Looked after children and young people: we can and must do better

04 / Being Emotionally, Mentally and Physically Healthy

Our Vision

Scotland's looked after children and young people will benefit from access to a range of appropriate services designed to meet their emotional, mental and physical needs. Professionals, foster carers, residential workers, teaching staff and parents will be trained to understand the importance and value of meeting these needs. All of our looked after children and young people should grow to be emotionally, mentally and physically healthy.

Where we are now:

Good physical, mental and emotional health is a fundamental and underpinning component of positive health and well-being.

"Mental, physical and emotional well-being of young people are essential preconditions for successful learning."
(The Journey to Excellence, HMIE 2006)

There are also strong links between the mental and emotional health of children and their personal and social development and academic performance.

One study of looked after children in Scotland found that three quarters of children looked after away from home thought that their health was 'good' or 'very good', a view backed by their carers.
(Triseliotis et al. 1996)

Another report concluded that:

"It is not the state of the child's health on the day they enter the system. It is rather the history of unmet need prior to being accommodated."
(Forgotten Children 2004)

Despite this, Extraordinary Lives makes clear that as a group, looked after children and young people have poorer physical and mental health than that of their peers. Children and young people with disabilities and/or complex needs can be further disadvantaged if their condition is either misunderstood or overlooked. Some studies have also found that young people looked after away from home are particularly vulnerable to drug and alcohol abuse and self harm.
(Ridley 2001; Meltzer et al. 2004)

Thus, Extraordinary Lives highlights the importance in creating "emotional warmth". Children develop their personal identity and a sense of self-worth through their relationships with other people; "Informal support networks, mainly friends, family and wider kin are extremely important to most young people …schools emerged as a very important site for the provision of support." Some solutions which Extraordinary Lives suggest helps to create stability for looked after children and young people are; links with birth families, regular attendance at school, friends and social networks.

Our attention is increasingly turning to the importance of developing resilience and the mental and emotional wellbeing of looked after children. Extraordinary Lives highlights that a supportive family is one of the single most powerful factors in creating resilience: "It is important that qualities of a supportive family are re-created in every setting in which children are cared for". Mental and emotional wellbeing has been described as "a state of wellbeing in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community".
The Mental Health of Children and Young People: A Framework for Promotion, Prevention and Care (Scottish Executive, 2005)

In recognition of these issues, we have seen an increasing drive to tackle some of these issues in both policy and also practice. HeadsUpScotland (the National Project for Children and Young People's Mental Health, funded by the Executive) is currently - and has been for the past year - running training sessions across the country, delivered by Young Minds, on the mental health of looked after and accommodated children and young people. This is being co ordinated by Social Work training managers. This year's activity is "training the trainers" so that there is a means to sustain the knowledge-base.

We have also commissioned HeadsUpScotland to produce a multi-agency training resource for all those who work with children and young people. The focus will be on resilience - What is it? How do you get it? How do we develop it? How do we maintain it? The training resource will be piloted in autumn 2006 and should then be available as a web-based resource by the end of the year.

We also provide an A-Z of special issues, in the Safe and Well handbook on child protection and wellbeing in school, including sections on looked after children and young people and mental health issues. Here we set out practical steps that schools may take to support looked after children and young people.

We have published National Care Standards across a range of care settings for looked after children. The Standards are founded on six key principles of dignity, privacy, choice, safety, releasing potential and equality and diversity; and set out what a young person can expect from a care service and how to raise any concerns. The Care Commission, as the national regulator, must take the standards into account when regulating care services.

In addition to the various initiatives which target looked after children and young people, there are numerous policies and initiatives aimed at improving the physical, mental and emotional wellbeing of Scotland's children and young people. For example:

• We have set every school in Scotland the target of becoming a health promoting school by 2007.
• We have developed nutritional standards and guidelines for schools, and early years settings. The Schools (Health Promotion and Nutrition) (Scotland) Bill will build on this, aiming to make the standards in schools statutory. This Bill will also seek to introduce a statutory duty for schools to be health promoting schools, which would involve a whole-school approach to promoting the physical, social, spiritual, mental and emotional wellbeing of all pupils and staff. The Bill will also seek to introduce standards for food in schools beyond school lunches and for food served in school hostels, local authority residential special schools and grant-aided schools.
• We provided financial support for the establishment of the Scottish Healthy Care Network and we will part-fund the appointment of a development worker to the Scottish Healthy Care Network.
• Healthy Respect is the National Health Demonstration Project for the sexual health and wellbeing of young people, hosted by NHS Lothian.
• We fund work being undertaken by the Scottish Health Promoting Schools Unit to provide information and guidance to schools on how to promote the emotional health, mental health and wellbeing of pupils and staff.
• We fund the see me campaign to eliminate stigma and discrimination associated with
  mental illness; this undertook two high-profile phases of campaign activity (2005 and 2006) specifically aimed at raising awareness of mental and emotional health problems in children and young people.
• We published The Mental Health of Children and Young People: a Framework for Promotion, Prevention and Care in 2005 to address the support needs of vulnerable young people. It is designed to support local planning and practice to take forward the aims of the 2003 Scottish Needs Assessment Programme ( SNAP) report on Child and Adolescent Mental Health. The Framework therefore covers:
  • promotion of positive mental wellbeing;
  • prevention of mental health problems;
  • care/treatment of mental health problems when they do arise.

We expect the elements outlined in the Framework to exist within local services by 2015. The Child and Maternal Health Unit are currently in the process of setting milestones for 2008 and 2010 with a view to working towards full implementation.

