CARING FOR BETTER HEALTH - Care Leavers
CARING FOR BETTERHEALTH: An investigation into thehealth needs of care leaversBy Jakeb Braden, Dr Jim Goddard andDavid GrahamThe Care Leavers’ Association
Copyright of The Care Leavers’ Association December 2017
This report is the culmination of a 3 year project conducted byThe Care Leavers Association and funded by the Department ofHealth Voluntary Sector Investment Programme.The Care Leavers Association is a national user-led charityworking to improve the lives of care leavers of all ages. We takethe voice and experiences of care leavers and use this toimprove policy and practice and to better able organisations tosupport care leavers with a wide range of issues.The project team consisted of Jakeb Braden and David Grahamwith data analysis conducted by Carla Cordner. Dr Jim Goddardalso contributed, alongside the team, to the final written report.The project team would like to thank all of the participants fromthe following Clinical Commissioning Groups who took part atvarious points over the 3 years: Tameside, South Tees, Corby,Bedfordshire, Thanet, Surrey, Waltham Forest,Westminster, Sutton and Merton.We would like to thank all the care leavers who attended andparticipated in the health forums. Your honesty and insightshelped produce a number of project resources.And last but not least we would to thank all the care leavers whotook part in the health survey. Thank you for sharing all yourexperiences, no matter how painful they may have been.As well as this report, we will work to ensure that your voices areheard loud and clear and it leads to real change in the world.2
Table of ContentsExecutive Summary 4Section Two: Introduction and Objectives 8Section Three: Methodology 11Section Four: Adult Care Leaver Survey 13Section Five: Forums 26Section Six: Professionals Survey 30Section Seven: Seminars with Professionals 34Section Eight :Cradle to Grave: Discussion 37Section Nine: Recommendations 41Section Ten: Final Thoughts 44References 45When asked aboutexperiencing low self-esteemduring care 87% (312) saidthey had. 83% (295) said theyexperienced this after leavingcare3
Executive SummaryThe health and wellbeing needs of careleavers of all ages are largely ignored.Research tells us that looked afterchildren are far more likely to experiencenegative mental health and physical healthissues than their non-care peers. Yet whenthat child in care becomes a care leaver,and the care leaver becomes an adult, anysupport that did exist stops. Servicesbecome tapered. Access criteria rise.Waiting lists go up. Its as if the stateapparatus conveniently forgets everythingthat went on in the young persons lifebefore and during care. A key conclusionfrom this project is that we must stoplooking at the care system in silos andinstead focus on the journey of a whole lifeand how everything joins and fits together.We must think about the experiences ofadult care leavers and work out how toprevent them earlier in childhood. Its notrocket science. But it requires effort andcommitment.This report attempts to address theproblems that arise from this act ofcollective amnesia. It is a summary of workcarried out by The Care Leavers Association, with funding from the UK Departmentof Health, during the period 2014-2017. Wesought the views of both care leavers andprofessionals on how health services canbe improved to better meet the needs ofcare leavers of all ages. In stretching ourfocus across the life – well beyond the usualfocus on care leavers between the ages of16 and 25 - we offer unique insights into thelong-term consequences of the relativeneglect of health care issues for this group.We aimed to work closely with ten CCGs bysetting up local working groups to explorecare leaver health needs in each area. Weended up working with more than ten CCGs,some for the full period of the project andothers for less. The working groups alsoprovided us with support in relation to otherstages of the project and helped us to placeour recommendations within a healthcommissioning context.During the project, we developed the mostcomprehensive survey of its kind of thehealth needs of care leavers. This wascompleted by 418 care leavers of all ages.This report highlights some of our keyinitial findings and conclusions and morecomprehensive treatment of the data willbe released after further analysis. The highnumbers in our survey who experienced lowself-esteem, anxiety, depression andisolation are consistent with otherresearch on care leavers and highlight theprominence of mental health issues in ourfindings. The continuation of theseexperiences over several decades, in somecases, highlights the importance of43
