Engaging Children and Young People to Improve Their Outcomes

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Engaging Children and Young People to Improve
Their Outcomes

• The Oxfordshire Story

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Do I contradict myself? Very well then, I
contradict myself. I am large, I contain
multitudes.Walt Whitman.
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Contents

• Starting points
• What we knew
• What we are learning
• Oxfordshire projects
• Ending points - impact on performance

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Starting Points

• No Leaving Care service
• Huge budget pressures
• Disaffected/frightened users
• Appalling outcomes
• Lack of choice of placements
• Difficulties in providing respite
• High Numbers in residential care
• Fire fighting
• Wanting to listen and work with CYPF

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What we KnewChances of Becoming Looked After

• 2-parent family
• More rooms than people
• Employed
• White UK
• Mother 21 at birth of first child
• Fewer than 4 children
• Odds 1 in 7000

• Single parent
• More people than rooms
• Reliant on Benefits
• Dual Heritage
• Young Mother lt21 at birth of first child
• More than 4 children
• Odds 1 in 10

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What We Knew
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What We Knew About Keeping CYP Safe

• Secure attachments and relationships
• Good care
• High warmth, low-criticism parenting
• Support when we need it, where we need it
• Consistent relationships between professionals
  and families

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What We Knew About Keeping CYP Safe

• Housing
• We know quite a lot about protective factors for
  successful housing
• EET
• We know significantly less about factors, other
  than housing, impacting on EET post 16

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What We Are Learning

• The effect of chronic stress and negative
  stimulation on babies brain development
• Too much cortisol is a bad thing
• Resilience in children and young people where it
  comes from, how it helps
• Families, rather than professionals, protect
  their children
• Families, rather than professionals, make the
  best decisions for their children
• Tightly controlled interventions with a clear
  rationale have better outcomes.
• The younger the child the better the outcome

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Source Worker Project

• Gives young people who have been in care a chance
  to have a voice - talk to us and it is our
  chance to listen to young people and talk to
  them
• Introduces childrens rights, consultation and
  the work that source workers will be asked to do
  for Children Young People and Families and other
  organisations
• Source Workers learn about Oxfordshire County
  Council, its structure, laws, what do we do and
  why

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Source Worker Project

• Training gives young people confidence, knowledge
  and skills to undertake consultation work, as
  well as skills for life. Source workers discuss
  issues with other young people and decision
  makers,challenge childrens rights and help
  implement CYPP
• The overall goal is to improve the life chances
  and opportunities of children and young people in
  the care system

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Source Worker Project

• Source Workers are accredited with AQAs for
  completing the training
• Source Workers receive certificates, signed by
  the Director and Head of Service, on successful
  completion of each Stage of the training, which
  outlines what they have achieved.

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Projects in Oxfordshire

• PCAMHS
• OXPiP
• Parents in Partnership Project
• Baby massage
• Parentline Plus
• Share Project
• - Aimed at training carers to know the
  importance of reading to children
• Adoption buddies based on Webster Stratton

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Projects in Oxfordshire

• Family Placement Support
• A range of services, including ATTACH, founded on
  family based decision making, aiming to prevent
  family and placement breakdown, with
  rehabilitation of children with family as soon as
  possible.

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Projects in Oxfordshire

• Family Placement Support Components
• Outreach offering practical support/relief
• Brief solution therapy
• Intensive adolescent support
• Services to address attachment difficulties
• Case consultations
• Learning mentors
• Restorative Justice

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Leisure Projects

• Out of School Activities
• Arts and drama projects
• Outward bound projects
• Linking learning with a fun activity
• Holidays

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Leisure Projects

• HILL END
• Every year 80 young people get together
• to create a show which incorporates
• music, drama, dance, art and media.
• Performed in a big top to an audience
• of parents, carers, siblings, officials and
• children and young people in care.