• We have established Breathing Space (a telephone advice service for people experiencing low mood or depression, targeted particularly at men aged 16-40) and established a national suicide prevention strategy ( Choose Life).
• We recommend peer support ( e.g. buddying or mentoring) in our frameworks for positive school ethos and relationships ( Better Behaviour - Better Learning) to promote positive peer group connections. Many Scottish schools have used peer support to help vulnerable pupils to cope in transition and to gain positive experiences of change.
• We fund a social networks co-ordinator, hosted by the Rock Trust, to take forward the Homelessness Task Force's recommendations on strengthening and promoting homeless people's social networks. This involves bringing together befriending, mentoring and mediation services and disseminating good practice to ensure that young people's family and social relationships are considered when they are facing housing difficulties.
• We currently support two demonstration projects examining how to develop children's social, emotional and behavioural skills, where these may be insufficiently developed in the context of difficult home and life experiences, through different approaches to Nurture Groups.
• We are continuing to work in partnership with councils, Association of Directors of Education Scotland ( ADES) and Association of Directors of Social Work ( ADSW), NHS Health Scotland and other key stakeholders to ensure high quality and appropriate Sexual Relationship Education, consistent with national guidance, is delivered in school and other settings to vulnerable young people.
• We provide funding to the Partnership Drugs Initiative, managed by Lloyds TSB Foundation for Scotland, which supports voluntary organisations working with children and young people affected by drug and alcohol misuse.
• We are developing catering specifications for the NHS which will improve the provision of healthy food for children in hospital.

What the Group said:

The group agreed that looked after children and young people generally experience poor physical and mental health and that this may impact (often negatively) on their educational experiences. They also agreed that many looked after children and young people will have had experience of separation, loss and/or trauma and that many lack self esteem, confidence, resilience and self worth.

This led the group to ask:

• Is each and every looked after child and young person registered with a dentist and a GP? Do they receive regular dental and medical health checks?
• Are financial/ mentoring supports available for children and young people who wish to take part in physical activity?
• What range of therapeutic support is available to young people?
• How readily available are these supports?
• Can a child or young person self refer for support?
• What level of training can parents, foster carers, residential workers and all relevant workers and professional access on critical topics such as child development, attachment, resilience, restorative practices, or positive behaviour management?

The group were adamant that appropriate supports need to be in place for looked after children and young people. For some young people this may include access to counselling services, a flexible curriculum and out of school support. For younger children nurture groups and various types of therapy such as art, music and play need to be considered. The group was emphatic that, in all cases and in all settings the ethos should be one of warmth; physical health, activity and mental and emotional wellbeing should be promoted and supported.

The group strongly felt that health and wellbeing should not sit only with those working in the health arena; emotional readiness, mental wellbeing and physical health have paramount importance to the educational and life outcomes of our looked after children and young people. They felt hopeful that health and wellbeing is moving closer to where it needs to be - at the centre of our strategy for improving educational outcomes for looked after children and young people.

What Scotland's looked after children and young people have said:

Having Your Say commented on the emotional barriers looked after children and young people felt that they faced. They highlighted a spectrum of feelings they might experience, including "feeling scared", "bullied", "anger", "lost" and "unwanted". They listed the types of support in schools that they both valued and wanted to see more of, including: buddy systems, chill out rooms, circle time and flexibility - from teachers and in their curriculum. In relation to the school base, the young people desired it to be somewhere where they could "chill out" and take "time out" and that there would be support within the base to "listen" to young people's "worries and concerns."

The Debate Project reinforced a lot of the points raised by Having Your Say. Here the young people focussed on emotional barriers such as, enormous stress, everyday problems of adolescence, peer pressure, in addition to exams, being moved around and catching up with education they may have missed. As with Having Your Say these young care leavers wanted resources and support which are "sensitive to the individual and....available on a needs-led basis." They too highlighted the importance of "people," calling for more "caring people in their lives".

Common themes:

• Physical, mental and emotional wellbeing are critical in facilitating positive educational outcomes for looked after children and young people.
• Positive, consistent relationships are equally critical in fostering identity, self-esteem,
  self-worth, resilience and a sense of stability and trust.
• School based supports are central to providing continuity and security, which in turn are essential pre-requisites for effective learning to take place.
• Support available must be varied in order to meet the spectrum of individual need.
• Accessing services and general awareness of what is available could be improved.

The way ahead - our pledge to Scotland's looked after children and young people:

The health of our looked after children and young people remains poor when compared to other children and young people. This has the potential to have a serious and negative impact upon educational outcomes and future lives.

Action 15:
Each NHS Board will assess the physical, mental and emotional health needs of all looked after children and young people for whom they have responsibility and put in place appropriate measures which take account of these assessments. They will ensure that all health service providers will work to make their services more accessible to looked after and accommodated children and young people, and to those in the transition from care to independence.

Next steps required:

a) We will encourage joint assessment and planning which takes into account the views of the young person and includes details of their particular health needs, including registration with a GP, dentist, regular health and dental checks, advice on sexual health, mental health and emotional wellbeing and access to any mental health services required.

b) NHS Scotland will scope the role and develop a competency framework for nurses of looked after children and young people.

c) In partnership with NHS Scotland, Learning and Teaching Scotland will develop supports to ensure high quality sex and relationship education and drugs education.

Action 16:
We have agreed with the Care Commission that they will review the health of looked after children and young people.

Next Steps required:

a) As part of their cycle of inspection, and taking account of the relevant National Care Standards published by Scottish Ministers, the Care Commission plan to look at nutritional standards and physical and mental wellbeing with a view to reporting on these by the end of 2007 and mid 2008, respectively.