NCERCC received a reply regarding concerns raised re Reset DOLS alternative
On the 30th January Community Care published online an article
NCERCC raised numerous concerns in the Comments section that followed. Numerous children’s social care leaders have contacted NCERCC in support and encouraging us to post the comments to the NCERCC website.
Please find below the text of the NCERCC posting containing the many concerns.
At a conference at the weekend just passed a highly respected ex-Director of a proper Therapeutic Community of old, it no longer exists, mused on his moving to a community and family-based service for children. He came with long experience and high degree of knowledge and practice in working with children with high level need and managing the organisations that can help. He needed all of those hard-won assets.
He had wanted to see if the TC practice could be translated to a different setting. Modestly, but resonantly, he observed the task should not be underestimated.
So, let’s look at what is being promoted here by Reset.
New organisation – ambition is one thing, but it is widely accepted that knowledge and expertise is essential. Many think they have them and then find they do not when the pressure of the psycho-social needs of the children is felt. Let’s be clear the children who require this type of setting have high level, multiple, co-occurring needs. The response has to be intensive, multidisciplinary, supported. It then has to be enhanced by experience. It cannot be that a new organisation can do this work at the get go. It takes time to create the required therapeutic environment; it is only after 5 years that it starts working optimally and this after many travails. Seven years and the therapeutic culture is embedded, truly a felt security and felt safety.
What are the complex needs? These are stated well in the work of the Nuffield Family Justice Observatory report Children deprived of their liberty: An analysis of the first two months of applications to the national deprivation of liberty court – Nuffield Family Justice Observatory (nuffieldfjo.org.uk) See Figure 10 page 27 ( see also re instability, length of time in care, early life adversity, multiplicity and complexity of needs, co-occurring). The list Reset provide is too slim compared to the NFJO.
Dedicated practitioners – it takes a lot for well supported person and group to remain resilient and unconditional when facing intense psycho-social pressures. Experience informs us that it takes a group of dedicated, even resolute, highly skilled people. These people are, now, in short supply and are probably working in therapeutic settings already. So, the task would be to develop such people and teams. This is a long job. The current qualification and much of the workforce development offer does not meet the needs of these children.
Reduce harm – ‘harm’ needs defining by Reset.
Improve stability – the children will probably have a history of instability throughout their lives. Their early years may have included unpredictable parenting. This has affected their inner world and their interaction with the external world. They may have had numerous care placements as children’s services use residential care hierarchically and serially, a child has to epxer4eince breakdown to be referred ‘upwards’. For decades we have been arguing for the right place first time. We still do not have them. The reason for rise in ‘solo places’, which is what these will be, is the loss of the therapeutic knowledge and skills necessary to meet the needs of the children. We do not have the ability to work with either the deep needs or the group dynamics. We have ‘forgotten’ how to do it. It has to be rediscovered. Reset does not appear to be engaging in this work rather it works to erase it further.
Another word on stability, there is a need to appreciate that such work is always in the area of uncertainty. See the work of Mason (1993) Safe Uncertainty. Look at the Organisational Operating Domains, and reflect.
An “alternative to containment” – this is to colonise the concept of emotional by putting it within physical containment. Children with high level needs require emotional containment. They need emotionally holding environments. These concepts need to be understood and not lost to by any redefinition.
18 months of intensive support – good. We are getting way from short term ‘stabilisation’ then moving out to the wheel of instability again adding further to the needs and insecurity until reaching the age of 18 when responsibility is handed on. The pace of recovery, or more often of starting emotional growth and learning, takes its own time. It used to be understood that it takes one year for each year of unsettlement. Each child has their own pace, it is a question of emotional growth, not the demands of a ‘treatment’ programme. The needs are more than trauma.
Short termism and its origins (see above) will always deliver ‘poor outcomes at high cost to the state’ as they are predicated on numbers of ‘staff’ rather than meeting needs.
Promote self-confidence – this will come with the self-confidence of the primary carers being absorbed by the child from the environment they are living in. First the child will need to establish dependency on the primary carers. On this interdependence and independence will follow. It is emotional security that precedes educational advancement, achievement, and attainment.
