Faculty for Children, Young People

& their Families

Psychological services for

children, young people and
families with complex social
care needs including looked
after children

www.bps.org.uk/dcp
Background
Children living in care – also called looked after children – are at significant
risk for lifelong difficulties in a range of areas and are over-represented in poor
outcome groups.
Research has found that circumstances such as childhood abuse, neglect
and dysfunctional family environments can change the whole path of
neurological development in children and make it harder for children to
develop healthy attachment relationships with appropriate adults. Such
attachment difficulties have been shown to lead to:
■■ anxiety,
■■ depression,
■■ behaviour problems,
■■ aggression and
■■ difficulties managing emotions.
Research has shown that at least half of all looked after children have
significant mental health problems and are more likely to have suffered
physical, sexual or emotional abuse or neglect than other children. They are
also more likely to:
■■ have special educational needs,
■■ be excluded from school or leave
school with no qualifications,
■■ to get in trouble with the law,
■■ go to prison,
■■ be involved in drug use and
■■ become homeless.
It is therefore essential that high quality
psychological services are provided for
children in public care to reduce the
risk of such negative impacts and
enable them to have the same life
chances as other children.

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 The organisations working with these
children and young people include Local
Authority Social Care departments, which
have a statutory responsibility to protect
children. They work with some families
requiring support where children are ‘in
need’.
Sometimes a multi-agency group including
social care, education and health (typically
primary care professionals) is gathered to
form a Common Assessment Framework
(CAF) plan to address their needs. Where
children have been harmed, or are at high
risk of significant harm, a child protection plan may be drawn up to protect
them. Often, emotional abuse or neglect of children has been ongoing for
significant periods of time before a threshold is reached that leads to action. If
the professional network needs to take immediate action to safeguard a child
or children, or if it has not been possible to work with a family to make the
child safe, then they might be removed to a placement with alternative carers.
This can take several forms:
■■ Extended family – grandparents or other family members may be able to
take on a caring role, which can provide stability and help the child protect
their sense of identity and belonging.
■■ Foster carers – children are placed with caregivers and live in their family
home for a short or long-term placement. Foster carers may have a lot of
experience, but the training and support they have access to is variable.
■■ Adoption – in this case, children are permanently removed from the family
of origin at a young age and placed with another family where they legally
become the child of new parent/s. This provides much more security
than other placements and the evidence shows that adoption can have
very positive outcomes for the child. The challenges of parenting adopted
children can lead to placement breakdown for a significant number of
adopted children, and should not be underestimated. Most commonly
children are moved into a foster placement before moving to their adoptive

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 family. This holds the child whilst assessments are carried out, decisions
reached and an adoptive family is sought. In a few local authorities foster/
adoptive homes are used. These families agree to foster the child with a
view to then adopting them if the decision for the child is adoption.
■■ Residential care – where children are older and/or their needs are very
complex, or where there have been many instances of previous care
arrangements breaking down, some children may be placed in residential
care homes (also known as children’s homes). They might live with some
other children who are in care, and a team of paid staff look after them.

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 Where might psychological services be helpful?
Future in Mind (DoH, 2015) emphasises the importance of promoting
resilience, early intervention, and prevention. Children who have experienced
trauma or maltreatment within their family can have multiple complex needs
and there is a high incidence of mental health difficulties. Provision of
services to support emotional wellbeing and sensitive, attuned care earlier
in the process may help to promote better outcomes for these children and
families.
There are two main sources of psychological support for children with
complex social care needs. These are:

Direct work delivered by psychologists

■■ Helping children and young people with emotional issues – instability and
grieving, feelings of shame, sadness, anger, isolation, perceptions of little
self-worth, self-blame.
■■ Helping carers to develop coping strategies and remain resilient.
■■ Working with caregivers and children and young people to build up
relationships and establish bonds.
■■ Providing parenting advice and support with a focus on the psychological
health of the carer.
■■ Assisting at times of transition, whether that be in age and stage, or as children
and young people move from one area of service provision to another.

‘I felt like we were alone in the dark, but your input has let us see the
light at the end of the tunnel. We’ve started to recognise the meaning
in her behaviour and begin to enjoy caring for our daughter again. And
now I step back and assess situations before reacting – showing and
giving empathy.’
An adoptive parent

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Psychologists working to support other services
■■ Acting as expert witnesses to help the family courts make informed
decisions about what is best for the child.
■■ Helping to inform decisions on whether children can be returned to their
birth families and what support might be needed, or what alternative
arrangements might be made.
■■ Advising on family contact so that it is provided in a way that meets the
needs of the child.
■■ Helping develop plans to improve the quality of care for the child, within
their family or placement.
■■ Working with other services to stabilise placements and improve mental
health where this is a concern.
■■ Providing training and support to professionals and carers who are
responsible for looked after children.

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‘Since the clinical psychologist talked to us, so much has just clicked
into place. I wish I knew this information in time to have worked
differently with the young people who have lived here before.’
A residential care worker
‘I only hear positives about the added value they offer and the
accessibility. They reduce disruption, and carers want more. The way
psychology is delivered feels empowering to social workers and carers.
It doesn’t take a problem away to fix, the input is collaborative and the
advice concrete and practical.’
A social work service manager
in relation to consultations with a clinical psychologist
What does good look like?
Effective services for children and young people with complex needs will:
■■ Take into account the multiple, interwoven neurodevelopmental, biological,
psychological and social factors that impact on these children and young
people and provide stable and joined-up support, rather than sporadic
input dictated by what is available locally.
■■ Provide support not only to the children but also to their carers, as the
most effective therapeutic change takes place within their relationships.
■■ Focus on developing carers’ understanding of how complex the
developmental trauma on children and young people can be, and
developing carers’ ability to manage and respond to this in a skilled way.
■■ Remove barriers to accessing services and support, recognising that these
are particularly challenging for young people in the looked-after system.
■■ Provide training and support for the professional network around the child.
■■ Plan for cross-service or cross-border funding and avoid unnecessary
delays where children are placed far from their original local areas.
■■ Be proactive and try to prevent breakdowns in placement arrangements.
■■ Continue to develop robust evidence for effective interventions for this
group.
Investing in Looked After Children during childhood has been shown to
pay dividends in terms of the costs that occur in adulthood, as well as the
outcomes children achieve. Thus investment in services for children and
families with complex needs is an investment in the future.

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We would recommend that this leaflet is read in
conjunction with other leaflets in the series and in Faculty for Children, Young People
& their Families

particular with Clinical and applied psychologists in child The Child & Family Clinical
Psychology Review
and adolescent mental health. No 3 Summer 2015

What good looks like in

This leaflet summarises a chapter in What Good Looks psychological services for
children, young people
and their families
Like in Psychological Services for Children, Young
People and their Families. Electronic copies can be
downloaded for free from: http://shop.bps.org.uk/
publications/child-and-family-clinical-psychology-review-
ISSN: 2052-0956

no-3-summer-2015.html
Hard copies can be requested for free from Helen Barnett, British Psychological
Society: Helen.Barnett@bps.org.uk

If you would like to discuss any of the information in this brochure further,
please contact: dcpchildlead@bps.org.uk

www.bps.org.uk/dcp

21.08.18