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Hill EndCreating the music for the performance
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Hill End - Robot
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Feedback from CYP

• Life changing experiences
• Meeting people, having fun
• Meeting people in similar circumstances
• Chance to express ourselves
• All decisions from planning to acting are made by
  CYP

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Diversion

• CLA Offending 9.7 times more than peers
• Restorative Justice training
• Diversion offered by Police and CPS
• YOT/Social Care Protocols
• Social Care/Police Protocols
• Liaison meetings around the Homes
• Mentor schemes
• Share Police/YOT databases
• Individually negotiated packages

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DBT

• A broad-based cognitive behavioural therapy for
  individuals with Borderline Personality Disorder
  (BPD) to treat chronic parasuicidal/ suicidal
  problems (Linehan, 1993).
• Based upon a biosocial and dialectical theory of
  personality functioning.
• Blends CBT with meditation practices, and
  elements of psychodynamic, client-centred,
  Gestalt, paradoxical, and strategic approaches.

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Why DBT for CLA?

• There is a higher incidence of mental health
  problems in CLA
• There is a higher rate of Attachment Disorder in
  CLA
• Insecure attachment is a vulnerability factor for
  developing mental health problems, including BPD
• A proportion of CLA who in high risk self harming
  behaviours, which is a trait of BPD/

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Attachment and BPD

• CLA have experienced severe levels of abuse/
  neglect usually over a significant period of
  time.
• Abuse (including sexual abuse) and neglect are
  the biggest risk factors for developing insecure
  attachments.
• Insecure attachment, and more specifically
  disorganised attachment (highly correlated with
  abuse and neglect) seen as fundamental part of
  the aetiology of BPD (Fonagy 1997).

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Case Study 1

• Sarah, 15 yrs, referred while in a secure unit.
• History of severe self harm (cutting, overdose,
  ligature tying), drug/alcohol misuse, low mood,
  suicidal ideation, absconding with men she does
  not know, sexual assault, forensic history
• Family history of domestic violence, alcohol
  addiction and mental health problems. Difficult
  relationship with SHC and health services.

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Case study 1 - cont

• The CLA DBT service provided
• Weekly individual therapy at the secure unit
• Weekly skills training sessions at the secure
  unit
• Regular consultation to the secure unit staff
• Telephone support to the client and staff
• Consultation to the social worker
• Input into care/secure review and placement
  planning
• Supported and attended regular professionals
  meetings

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Case study 1 - cont

• Outcomes
• Significant reduction in frequency and severity
  of cutting from daily to very occasional (twice
  in 3 months)
• A cessation of overdosing and ligature tying
• Has moved out of secure unit and managed
  transition into the community
• Living in a stable placement in the community and
  accessing appropriate support from the Leaving
  Care team

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The Reach Up Team

• Multi-disciplinary team
• Supporting school age Children Looked After to
  achieve
• Includes
• Case conferencing for CLA in Primary and
  Secondary schools
• Learning mentors providing one-to-one additional
  support to CLA in years 10 and 11
• PEP monitoring

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Achievements

• The Reach Up team learning mentors - raising
  attainment at GCSE in year 11
• 1 A-G 32 in 2003 to 78 in 2006
• 5 A-G 18 in 2003 to 51 in 2006
• Increased progression to FE by young people
  previously identified as at high risk of becoming
  NEET on finishing compulsory schooling.

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RAISE

• 15 employment, education and training support
  team, working alongside Leaving Care Team
• Supports young people and LCPAs with EET issues
• Targets young people from year 11 upwards
• Delivers group and 1-1 work
• Accreditation of both group and 1-1 work through
  AQA.

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Achievements

• A4 component of the OC3 figure up
• Flexible, accessible accredited learning,
  including for young parents, through AQA
• Group work offering focused, tailored on-going
  sessions around work and learning.

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Performance of Care Leavers at 19
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CLA Education Performance

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Numbers of CLA 0ffending

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Issues, Challenges, Next Steps

• Do more of what works extend preventative
  services for LAC to children and young people on
  the edge and vice versa
• Ensure these groups are everyones responsibility
  and priority, across all the agencies
• Build on values and principles
• Embed family-based decision-making.

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Summary and Conclusion

• Incremental no year zero
• Improvise
• Involve users
• Intractability