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Wed, 06 Jul 22 11:59

Therapeutic Communities

What is care for and what should it look like? The answer, of course, is different for each child or young person, built around and responsive to their individual needs. However, there are a few basic principles that I think we can all agree on.

Care should protect children from harm and improve their experiences and outcomes. More than that, care should be caring and loving, and it should foster the development of positive and meaningful relationships between children and the carers and professionals in their lives as well as the families from which they come. This is not an exhaustive list.

Children and young people are coming to our attention with more complex and multiple needs (ADCS Safeguarding Pressures Phase 7). Directors of children’s services are especially concerned about growing difficulties in accessing the right help and support for a small but extremely vulnerable cohort of children and young people with the most complex and overlapping health and social care needs, who find themselves on the edge of the criminal justice or care systems and/or on the brink of hospitalisation.

A particular issue for us is access to CAMHS for children and young people who require inpatient services. Due to the extremely limited availability of Tier 4 CAMHS beds there can be long delays before children receive the mental health support and therapeutic intervention they need. When a bed is found it is likely to be many miles away from anything familiar or important to them, such as their friends, family and community.

The needs of these young people are severe. They can often present a huge risk to themselves, and sometimes others too. When placements are needed, they are often needed urgently and at very short notice, but a placement in a secure children’s home (SCH) is often the only option and there are issues here too. It can take days or even weeks to find a placement in a SCH, regardless of the severity of the situation. While staff in SCH’s can keep children safe they aren’t mental health professionals and can’t provide the treatment these young people need. Research commissioned by DfE exploring local authority use of secure placements found whilst providers may claim to provide therapeutic services, when this ‘offer’ is interrogated, it can mean many different things across a vast spectrum. There is no clear definition or set of standards for a placement which provides ‘therapeutic’ care and there is, therefore, a gap in provision.

A wholly new approach and therapeutic offering is required to respond to the needs of these children with acute needs and that these low incidence but high cost placements are best viewed, coordinated and commissioned in partnership whether the child’s primary presenting need is justice, welfare or mental health related. A range of appropriate step-down arrangements including therapeutic support provided in the community are also required to ensure we can support young people to successfully reintegrate into the community when they are ready to.

Meeting the needs of this very vulnerable cohort of young people must be a key focus for the Care Review, and for the SEND Review.

Charlotte Ramsden, ADCS President 2021/22

This column first appeared in CYP Now magazine

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