Issue 149: july 2011

the care sys tem. This ap proach builds

con fi dence  and  com pe tence  in  ad dress ing

needs within care set tings from a per spec -

tive that re cog nises the im por tance of

pro mo tion and pre ven tion and does not

only re spond to pre sent ing prob lems and

cri ses. In ad di tion, it pro vides a means for

care staff to gain a deeper un der stand ing

of the fac tors that con trib ute to a child’s

be hav iour and of the im pact of the care

en vi ron ment  in  pro mot ing  men tal  health

and wellbeing.

The men tal health ser vices that work in 

this way are seek ing to embed men tal

health into the way care ser vices op er ate

day-to-day so that this be comes sus tain -

able:

• Train ing has been de signed to maxi -

mise reach by build ing this into core

staff train ing;

• For mal link roles have been des ig nated

to  en hance  li ai son  be tween  res i den tial

units and the local CAMHS;

• Ser vices have worked closely with care 

ser vice  man ag ers  and  so cial

workmanagers to main tain ef fec tive

work ing  re la tion ships  and  ad dress

emerg ing  is sues.

Not with stand ing  the  dif fi cul ties  in -

volved in eval u at ing the im pact of

interventions that seek to achieve change

within a com plex care sys tem, sev eral in -

de pend ent  eval u a tions  by  SIRCC,  the  SDC 

and oth ers show prom is ing re sults. Find -

ings sug gest that ded i cated men tal health

ser vices work ing with chil dren and young

peo ple who are looked after away from

home can achieve gains in strength en ing

the ser vice sys tem in a num ber of ways:

• Lev els  of  aware ness,  un der stand ing  and 

con fi dence  among  res i den tial  care  staff

and fos ter carers can be im proved;

• More at ten tion is given to the men tal

health needs of the looked-after pop u -

la tion;

• More of this group of chil dren get ac -

cess to as sess ment and sup port for

men tal health needs;

• These ser vices can make a sig nif i cant

con tri bu tion  to  chang ing  cul tures  in

res i den tial  care  by  pro mot ing  pos i tive

prac tice in ad dress ing young peo ple’s

pre sent ing and more long-stand ing

prob lems.

Dis cus sion

The find ings which have emerged from 

a range of ap proaches de vel oped in dif fer -

ent parts of Scot land high light sev eral

crit i cal fac tors needed to en sure that the

men tal health needs of chil dren and young 

peo ple who are looked after away from

home are ef fec tively ad dressed in the

short and lon ger term. One key point is

par tic i pa tion  of  chil dren  and  young  peo -

ple. Al though there has been con sid er able 

in vest ment in en abling young peo ple in -

volved with a care sys tem to have a

stron ger voice, lev els of in volve ment in

spe cific men tal health ini tia tives for those

who are looked after re main rel a tively low 

and re quire de vel op ment. Also, it has be -

come clear that strong lead er ship across

agen cies is es sen tial to achieve the qual ity,

sta bil ity and con ti nu ity of care that should

be the en ti tle ment of chil dren who be -

come looked after as they jour ney

to wards adult hood. In the ex am ples re -

ferred to ear lier, con sid er able time and

ef fort were in vested in rais ing aware ness

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of men tal health needs and in de vel op ing

agree ment on ap proaches, struc tures and

re la tion ships.  This  de vel op ment  work

needs to un der stand and work with the

dif fer ences in ser vice cul tures. The pro vi -

sion of con sul ta tion sup port to care giv ers

in res i den tial and fos ter care can be a val -

ued re source which en riches car ing

re la tion ships,  en vi ron ments  and  pro -

cesses. How ever it re quires a great deal of 

ground  work  and  re la tion ship-build ing  to

op er ate ef fec tively. A shared focus on the

child’s wellbeing can help es tab lish com -

mon ground. In re la tion to di rect work

with chil dren who are looked after, there

is a need to con sider how spe cial ist men -

tal health ser vices can be come more

ac ces si ble  and  ac cept able.  This  may  need

re source-in ten sive  in ter ven tions  to  sup -

port young peo ple to use ser vices. The

fol low ing di a gram shows a model of how a 

ded i cated  re source  of  men tal  health

ex per tise can serve a range of func tions in

sup port ing the ser vice sys tem to achieve

better out comes.

Finally, the im por tance of ef fec tive

throughcare and af ter care ser vices can not

be ig nored. Com monly, ser vices are not

geared to sus tain at ten tion on the men tal

health needs of young peo ple as they

move on from care. In deed much of the

focus of care plan ning tends to be on prac -

ti cal re quire ments needed to sup port

in de pend ent  liv ing  with  less  at ten tion  to

emo tional and psychosocial needs. As

throughcare  and  af ter care  pro vi sion  de vel -

ops it will be im por tant to re dress this

bal ance. 

Con clu sion

The key prin ci ples driv ing ser vice and

prac tice  de vel op ment  in  chil dren’s  ser -

vices are now fo cus ing at ten tion on

po ten tial as sets and areas of

strength within the sys tem around

the child and emphasising the im -

por tance  of  pos i tive  re la tion ships  in

nur tur ing  self-be lief  and  wellbeing

(Scot tish  Ex ec u tive,  2006;  Dan iel,

2008). This cre ates re newed op por -

tu ni ties to ad dress the men tal health 

and wellbeing of all chil dren who

are looked after: to iden tify how

best to pro mote men tal health and

wellbeing; to pre vent the de vel op -

ment of men tal health prob lems;

and to as sure the pro vi sion of treat -

ment, care and sup port for those

who  re quire  such  in ter ven tion.

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