Why is this needed?
Adoptive families often require support from a range of professionals who are employed and managed by different agencies; e.g.
Safeguarding, ‘edge of care’ and LAC services – RAA/LA
CAMHs professionals - Health Trusts
Education support services/virtual schools/educational psychology – LAs
Therapeutic providers from VAAs and third sector providers
National Minimum Standards (NMS) state:
5.4 Children have prompt access to doctors and other health professionals, including specialist services (in conjunction with the responsible authority), when they need these services.
7.3 Children are helped by their prospective adopters to achieve their educational or training goals and prospective adopters are supported to work with the child’s education provider to maximise each child’s achievements and to minimise any underachievement.
7.4 The placing agency has, and is fully implementing, a written education policy that promotes and values children’s education.
15.5. The Adoption Support Services Adviser assists prospective adopters and adoptees through liaison with education and health services; across local authority boundaries and between departments within the local authority.
Adopters often describe the difficulties of navigating their way through different services based in different agencies with multiple assessment processes and eligibility criteria:
An overriding feature of my family's battle with the system is that the three arms of the state needed to support our adopted child, health, education and social care departments do not join up. Each service has its own panel which considers only that service's resources and scope. Parents frequently find they have to coordinate these three essential arms of state services. Parents also frequently find they are faced with services that will not engage because other services are also in the conversation. This often results in no service engaging to support children who deserve the state's full attention. Our child needs coordinated help from all three departments: health, education and social services.
Generally, our feeling was there was no clear-cut route into mental health services provision for adopted children and that we, as adopters, are expected to do our own research in order to find how to access such services. It is not straightforward, and neither are our children.
(quote from an adopter)
Adoption Counts Adopter Advisory Board Report 2018 (unpublished)
Presence of diagnosable conditions – Selwyn et al (2014 p10f) identified the high prevalence of diagnosable conditions (including ADHD, PTSD, ASD, FASD) in children who had left the adopted home or where the family situation was ‘challenging’. Neil et al’s (2018) study in Yorkshire and Humber identified that 28% of children had received a diagnosis of, or treatment for, some type of mental health, emotional or behavioural issue.
Schools and Education Services – An AdoptionUK survey (AdoptionUK 2017) revealed that:
- Nearly half of all adopted children represented in the survey have a recognised SEND/ASN
- 60% of the adopted children with SEND have an EHCP plan or equivalent compared to figures for England showing that just over 20% of all children with SEND have an EHCP, suggesting that adopted children have comparatively more high-level support needs
- 23% of children had received a fixed period exclusion and 14.5% of these had been excluded more than ten times in their school career
- The children in the survey were permanently excluded at a rate just over 20 times that of the general pupil population
Examples of Multi-disciplinary services – including social workers, clinical and educational psychologists
Building on previous work in Manchester CC (with After Adoption) and Salford CC, Adoption Counts has commissioned Manchester Foundation Trust and One Education to deliver an Adoption Psychology Service working closely with adoption support social workers. Key elements of the service include:
Access to a range of services (including Educational and Clinical Psychology and a Child Psychiatrist) via the one front door and a common assessment process
Provision of training to adopters
Joint working between Social Workers, Psychologists and a Psychiatrist – including regular consultation, advice and guidance
Assessment for conditions such as ADHD, FASD, ASD etc and intervention within an adoption context
Clinical Supervision for Therapeutic Social Workers
Staff training and development
Development of new jointly delivered group work programmes
Input to family finding and matching processes (including the Adoption Support Plan)
Greater access to core CAMHS or Educational Support services when necessary
A feature of the service is that the Education and Clinical Psychologist are commissioned to work as a team. The specification for this service is attached as appendix two. Work is underway to add an Occupational Therapist to this team to undertake sensory integration assessments and therapy.
Families for Children, a Voluntary Adoption Agency in the South West, provide multi-disciplinary adoption support assessments designed to provide a holistic understanding of the child’s needs in the following areas:
- The impact of developmental trauma and how this affects family dynamics
- The sensory processing and integration skills and abilities
- Attachment profile and strategies
- Cognitive and executive functioning
- Understanding of functioning at school and in other environments
The assessment includes analysis of developmental trauma issues by a Clinical Psychologist, Therapeutic Social Worker and Senior Occupational Therapist and other professionals as appropriate.
