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).
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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
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