addressing the causal factors as early aspossible. In some cases, if young careleaver adults are given the skills, strategiesand support to deal with mental distress itcould significantly enhance their later lives.1. The health needs of looked afterchildren and care leavers to be a distinctsection in the Joint Strategic NeedsAssessment (JSNA). This should, ifpossible be extended to adults aged 25 We also listened to care leavers directlythrough our health forums and toprofessionals currently working in the fieldthrough our health seminars. Through bothof these routes, some key themes arose.Both younger and older care leavers spokerepeated about the debilitating effects offeeling isolated from others and havinglimited social connections within thecommunity. Transition periods were alsohighlighted as important, stages where anindividual is more vulnerable but mayreceive less or insufficient support.Problems with accessing mental healthservices were also raised several times,with services either having too high accesscriteria or not able to adequately supportcare leavers. There was a broad senseamongst care leavers we spoke to that thehealth care system took inadequateaccount of the lifelong effects of traumathat is a frequent legacy of a child’s journeyinto and through the care system. Supportfor adult care leavers in their thirties andbeyond, for example, remains limited.2. Each CCG area to conduct formalassessment of health needs of lookedafterchildren and care leaversThe combined findings of the researchtechniques deployed by this project has ledto a number of recommendations designedto improve the commissioning process andimprove health outcomes for care leavers:3. Commissioning of all mainstream healthservices to include targets forimproving health outcomes for childrenin care and care leavers.4. Commission a range of mental healthand wellbeing services, from low level topsychiatric, that specifically supportlooked after children and care leavers.5. Ensure that care leaver health needs areidentified in broader commissioningprocesses.6. That a young person in care has acomprehensive health assessment atentry into care which is then monitoredand updated on a regular basis7. Health assessments should focus onmental health and wellbeing as well asphysical health.8. All local authorities to appoint a MentalHealth and Wellbeing lead9. Implement a protocol to supportplacement stability4
10. Improved training for all staff (socialworkers, foster carers, residentialworkers) to better respond to a youngpersons needs not their behaviour.11. All social care professionals to havetraining on attachment and traumatheory.12. Deliver a range of emotionalwellbeing and self-developmentinterventions to young people13. Increase the availability oftherapeutic placements.14. Reduce waiting times and increaseopportunities to access mental healthintervention for looked after children andcare leavers15. All care leavers 18-25 to receive ahealth assessment as part of thepathway plan16. Care leavers to be given prioritystatus in relation to accessing healthservices17. At 18 services continue and anyyoung person in care is being treatedwith a stage not age approach sowhether 17 or 20 they access the sameservice with the same access criteria.18. Increase the status of the PA role andprovide improved training and support toall PA’s19. All local authorities to have amentoring/coaching/befriending servicefor care leavers20. Increase the statutory requirement toprovide accommodation for care leaversto 2521. All care leavers to be provided withfree access to health records alongsidetheir social care file22. Implement guidance on care leaverinvolvement and participation in thedesign and delivery of services23. Deliver a range of emotionalwellbeing and self-developmentinterventions to young people24. The health of adult care leavers (25 )to be recognised as a specific area offocus for mainstream health services.25. All health services and professionalsneed to have an understanding of thecare experience and how it can affect apersons health at any stage in life.26. Develop guidance and support forhealth services in relation to workingwith adult care leavers.27. Improved training on mental healthneeds and ACE’s research for frontlinehealth professionals28. Increase access to IAPT services foradult care leavers.5