Birmingham CT delivers a similar service but using a different model. The local authority directly employs Clinical Psychologists as part of its adoption support service rather than contracting with the Health Trust. The service aims to provide (and support the facilitation of) highly specialist support to meet the often complex or multi-faceted psychological health and well-being needs of adopted children, young people and families as well as providing systemic support to professionals and systems/teams involved in their care. The service provides individual, family and group-based therapy, advice, consultation, teaching, training, and clinical supervision. See overview at appendix three.
Oxfordshire County Council’s ATTACH (Attaining Therapeutic Attachments for Children) team work with children and young people who are having difficulties related to the impact of not living with their birth parents. The team offers specialist therapeutic interventions suited to the needs of adoptive families. The service is managed, and the staff employed by Oxfordshire CC, but it also delivers a service to adoptive families from across the Adopt Thames Valley region.
In 2014, Kent County Council set up an integrated, multi-disciplinary adoption support service in partnership with Coram. The service gives priority to adopted children. At its core is a psychological, trauma-informed approach to adoption: not just post adoption support and a commitment to share learning across disciplines. It is an attachment, regulation and competency developmental model.
The AdCAMHS service started in 2014 in East Sussex. It is a psychoanalytically informed service that involves social care and mental health professionals working together to provide therapeutic support for adoptive families. All new cases referred to AdCAMHS are assessed for post-adoption support needs through the post-adoption support service. A post adoption support worker is usually the main contact for liaising with the family, closely supported by a clinician. An initial consultation is offered and then the family is referred to a clinician internally, or an application is made to the ASGSF for funds to commission a preferred private provider.
Examples of joint working with education services:
OAWY has reached an agreement with their five virtual schools Head Teachers to deliver their new statutory duty to provide advice and guidance to adopted children. Amongst other responsibilities, the role will:
Support the ‘triage’ of queries from adopters during their journey to adoption and post-adoption, including sign-posting to other services
Develop a direct working relationship with each individual Virtual School, including time spent working in each Virtual School location to build a ‘knowledge base’ to support advice and guidance
Co-ordinate an expert, consistent CPD offer to adoption social workers and adoption support services in OAWY that is supported by each virtual school
Support the development of a resource pack/guide on child development, learning and education for adopters & special guardians
Deliver an annual CPD presentation/workshop to designated teachers in each individual Virtual School to promote attachment awareness
AdoptionUK, in partnership with Hertfordshire, has developed a new pilot service for families who need advice and guidance on the education of their children. The service will accompany parents to meetings with their child’s school and help to develop support and transition plans.
Example of joint working with Occupational Therapists to deliver a service to promote sensorimotor integration
OAWY has engaged an occupational therapist working with the service to build understanding of the BUSS model: Building Underdeveloped Sensorimotor Systems in Children who have experienced Developmental Trauma. The model focuses on building bodily regulation within a nurturing relationship as a foundation to emotional regulation. The occupational therapist has trained workers in the underlying principle of the BUSS model and has trained a number of OAWY adoption support workers and schools in each geographical area in screening children and families for this intervention.
Possible future developments
It is rare to find multi-agency services which are multi-agency funded. Local authority or grant funding is generally being used by RAAs to buy-in mental health, education support and other services. A joint commissioning approach between LA, Health and perhaps schools, would be a step towards a more sustainable model.
The Greater Manchester Health and Social Care Partnership has developed a set of “Therapeutic/ Support Standards for Looked After Children”, together with an audit tool, for the delivery of services to looked after children. This is currently being adapted to provide a set of standards specific to adopted children and their families.
The NHS 10 Year Plan (chapter 3), building on the Green Paper, Transforming Children and Young People’s Mental Health Provision, should signal a significant change in the working relationships between schools and mental health services, with recognition of the needs of looked after and previously looked after children.
Adopting a multi-agency approach to adoption support by engaging with health and educational services (let alone schools) with competing priorities and limited capacity, across more than one local authority, is challenging and time consuming for RAAs. A joint approach to governance and service planning is key to making this work (See section 3).