Issue 149: july 2011



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other  out comes  (Scot tish  Ex ec u tive,

2007) and the Min is te rial  task  force  on



health  in equal i ties in Scot land (Scot tish

Gov ern ment,  2008)  rec om mend  that  all

NHS Boards should as sess the phys i cal,

emo tional and men tal health needs of chil -

dren who are looked after and act on that

as sess ment with their local part ners, to

en sure that health ser vices are more ac -

ces si ble to this group, es pe cially when

they are mov ing on from care to in de -

pend ence. Each local NHS Board is

ex pected by 2015 to offer a men tal health

as sess ment to every child or young per son 

who is looked after. 

Ser vice  and  prac tice  de vel op ment

Achiev ing  im proved  out comes

It is not pos si ble to de fine ‘good qual -

ity’ fos ter care or res i den tial care in terms 

of spe cific as pects of an in di vid ual ser vice

in iso la tion from the wider care sys tem, in

view of the com plex so cial and fa mil ial fac -

tors that shape the course of a child’s life

and the sig nif i cance of wider cul tural ex -

pec ta tions and in flu ences. From a men tal

health  per spec tive  ‘ev ery thing  counts’:

struc tures,  re la tion ships,  the  phys i cal  en vi -

ron ment,  in ter ven tions,  ac cess  to

spe cial ist re sources and ac cess to fam ily

and com mu nity sup ports (Clough et al.,

2006).  The  Scot tish  De vel op ment  Cen tre

for Men tal Health (SDC) de scribed mod -

els and ap proaches to sup port chil dren’s

men tal health (McCollam et al., 2008b). In 

this work, the fol low ing fac tors emerged

as major is sues that care sys tems need to

ad dress to be able to meet the full range

of men tal health needs of chil dren who

are looked after:  

• Aware ness  and  un der stand ing  among

de ci sion  mak ers  and  care  pro vid ers  of

the im por tance of men tal health and

wellbeing, likely in flu ences on the men -

tal health of chil dren who are looked

after, and steps that can be taken to

im prove  out comes;   

• Ca pac ity to sup port chil dren and young 

peo ple in care set tings that:  

en cour age  per ma nence  and  maxi -



mise  sta bil ity  and  con ti nu ity  through 

cri ses;   

build on areas of strength and as sets 



in the child’s per sonal, fa mil ial and

so cial  en vi ron ment;   

cre ate  op por tu ni ties  for  pos i tive  ex -



pe ri ences;   

fos ter  con sis tent  and  sup port ive  re -



la tion ships;   

• Ac ces si bil ity  of  men tal  health  ex per tise

when re quired, along with ‘stickability’

and  con ti nu ity  of  ser vices  to  an tic i pate

and  re spond  flex i bly  to  what  in di vid ual

chil dren need;  

• Co-or di na tion  of  roles  and  re spon si bil i -

ties – a crit i cal fac tor in view of the

com plex ity of the is sues young peo ple

face and the mul ti ple sec tors and agen -

cies likely to be in volved across the

ser vice  sys tem.  This  in cludes  en sur ing

ef fec tive links with CAMHS;  

• Ac tive in volve ment of young peo ple

and  fam i lies.   

The views of young peo ple who have

been looked after cor rob o rate these

points (Happer et al., 2006; Stan ley, 2007).

37

CYC-Online July 2011  /  Issue 149




  De vel op ing  a  men tal  health  re source  for 

chil dren and young peo ple who are looked

after away from home 

There are in her ent ten sions be tween

the need to cope with and re spond to the

im me di ate men tal health needs of the cur -

rent looked-after pop u la tion and the need 

to take a lon ger term stra te gic focus on

achiev ing  po ten tially  more  last ing  so lu -

tions. The lat ter re quires ac tion to

sup port  fam i lies,  fa cil i tate  early  in ter ven -

tion, pre vent fam ily or place ment

break down, and en able chil dren to re -

ceive care within their local area, as far as

pos si ble. Tak ing steps ac tively to ad dress

men tal health needs can make a sig nif i cant 

con tri bu tion  to wards  achiev ing  the  lon ger

term health, so cial and eco nomic out -

comes de sired for this group.

Whilst the long-term vi sion may be to

‘main stream’  re spon si bil ity  for  the  men tal

health of looked-after chil dren as a core

com po nent of the work of child and fam ily 

ser vices, for the fore see able fu ture the

need  re mains  for  tran si tional  in vest ment

in ser vice mod els such as those de vel oped 

in some parts of Scot land. A com mon fea -

ture of these ser vices is that they op er ate

at sev eral lev els and en com pass di rect

work with some chil dren and young peo -

ple, as well as train ing and con sul ta tion

with carers. These ser vices share com -

mon goals to:

• Raise aware ness of the men tal health

needs of chil dren who are looked after;

• Build ca pac ity within care set tings to

pro vide  an  en vi ron ment  that  pro motes 

men tal health and wellbeing and to re -

spond to needs as they arise. This

in cludes en abling carers to un der stand

what may lie be hind pre sent ing be hav -

ioural prob lems that can be dif fi cult to

man age by, for ex am ple, look ing at the

child’s his tory, early at tach ments, cur -

rent  re la tion ships;

• Pro vide a bridge be tween CAMHS and

care ser vices to find ap pro pri ate ways

for this group of chil dren to en gage ef -

fec tively  with  as sess ment  and

treat ment when needed;

• En able  clear  com mu ni ca tion  and  in for -

ma tion shar ing among care pro vid ers;

• In form  stra te gic  plan ning  and  de vel op -

ment. (McCollam et al., 2008b). 

Some men tal health pro jects work ing

with chil dren and young peo ple who are

looked after away from home have fo -

cused  spe cif i cally  on  pro vid ing  di rect

sup port to chil dren and young peo ple, for

ex am ple the LEAP ser vice in Ayr shire that 

of fered  coun sel ling  sup port  (Milligan,

2004). Most, how ever, com bine di rect

work with train ing and con sul ta tion func -

tions, in dif fer ing pro por tions. There is no

blue print to de ter mine the ‘best’ way to

con fig ure a men tal health re source or the

op ti mum scale or scope of such a re -

source. The pri mary aims of a ser vice and

the  al lo ca tion  of  roles  and  re spon si bil i ties

vary from one local con text to an other

de pend ing on local ser vice pat terns and

how skills and re sources are de ployed.



Build ing  ca pac ity  and  ca pa bil ity  to  ad dress

men tal health in care set tings 

Train ing programmes and case con sul -

ta tion of fered by the men tal health

ser vices help gen er ate a shared un der -

stand ing of men tal health and how that

can be operationalised in prac tice across

38

CYC-Online July 2011  /  Issue 149




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