Mental health and young children in the care system

Anthony Douglas discusses how evidence in the social care system can help the mental health needs of young children in care   

Cafcass is about putting children first in the family courts. When a child comes into the care system it’s our job to hear and bring out their voice.

But this is difficult and complex work to get right as each child is complex and unique.

To do our job well we need to understand a child’s daily, lived experience. We have to work out what they’re going through and then what should happen to them. Ultimately, the quality of our recommendation to the court has a lifelong impact on the life of that child.

I believe that across social care, we need to focus more on understanding the impact of abuse and neglect on a child – not so much what happened, but the emotional and psychological scars left behind. 

"How has the child’s mental health been affected, and what should we do in response?"
Anthony Douglas / CBE, Chief Executive of Cafcass

Looking at child impact as a crucial source of evidence

At the moment we have, at least in legal terms, an adversarial system that’s rooted in observable evidence and data. By and large social workers assess for particular incidents of abuse and look at neglect in terms of the care given to the child.

But often the evidence, like the abuse or neglect itself, is invisible. The facts are usually ambiguous and in many cases the child will not have told their story in their own words.

Identifying what has happened to a child is important, but shouldn’t we also be considering; a) What is the impact? b) What is the significance of that impact? and, c) What might the continuing impact be?

Some of the work we’re doing at Cafcass and across the sector is about developing child impact analysis as a mainstream tool. A Child Impact Analysis is a discipline for practitioners that helps vulnerable children describe how ongoing significant harm is affecting them individually and how the impact can be minimised or turned into greater resilience. 

Recognising the mental health needs of young children 

When it comes to considering the impact of abuse and neglect on the mental health of children, especially young children, coming into the care system, I’m not convinced that we’ve got things right.

It’s pretty clear to me that the mental health problems suffered by children in care are a consequence of their experiences and that poor mental health can be an internal prison sentence across a person’s lifetime. Damage that was caused in the first few months of a child’s life never quite goes away, and it can recur, sometimes in a dramatic way.

Of course these problems aren’t easily solved. Mental health issues may not have overt symptoms until there's seriously challenging behaviour. And supporting mental health just isn’t enough of a focus within children’s services, unless there’s a statutory responsibility and that effects only a handful of children.

We're a long way from both the recognition of mental health issues in young children and from doing anything much about it, despite its recent high profile.

Focusing on recovery from trauma

We need to find ways of identifying and dealing with the mental health needs of children in care – and doing this early.

Most services, especially at times of financial pressure, focus on short term timescales and short term solutions. A solution that’s a placement for a child matters a lot, but mental health treatment is a much needed, longer term investment.

Recovery from trauma is missing from welfare checklists, even though it’s a major need for the children we work with. I’d like to see trauma-informed practice and caring brought more into the mainstream. It gives a framework for working with children and families that’s slightly different from using the standard assessment search engine to focus on parental strengths, weaknesses and capacity.

While the system focuses on completing assessments, sourcing data and gathering information, it’s not an obviously therapeutic process. Assessments can be a disempowering and often fear-inducing examination. Alternatively, an open, co-produced assessment with families and an emphasis on concurrent assessment and help can influence the quality of life for a child.

Some social workers are brilliant; this is just the way they work and they do it instinctively, but the system as a whole drives a much more managerial approach to responding to distress which can, at worst, heighten the distress. 

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