Relationships – are key. They will be tested severely as children need certainty that this time will be different.
An evidenced by experience model of care, tested over years, is essential – note Reset is ‘based on the hypothesis that the Breaking Cycles model could work with this cohort of children’.
Cost – this work should not be led by a balance sheet but by a needs assessment. Another factor in the rise of solo placements is that social work assessments rarely capture the needs to such children. Effective care will bring efficient spending. The inclusion of savings is a worrying feature; such predictions are alluring but even a few children not completing the programme will affect the projections. This has been seen time and again. What are the projections if only 1/3rd complete? This is a routine figure observable in other such experiments over the years. What are the costings when the other 2/3rds are factored in? The costings also require the selection of young people to ensure the needs can be met, required for Ofsted registration and inspection. It must be children’s homes registration required, no exceptions or exemptions. Who will be assessing to ensure matching is maximised? What are the costs of the children who ‘do not fit’?
There is a worrying number of aspirational aspects – e.g. ‘believed its approach would provide much greater stability for children’. Predicted ‘the model would reduce the numbers of missing episodes and boost educational outcomes for the young people’.
‘Enabling them to live safely with their birth parents, with foster or adoptive parents, or in more suitable – and lower-cost – residential settings’. If this were possible it would already be happening.
It is worrying that an unevidenced, untried, uncosted experiment is being included in the South East regional care co-operative.
It is agreed that change is desperately needed and we need to ‘embrace nuance, create aspiration and hope’.
But is this the change needed or long-term recovery of the knowledge and skills in truly therapeutic psycho-social group care? (see Royal College of Psychiatrists Standards for Therapeutic Child Care).
Kind regards
Jonathan Stanley
Principal partner NCERCC
On 12 02 26 NCERCC received a reply from DfE as follows
Thank you for your email.
Reset is an independent model developed by Purposeful Ventures and is not a government programme. Local authorities are responsible for ensuring that any provision they commission is safe and capable of meeting the complex needs of the children they place. Our focus remains on ensuring that children receive high quality care in settings that meet statutory standards
We recognise the significant and multi-layered needs of children who are at risk of deprivation of liberty. That is why government reforms prioritise increasing specialist capacity, strengthening multiagency practice, and investing in high quality residential and foster provision, with £560m to expand children’s homes places including for those with the most complex needs.
Department for Education and NHS England have a joint programme of work, including legislative changes and capital investment, which is focused on improving the outcomes for children in complex situations.
Progress includes:
We are building the evidence base, having recently published research which explores how children’s needs escalate as well as different interventions and their impact on children’s outcomes.
- West Sussex, part of the South East Regional Care Cooperative, is working closely with the ICB to test how a cross-system team can drive integrated support, build an understanding of need, including through an assessment of need tool, and identify gaps in the current pathways across health, social care and justice for the most vulnerable cohort of children.
- In addition, we are investing in a Community of Practice and supporting portal for local authorities, providers, charities, health practitioners, academics and other professionals to improve cross-sector support for children in complex situations with multiple needs. This is being delivered by the Anna Freud Centre/UK Trauma Council and the voices of children, parents and carers will be a vital part of the community.
- Following this testing and evidence building phase, we will pilot an integrated intervention model that includes a cross-system team and shared assessment of need approach to support those caring for this cohort of children, better meet their needs and improve their outcomes.
This work is focused on maintaining community links for children, through join up between health, social care, youth justice and education.
Children with the most complex needs can often be involved with multiple services across local authorities, health and justice. For example, the same child might move between mental health provision, secure provision and a local authority children’s home with their needs considered differently each time – but the child’s needs won’t necessarily have changed.
We want RCCs to work across children’s social care services, health services and youth justice services so that they can join up better.
- For example, health and CSC could jointly commission services for certain groups of children, such as children with complex health needs and disabilities, as recommended by the national Child Safeguarding Practice Review Panel.
- Similarly, we’ve made it a requirement that regional data analysis and forecasting the need for homes for children should involve health and youth justice partners.
HMG collectively are piloting an approach which we hope will start to make the much needed system change so children with living with underlying trauma receive a consistent, joined up and therapeutically informed support, no matter which part of the system they encounter.
Kind regards
