Host Mark Leech listens in to Lisa Pascoe, deputy director (regulation and social care policy), Helen Humphries (specialist adviser for residential care) and Jenny Bird (research lead) as they discuss the findings from our recent research report ‘Good decisions: children with complex needs in children’s homes’.

Read the report 'Good decisions: children with complex needs in children's homes'

Read the blogs:

Providing good experiences for children with complex needs

Children with complex needs in children's homes

Transcript

Mark: Hello and welcome to Ofsted Talks. My name is Mark Leech, and in this episode, we're going to be hearing about children with complex needs and what that means to local authorities, children's services and those working with children who live in children's homes. Earlier this year, we published a research report called good decisions children with complex needs in children's homes, and I listened in to colleagues from our social care policy and research teams as they discussed the findings.

Lisa: I'm Lisa Pascoe. I'm the Deputy Director here at Ofsted with responsibility for regulation and social care policy and I'm joined today by Helen, our specialist advisor for residential care, and Jenny, our research lead.  Jenny, let's start with you. It would be really helpful to set out for people why we did this research.

Jenny: Yeah, absolutely. So, it follows on really from a piece we'd done previously, which was looking at local authorities plans for sufficiency. And from that piece of work, we could see that local authorities were really struggling to find supportive homes for children who have complex needs. So we wanted to look at that even more. We knew as well that stakeholders were concerned about children's homes not accepting referrals for children with complex needs. We'd heard some things about them holding out for children who present fewer risks and, sort of preferring to take referrals for those children. And we heard as well about some concerns around the potential impact it could have on Ofsted inspections. So we really wanted this research to look into that further and to highlight good practice that was already out there, as well as the challenges that still exist, and what action could potentially be taken, either across the sector or by ourselves.

Lisa: So how did we make it work? Jenny, what did we actually do?

Jenny: So we used a two-phase design in this research. We started off at the start of 2023 with a survey that went out to all local authority Children's Services and all registered children's homes, and we asked them things like what they think complex needs means, what happens when they try to find places or are approached with a referral, and what the facilitators and the barriers are to finding good homes for children.

Lisa: If I remember rightly, Jenny, didn't we publish something after phase one?

Jenny: We did, yeah. We published a blog in around May time to highlight the findings of that survey in more detail.

Lisa: And then we moved into phase two.

Jenny: We did, yeah. So that built on phase one, and it was made up of two parts. The main bulk of the work was case studies. We'd completed 10 case studies, which we identified through working with three different local authorities across two regions. And in those we spoke to people who were involved in making decisions about children's care or in providing the care itself, as well as children. To supplement those, we also ran some focus groups with other groups of professionals who are involved in the care of children with complex needs. So that was people from the Association for Virtual School Heads, as well as staff who work in local authority commissioning. And we also held a focus group with some of our own Ofsted inspectors as well to talk about how they experience inspections when they're going to homes where children with complex needs are living.

Lisa: I think one of the things, Helen, was about this use of the phrase complex needs, wasn't it? I mean, it camouflages what's actually happening for children.

Helen: Yes, it's a global term that I think is on unhelpful and categorizes children into this uncertainty which is complex needs, instead of actually saying this child's particular need is related to their mental health, or, because of that this is what happens and this is how their behaviour is demonstrated.  It just draws children into a classification that actually isn't helpful and we'd really prefer not to have that phrase bandied about and used so much.

Lisa: Yeah, I mean, I think there was some common themes. Weren't there. There were certainly children who needed help from a variety of professionals. They needed specialist help from, you know, from health services. They needed specialist input and there was certainly some common kind of characteristics of the children Jenny, as well wasn't there in terms of children, particularly children with serious mental health needs, but also children who had needs that led to behaviours that were placing either themselves or others at risk? There was certainly some commonality there, but I think as an umbrella, it certainly masked what was actually happening for children, rather than thinking about them as individuals.

Helen: Yes, I think it stops professionals looking any further. And I would imagine that if a children's home received a referral that just described the child as having complex needs, that might be straight away, this isn't a child we can help, rather than actually looking underneath that and saying, well, actually, what are these children's needs? Is there something here that we can provide some help and support to?

Lisa: one of the things we weren't surprised at, sadly, was that there was 91% I think it was Jenny of local authorities that had difficulty finding the right homes for children.

Helen: Because of that, some children are waiting months, or in one of the examples given, they were waiting years to find that placement that could actually meet their needs, which meant that they were then moved through a variety of placements, and to a large extent, that could have made the situation and the challenges even worse.

Lisa: absolutely, and we certainly found that these were the children who were most likely to be placed out of area weren't they? As you say, Helen, experienced those unplanned moves. You're absolutely right. When children's homes were looking at those referrals, the fact they'd had those unplanned moves sort of became a bit of a self-fulfilling prophecy, and how difficult it then became to find the right place for them.

Helen: yeah, absolutely. I mean, you can't imagine what it must be like for a child living in a children's home knowing that any day, any moment, they could receive the information that they are then moving again and how that, you know, how that must make them feel.

Lisa : And, we certainly heard quite a lot from commissioners, didn't we, about how challenging it was for them to negotiate what they needed.  We heard examples of bidding wars with other local authorities, about having to purchase beds in advance, sometimes buying more beds than they needed to try and secure a placement. There was a whole range of experiences from commissioners about the difficulties that they felt. But I think we must sort of counteract that with the other side as well, in terms of what the managers were telling us about the quality of the information that they got.

Helen: That's right. And when we started to look at the things and some of the factors that means that placements work? Well, it was definitely around honest communication between the local authority and the home, and with providers saying that if it was an honest referral, that actually was far better.  And, that children's homes and commissioners who had built up honest, trusting relationships so that a manager of a children's home could read a referral and be confident that this was all the information that they needed, and that none of it had been exaggerated or none of it had been redacted, meant they had confidence in accepting that referral.  But, also the commissioner had confidence in making that referral, that there was a likelihood that the children's home would be able to say yes, and would be honestly, be able to say yes we think we can possibly care for this child. So there was definitely, definitely something about building up honest and trusting relationships

Lisa: And as well as the referrals, it was really clear how the statement of purpose was quite important to commissioners as well, wasn't it?

Helen: Absolutely and the statement of purpose needs to clearly set out what a home can do so that the commissioners can place confidently and that placements are less likely to break down. And the and the other thing that became clear was that building on the notion of the positive and trusting relationship is that children's homes felt more confident in taking children who had a range of difficulties that they then weren't going to be sort of left with the child.  That the local authority would continue to be involved in the child's life, that they would support partnership working, that they would they would support the placement, perhaps by adding in things and putting them in touch with other professionals who could support the placement.  So that it really was a true partnership, and not a feeling that