fulfilled, for example a change of menu.

Food - improving quality, quantity, variety and availability - With one exception, young people across all settings commented on the (poor) quality of food. Again, the skill of the cook is critical - food tastes better, is better presented and is more imaginative, depending on the chef on shift. In addition, the quality of the ingredients can play a part in this issue.

In residential schools and secure units, the reportedly poor quality of food was also attributed to it being transported from a central kitchen and reheated in the trolley. If young people missed mealtimes, food was again reheated with further loss in quality and appeal, resulting in wasted food. Many also spoke about how unappealing it is to think about how leftovers will be used the next day.

"…they plate it up…but you can be away for two or three hours… and it's lying there and it's no very nice…" (Male, residential school)

Regularly young people requested that further and more varied foodstuffs be stored in their individual unit kitchen, as not enough ingredients were available to make a "proper meal" and the food stored was not always to young people's taste. While those reporting an overall positive experience gave more examples of the types of food held in their kitchen than all other groups consulted, they too suggested improvements that could be made to the variety and quantity of locally held foodstuffs.

Flexible and alternative eating arrangements - the young people stressed the need for more flexibility around food-related structures and processes, such as occasionally having music on while eating or having a meal while sitting on the sofa, even if it was just once a week as a treat. Young people wanted to be considered as individuals in eating arrangement decisions. Feeling uncomfortable eating in front of others was identified as one of a range of reasons as to why a young person may want to sit away from the table. Having a 'nice' alternative should be available as an option.

Comments reflected on the often unchanging nature of set mealtimes and menus. Feedback included the lack of variety, availability and quantity of foodstuffs made available within the units. If residents were not hungry or were absent at set mealtimes, the only option offered was pre-plated or reheated food. Individuals' activities and timetables can change, with young people returning to the unit at varying times and having eaten differently to each other during the day.

Acting on the learning

Residential establishments may replace the family home for young people who are 'looked after away from home' for at least part of their lives, sometimes all year round and, sometimes, long term. The insights offered by children and young people suggest areas of action for residential establishments to consider. These may have the potential to help improve young people's experience of food and their sense of health and wellbeing while living in residential care settings. The learning offered within the 5 key themes has potential implications for management, operations, policy, staff practice and training. In addition, it offers the potential to increase effectiveness and maximise use of resources while adopting approaches which 'place the child at the centre' as directed by current policy.

On the whole, young people reported positively on certain areas of good practice such as the opportunity to be involved in food-related processes and decisions to a degree of their choosing. They valued the support of staff who understood their individual needs and preferences. The willingness of staff to listen and have the commitment and resources in place to respond, played an important part too. Key areas of good practice viewed favourable included:

• planning of meals;
• buying of food;
• preparing and cooking of food (with adequate facility to do so, i.e. kitchen and equipment);
• provision of sufficient foodstuffs (both in variety and quantity).

This appears to support the importance which the young people placed on having access to 'the conditions of everyday living' which should be as close as possible to those common in the wider society. This includes an emphasis on individualised, personalised care and minimising institutionalisation. In addition, 'normalising' everyday experiences and opportunities in acquiring skills for independence can help prepare young people for life after residential care.

"We should do all our cooking in each unit rather than it being brought up for everyone [ on trolleys]. Then we'd just be cooking for the four of us in the unit and we'd have more choices and be more involved in the decisions about what to cook each night." (Female, secure unit)

In short, the findings make a strong case for decision-making which involves young people and incorporates localised solutions rather than a centralised function. They call for arrangements able to flex and respond to the individual and the 'household'. Incorporating these views may have resource implications. Others may be implemented with little or no cost, but have practical aspects which can be successfully achieved by changes in practice.

"If you cook it yourself, it's helping you to move on rather than other people cooking it for you." (Male, residential school)

Some practice changes may initially be more challenging for larger establishments, such as those with central kitchens and dedicated catering staff and this is acknowledged.

Recommended Areas for Action include:

• Decentralised processes including localised food budgets as young people's feedback suggests both food quality and participation can suffer where central purchasing and preparation of food takes place.
• Kitchens (and adequate equipment) at individual unit or house level.
• Maximisation of the role and skill of the cook, as part of the team working with young people, with cooks sited and managed at unit or house level, with a clear remit and scope to respond to individual young people's needs and preferences. In units that do not have an onsite cook, children and young people should have the opportunity to make comments and suggestions about food to an appropriate member of staff.
• Staff practice and training, ensuring an explicit focus on understanding and incorporating young people's individual food and food-related likes and dislikes, building knowledge about healthy eating; and on participatory practice and how it can be applied to food and food-related issues.
• Detailed consideration of food and food-related issues (including physical exercise) in individual care planning.
• Detailed consideration of food and food-related issues in individual pathway planning with young people preparing to leave care.
• Use of practical and creative tools to build young people's understanding of and own capacity about food and healthy eating choices such as a ' traffic light system'.
• Development of organisational policy and creative processes to facilitate young people's active involvement in all matters relating to food and healthy eating.
• Perhaps most significant and challenging of all, attention to creating a 'household' culture which also relates to food and food-related issues which, as far as possible, promotes 'normalisation' of the setting.