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29. Fast track access to talking therapiesfor care leavers30. All CCG’s to appoint a champion forthe health needs of care leavers (of allages)31. Commission a range of health andwellbeing support services for careleavers including emotional wellbeing,self-development interventions andmentoring/befriending32. Commission services widely toreduce isolationThere is much work to be done. Listening to some of the experiences from careleavers was extremely harrowing. Yet it was also inspiring to see the amount of peopleprepared to be courageous and attempt to make a difference to their own lives, nomatter how challenging. Sometimes even though the system is well meaning it can domore harm. We must take stock and reverse this situation. We need to ensure that we viewthe path into, through and after care as a life journey and build our responses to meetneeds throughout this life journey. All policy makers and practionners must have abetter understanding of the experiences of young people in care and care leavers. Wemust respond positively to what is really happening in the daily lives of care leavers.Service commissioning needs to be needs led, but it also must provide the best outcomesfor care leavers. Historically this has not happened well enough. The health sector and thesocial care sector must get better at working together and developing joint initiatives thatnot only focus on care leavers health and wellbeing but provide positive, loving andnurturing opportunities.We want thriving, not just surviving.7
Section Two: Introduction and ObjectivesYoung people leaving care constitute one ofthe most vulnerable groups in our society.However, outcomes for care leavers remainmuch worse than for their counterparts inthe general population (H.M. Government,2016: 6)A quote from the UK government’s careleaver strategy from 2016 considers theneed to improve health care support inrelation to both physical and mental health,acknowledging that care leavers face adisproportionate range of challenges andissues in both areas. However, thegovernment’s approach is based on alimited understanding of the health issuesthat care leavers face and is only focussedon care leavers up to the age of 25. Thisreport remedies those twin deficits by beingthe largest-ever investigation of the healthneeds and experiences of care leavers ofall ages.The vision of The Care LeaversAssociation is the achievement of ‘A goodlife in care and a good life after care’ for allwho go through the child care system. Weare unique in being run by, and focussed onthe needs and experiences of, care leaversof all ages. We recognise that many issuesfaced by care leavers, including physicaland mental health, stretch across the lifecourse and are best understood within thatwider framework. This research reportreflects that understanding.BackgroundThere is a relative lack of research on thehealth outcomes of care leavers,especially of those over the age of 25.There is more research into the health oflooked after children and in particular theirmental health. An influential studyconducted by Meltzer and colleagues(2003) suggested that 45% of the lookedafter population could be diagnosed withat least one psychiatric diagnosis, rising to72% for those inresidential care, incomparison to around ten percent of theoverall population of young people(Meltzer et al., 2000). It is safe to assumethat a number of those looked after childrenwill continue to experience mental healthissues as care leavers.Indeed there is research to show that asignificant number of care leaverscontinue to experience mental healthdifficulties, such as depression, long afterleaving the care system (her use ofnational child development data stretchedup to age 33) and to a higher degree thanother disadvantaged groups (Buchanan,1999). The most recent study into themental health needs of care leavers, areview by Barnardo’s of 274 of their careleaver case files, showed high numbers(46%) with mental health needs (Smith,2017). The Barnardo’s report highlightsissues with drugs, alcohol, self-harm andpost-traumatic stress disorder and itemphasises the findings of several previous8
studies (Lynes and Goddard, 1995;Richardson and Joughin, 2000; Broad,2005; Goddard and Barrett, 2007). In short,we already know a great deal about thehealth problems that looked after childrenand young care leavers face.Less well known is research on thelong-term health experiences of adult careleavers. In truth, there is far less of suchresearch Aside from Buchanan’s (1996)and recent studies of the long-term effectson survivors of abuse in the care system(e.g. Penglase, 2007). Those which haveappeared have focussed on general issuesor specific areas of the lives of care leaversthat are either tangentially or unrelated tohealth issues (e.g. Murray, 2015).However, research more broadly on thesurvival of childhood trauma has obviousrelevance to adult care leavers and suchresearch
health care system took inadequate account of the lifelong effects of trauma that is a frequent legacy of a child’s journey into and through the care system. Support for adult care leavers in their thirties and beyond, for example, remains limited. The combined findings of the research techniques deployed by this project has led to a number of recommendations designed to improve the .
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